Evaluation of the clinical Symptoms and the images of nutcracker syndrome (Report of 13 cases)

Objective:To improve the standard of diagnosis of nutcracker syndrome.Methods:The data of 13 cases of nutcracker syndrome were analysed.Results:Ten patients had complaints of hematuria and two patients had left varicocele. One patient had proteinuria. One Female had increased catamenia. All of the men had varicocele signs. The urinalysis showed that ten patients had hematuria and one patient had proteinuria. Color Doppler ultrasound findings implied compression of the left renal vein in all aortomesenteric patients in all patients. The anteroposterior diameter varied from 1.6to 6.1 mm with a mean of 2.64 mm. The diameter in hilar portions varied from 7.1to 21.0 mm with a mean of 10.9 mm. CT provided fine outlines of compression of the left renal vein between the aorta and the superior mesenteric artery and the abnormal acute angle between them in 13 patients. Some degree of obstruction was observed in the notch between the aorta and superior mesenteric artery in tow patients on selective left renal angiography. Cystoscopic examintion revealed bloody urine emerging from the left ureteral orifice.Conclusions:Hematuria, proteinuria and varicocele are important clinical symptoms of the nutcracker syndrome. Doppler ultrasound and computed tomography scan of the left renal vein may be useful screening tool in patients with suspected nutcracker syndrome. The diagnosis of nutcracker syndrome must depend on clinical symptoms and the image findings.