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Case Reports
. 2021 Jul 16;13(7):e16422.
doi: 10.7759/cureus.16422. eCollection 2021 Jul.

A Rare Cause of Abdominal and Flank Pain in Children: Nutcracker Syndrome

Ankit Agarwal  1 , Florentina Litra  1 , Lori L Barr  2
Affiliations
Case Reports

A Rare Cause of Abdominal and Flank Pain in Children: Nutcracker Syndrome

Ankit Agarwal et al. Cureus. .

Abstract

The nutcracker phenomenon is characterized by compression of the left renal vein typically between the abdominal aorta and superior mesenteric artery. It is an uncommon and often undiagnosed condition that has the potential to cause a range of symptoms including hematuria and abdominal or flank pain. The term nutcracker syndrome refers to the clinical manifestations of the nutcracker phenomenon. Diagnosis can be made with Doppler ultrasound, computed tomography angiography, magnetic resonance angiography, or venography. Management can range from conservative treatment in the pediatric population due to high spontaneous remission rate to surgical and endovascular interventions. We discuss the case of a previously healthy young female who presented with abdominal pain. Diagnosis of nutcracker syndrome was made based on imaging. The patient was managed conservatively. This case highlights the importance of considering nutcracker syndrome in the differential diagnosis when evaluating patients with abdominal and flank pain.

Keywords: abdominal pain; flank pain; left renal vein compression; nutcracker phenomenon; nutcracker syndrome.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Transverse ultrasound of upper abdomen demonstrates compression of the LRV (1) between SMA (2) and the aorta (3).
LRV - left renal vein; SMA - superior mesenteric artery
Figure 2
Figure 2. Sagittal abdominal ultrasound shows the angle between SMA and the aorta.
SMA - superior mesenteric artery
Figure 3
Figure 3. Sagittal CECT shows the aortomesenteric angle (green lines) of 11 degrees. Note resultant compression of the LRV (yellow arrow) between the aorta (1) and the SMA (2).
CECT - Contrast-enhanced computed tomography; LRV - left renal vein; SMA - superior mesenteric artery
Figure 4
Figure 4. Axial CECT shows a 2-mm AP diameter of the LRV as it crosses between the aorta and SMA.
CECT - Contrast-enhanced computed tomography; AP - anteroposterior; LRV - left renal vein; SMA - superior mesenteric artery
Figure 5
Figure 5. Left parasagittal CECT shows dilatation of the LRV proximal to the compression with an AP diameter of 8 mm.
CECT - Contrast-enhanced computed tomography; AP - anteroposterior; LRV - left renal vein
See this image and copyright information in PMC

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