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Review
. 2022 Dec 17;9(12):1988.
doi: 10.3390/children9121988.

Diagnostic Clues in Pediatric Nutcracker Syndrome: From Two Clinical Cases to Current Literature Analysis

Speranza Cioffi  1 , Federica Di Domenico  1 , Giuseppina Russo  1 , Angelica De Nigris  1 , Stefano Guarino  1 , Emanuele Miraglia Del Giudice  1 , Pierluigi Marzuillo  1 , Anna Di Sessa  1
Affiliations
Review

Diagnostic Clues in Pediatric Nutcracker Syndrome: From Two Clinical Cases to Current Literature Analysis

Speranza Cioffi et al. Children (Basel). .

Abstract

Nutcracker syndrome (NCS) is a rare pediatric disease caused by left kidney vein compression. Besides the "Triade's symptoms", including hematuria, proteinuria, and flank pain, a wide spectrum of clinical manifestations has been reported. As the significant hemodynamic changes secondary to the dilatation of the left renal vein, serious consequences such as renal vein thrombosis and severe anemia might occur in these children. NCS diagnosis includes a variety of invasive and non-invasive imaging tools, but cutoff values need to be further validated. A conservative treatment represents the most common therapeutic approach for these patients, but operative options are available in selected cases. To complicate matters, a standard diagnostic and treatment algorithm is currently lacking and scientific pediatric evidence in this field is still poor and limited. In this perspective, early recognition of NCS is crucial but challenging for pediatricians. Therefore, a better knowledge of the disease is recommended. Starting from two different clinical presentations of NCS, we aimed to provide a comprehensive overview of the disease in children.

Keywords: children; compression; diagnosis; left; nutcracker; renal; syndrome; treatment; vein.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
A transversal ultrasound section (A) showing the anatomical relationship between LRV, aorta, and SMA and the impingement of LVR, confirmed by Doppler imaging (B).
Figure 2
Figure 2
Main clinical features of the Nutcracker Syndrome. Abbreviations: LRV: Left renal vein, SMA: superior mesenteric artery, LRA, left renal artery.
See this image and copyright information in PMC

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