Secondary vascular alterations in nutcracker phenomenon and its variants on multidetector CT

Amaç: Nutckracker fenomeni sol renal venin süperior mezenterik arter ile aorta arasında sıkışması sonucu oluşur. 'Posterior nutcracker fenomeni' olarak adlandırılan ve sirkumaortik veya retroaortik sol renal venin aorta ve vertebra korpusu arasında sıkışması sonucu oluşan varyantı da mevcuttur. Bu çalışmanın amacı anterior ve posterior nutcracker phenomeninde sol renal ven dışındaki damarlarda oluşan sekonder değişiklikleri ortaya koymak ve tanıya katkısına vurgu yapmaktır. Yöntem: Çalışmaya dahil edilen 258 hastanın bilgisayarlı tomografi görüntüleri retrospektif olarak incelendi. Nutcracker fenomeni olan 57 hastanın görüntüleri sekonder vasküler patolojiler yönünden, ayrıca retroaortik sol renal ven vayasyonu olan 169 ve sirkumaortik sol renal ven varyasyonu bulunan 32 hastanın görüntüleri posterior nutcracker fenomeni ve sekonder vasküler bulgu varlığı yönünden araştırıldı. Bulgular: Nutcracker fenomeni olan hastalarda sol gonadal (n: 15, 26%), sol lomber veya asendan lomber (n: 9, 16%), hemiazigos/aksesuar hemiazigos (n: 4, 7%), sol suprarenal (n: 4, 7%), ve inferior frenik (n:2, 4%) venlerde dilatasyon saptandı. Pelvik varisler/varicoseller ve sol renal vende psödothromboz sırasıyla 7(12%) ve 4 ( 7%) hastada mevcuttu. Retroaortik sol renal veni olan 169 hastanın %14'ünde, sirkumaortik sol renal veni olan 32 hastanın % 16'sında posterior nutcracker fenomeni ve ilişkili vasküler değişiklikler görüldü. Sonuç: Nutcracker fenomeninde oluşan sekonder vasküler bulguların bilinmesi tanıya yardımcı olabileceği gibi hastanın tedavisinde de yol göstericidir.

Nutcracker fenomeni ve varyantlarında çok kesitli BT'de görülen sekonder vasküler değişiklikler

Objectives: Nutcracker phenomenon is caused by the compression of left renal vein between the superior mesenteric artery and the aorta. There are also variants namely the 'posterior nutcracker phenomenon' where the posteriorly located retroaortic or circumaortic left renal vein is compressed between the aorta and the vertebral body. The aim of this study is to define the vascular alterations in veins other than the left renal vein secondary to anterior and posterior nutcracker phenomena and emphasize their contribution to the diagnosis. Method: A total of 258 patients were enrolled in the study. Computed tomography images of 57 patients with nutcracker phenomenon were retrospectively investigated for the presence of secondary vascular alterations. In addition, images of 169 patients with a retroaortic and 32 patients with a circumaortic left renal vein variation were searched for the presence of a posterior nutcracker phenomenon and associated secondary vascular findings. Results: Dilatation of left gonadal (n: 15, 26%), left lumbar or ascending lumbar (n: 9, 16%), hemiazygos/accessory hemiazygos (n: 4, 7%), left suprarenal (n: 4, 7%), and inferior phrenic (n:2, 4%) veins were seen in anterior nutcracker phenomenon. Pelvic varices/varicoceles and pseudothrombosis in the left renal vein were present in 7(12%) and 4 ( 7%) patients, respectively. 14% of 169 patients with a retroaortic left renal vein and 16% of 32 patients with circumaortic left renal vein showed a posterior NC phenomenon and associated vascular alterations. Conclusions: Awareness of the secondary vascular findings in nutcracker phenomenon may aid in the diagnosis and guide management.

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