Ultrasound Scan:
Nutcracker Assessment

Nutcracker syndrome, also known as left renal vein entrapment syndrome, is a rare vascular disorder that involves compression or entrapment of the left renal vein between the superior mesenteric artery and the aorta. This compression can result in various symptoms and complications. The name "nutcracker" syndrome comes from the analogy of the left renal vein being squeezed or compressed, resembling a nut being crushed by a nutcracker. This compression can lead to impaired blood flow and increased pressure in the left renal vein.

We request a 4 hr fast for this study.

Eating creates a gas that ultrasound is unable to scan through and may obstruct structures we need to see.

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This scan usually takes between 20- 30 minutes.

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The purpose of this ultrasound is to assess the blood flow through the left renal vein and assess for any compression from the superior mesenteric artery and aorta. This ultrasound requires direct contact with your skin. The scan will assess the arteries from around the level of the diaphragm. We will require you to lift your jumper and shirt up. We will ask for you to lie on your back on our examination bed. During the scan we will apply ultrasound gel to your abdomen and use the ultrasound machine to look at the the arteries to assess for narrowing and blockages. You will hear noises from the ultrasound machine; this is all normal and is the sound of the blood flow moving through your arteries.

A nutcracker ultrasound, also known as a renal vein Doppler ultrasound may be performed to evaluate the anatomy and blood flow dynamics of the left renal vein and surrounding structures. It is primarily used to assess for nutcracker syndrome, a condition characterised by compression or entrapment of the left renal vein between the superior mesenteric artery and aorta.

The symptoms of nutcracker syndrome can vary in intensity and presentation among individuals. Common symptoms may include:

Hematuria

The presence of blood in the urine is a typical symptom of nutcracker syndrome. It may manifest as visible blood (gross hematuria) or microscopic blood (microhematuria).

Flank pain

Pain in the left flank region is a common symptom. The pain can range from mild to severe and may be intermittent or persistent. It is typically located on the left side, as that is the side most commonly affected by nutcracker syndrome.

Pelvic pain

Some individuals with nutcracker syndrome may experience pain in the lower abdomen or pelvic region. This pain may be associated with menstrual periods or may occur more frequently in women.

Varicocele

In males, nutcracker syndrome can lead to the development of a varicocele, which is an enlargement of the veins within the scrotum. Varicoceles can cause discomfort, a feeling of heaviness, or visible swelling in the scrotum.

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Left-sided flank or abdominal venous congestion

Nutcracker syndrome can result in increased pressure in the left renal vein and other surrounding veins. This can lead to congestion and dilation of veins in the left kidney, left adrenal gland, and left ovary in females, causing symptoms such as left-sided flank or abdominal fullness or swelling.

Fatigue and orthostatic intolerance

In some cases, nutcracker syndrome may cause symptoms related to chronic venous insufficiency, such as fatigue, dizziness, or orthostatic intolerance (feeling lightheaded or faint upon standing).

It's important to note that the severity and combination of symptoms can vary among individuals, and some individuals with nutcracker syndrome may be asymptomatic. If you suspect you may have nutcracker syndrome or are experiencing any concerning symptoms, it is important to consult with a healthcare professional for a thorough evaluation and appropriate diagnostic testing.