Department of Paediatrics, Centro Hospitalar do Oeste, Unidade de Caldas da Rainha, Caldas da Rainha, Portugal
Department of Imaging, Centro Hospitalar do Oeste, Unidade de Caldas da Rainha, Caldas da Rainha, Portugal.
BMJ Case Rep. 2021 Apr 16;14(4):e240228. doi: 10.1136/bcr-2020-240228.
We describe a case of a 17-year-old man admitted in the emergency room with a 2-month history of intermittent macroscopic haematuria and left lumbar pain. Physical examination and vital signs were normal. Investigation indicated a recurrent non-glomerular haematuria. The Doppler ultrasound revealed a compression of the left renal vein with upstream dilatation which was subsequently confirmed by CT angiography. These findings are in keeping with a case of nutcracker syndrome (NutS). Although asymptomatic in most cases, it can be a rare cause of haematuria. The teenager was referred to paediatric nephrology and was treated conservatively with spontaneous resolution of macroscopic haematuria. With this case, we would like to highlight that in children or adolescents with haematuria without an apparent cause, a high level of suspicion and appropriate imaging are necessary for the diagnosis of NutS.
我们描述了一例 17 岁男性患者因间歇性肉眼血尿和左侧腰痛就诊于急诊室，病史 2 个月。体格检查和生命体征正常。检查提示复发性非肾小球性血尿。多普勒超声显示左肾静脉受压，上游扩张，随后 CT 血管造影证实。这些发现符合胡桃夹综合征（NutS）。虽然大多数情况下无症状，但血尿少见。该青少年被转至儿科肾病科，并接受保守治疗，肉眼血尿自发缓解。通过本病例，我们想强调，对于无明显病因的血尿儿童或青少年，应高度怀疑并进行适当的影像学检查以诊断 NutS。
