Daily Ryan, Matteo Jerry, Loper Todd, Northup Martin
University of Florida, Shands Jacksonville, Jacksonville, FL 32209, USA.
Vascular. 2012 Dec;20(6):337-41. doi: 10.1258/vasc.2011.cr0320. Epub 2012 Jun 25.
'Nutcracker syndrome' encompasses classical symptoms of hematuria and flank pain resulting from the compression of the left renal vein between the aorta and the superior mesenteric artery. In patients with unexplained left-sided hematuria, flank pain or non-specific abdominal pain, careful interrogation of diagnostic abdominal imaging should be performed to exclude the possibility of external compression on the left renal vein. The patient discussed in this case report is a 19-year-old woman with unilateral hematuria. Her symptoms started 13 months prior with nausea, lower abdominal pain and weight loss. Six months after the nausea began, she started having syncope, sometimes multiple episodes in one day. Syncope is one of the more rarely reported symptoms associated with nutcracker syndrome. As more cases are reported, endovascular repair is becoming an alternative treatment for nutcracker syndrome. The patient was treated with stenting of her left renal vein. At the three-week follow-up, she reported near resolution of nausea and abdominal pain. She had gained four pounds, no longer had gross hematuria and had had no episodes of syncope and her blood pressure had normalized. Endovascular specialists should be aware of the variety of symptoms that can occur with nutcracker syndrome, including syncope. The severity of these symptoms should guide the recommendation for intervention.
“胡桃夹综合征”包括因左肾静脉在腹主动脉和肠系膜上动脉之间受压而导致的血尿和侧腹疼痛等典型症状。对于原因不明的左侧血尿、侧腹疼痛或非特异性腹痛患者，应仔细检查诊断性腹部影像学检查结果，以排除左肾静脉受到外部压迫的可能性。本病例报告中讨论的患者是一名19岁的单侧血尿女性。她的症状始于13个月前，伴有恶心、下腹痛和体重减轻。恶心开始6个月后，她开始出现晕厥，有时一天内会发作多次。晕厥是与胡桃夹综合征相关的较少被报道的症状之一。随着更多病例被报道，血管内修复正成为胡桃夹综合征的一种替代治疗方法。该患者接受了左肾静脉支架置入术治疗。在三周的随访中，她报告恶心和腹痛几乎消失。她体重增加了4磅，不再有肉眼血尿，没有晕厥发作，血压也已恢复正常。血管内专家应了解胡桃夹综合征可能出现的各种症状，包括晕厥。这些症状的严重程度应指导干预建议。
