Left Varicocele Revealing a Nutcracker Syndrome: A Case Report and Review of Literature

Hicham El Bote^1, , Oussama Ziouani¹, Abdelilah El Alaoui¹, Hachem El Sayegh¹, Ali Iken¹, Lounis Benslimane¹ and Yassine Nouini¹

¹Department of Urology A, Ibn Sina University Hospital, Rabat, Morocco

Cite this paper

Hicham El Bote, Oussama Ziouani, Abdelilah El Alaoui, Hachem El Sayegh, Ali Iken, Lounis Benslimane and Yassine Nouini. Left Varicocele Revealing a Nutcracker Syndrome: A Case Report and Review of Literature. American Journal of Medical Case Reports. 2017; 5(5):110-112. doi: 10.12691/AJMCR-5-5-1

Abstract

Nutcracker syndrome (NCS) is a rare entity defined by the symptomatic hypertension of the left renal vein (LRV) compressed in the majority of cases between the superior mesenteric artery and the aorta. Hematuria, pelvic or back pain and left varicocele are the most commonly symptoms. Doppler ultrasound, computed tomography (CT) and selective left renal vein phlebography are useful to confirm the diagnosis. Treatment criteria are not well established, however for asymptomatic patients with no haematuria, the treatment remains conservative. We report the case of a 17-year-old man, with an intermittent left flank pain for 4 years and increasing volume of the left testicle for 8 months.

Keywords

nutcracker syndrome, varicocele

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Grant J. Methods of Anatomy. Baltimore, Md, USA: Williams and Wilkens; 1937.
[2]	El-Sadr A.R., Mina E. Anatomical and surgical aspects in the operative management of varicocele. Urol. Cutaneous. Rev. 1950; 54: 257-262.
[3]	de Schepper A. Nutcracker phenomenon of the renal vein and venous pathology of the left kidney. J. Belge Radiol. 1972; 55: 507-511.
[4]	Pastershank S. P. Left renal vein obstruction by a superior mesenteric artery. Canadian Association of Radiologists Journal. 1974; 25(1): 52-54.
[5]	Kurklinsky A. K., Rooke T. W. Nutcracker phenomenon and nutcracker syndrome. Mayo Clinic Proceedings. 2010; 85(6): 552-559.
[6]	Russo D, Minutolo R, Iaccarino V, Andreucci M, Capuano A, Savino FA. Gross hematuria of uncommon origin: the nutcracker syndrome. Am J Kidney Dis 1998; 32:E3.
[7]	Hanna HE, Santella RN, Zawada ET Jr, Masterson TE. Nutcracker syndrome: an underdiagnosed cause for hematuria? SD J Med 1997; 50:429-436.
[8]	Kim WS, Cheon JE, Kim IO, et al. Hemodynamic investigation of the left renal vein in pediatric varicocele: Doppler US, venography, and pressure measurements. Radiology 2006; 241: 228-234.
[9]	M. Unlu, S. Orguc, S. Serter, G. Pekindil, Y. Pabuscu. Anatomic and hemodynamic evaluation of renal venous flow in varicocele formation using color Doppler sonography with emphasis on renal vein entrapment syndrome. Scand J Urol Nephrol, 41 (2007), pp. 42-46.
[10]	A. Chait, K.W. Matasar, C.E. Fabian, H.Z. Mellins. Vascular impressions on the ureters. Am J Roentgenol Radium Ther Nucl Med, 111 (1971), pp. 729-749.
[11]	Wang L., Yi L., Yang L. Dianogsis and surgical treatment of nutcracker syndrome: a single-center experience. Urology. 2009; 73: 871-876.
[12]	Ekim M, Bakkaloglu SA, Tu¨mer N, Sanlidilek U, Salih M. Orthostatic proteinuria as a result of venous compression (nutcracker phenomenon) a hypothesis testable with modern imaging techniques. Nephrol Dial Transplant 1999; 14(4): 826e7.
[13]	Zhang H., Zhang N., Li M. Treatment of six cases of left renal nutcracker phenomenon: surgery and endografting. Chin. Med. J. (Engl.) 2003; 116: 1782-1784.
[14]	O. Hartung, D. Grisoli, M. Boufi, I. Marani, Z. Hakam, P. Barthelemy, et al. Endovascular stenting in the treatment of pelvic vein congestion caused by nutcracker syndrome: lessons learned from the first five cases J Vasc Surg, 42 (2005), pp. 275-280.
[15]	M.T. Menard, Nutcracker syndrome: when should it be treated and how? Perspect Vasc Surg Endovasc Ther, 21 (2009), pp. 117-124.