European Journal of Echocardiography (2009) 10, 993 doi:10.1093/ejechocard/jep108
VASCULAR ECHO VIGNETTE
Nutcracker syndrome Francesco Natale*, Chiara Granato, Luigi Aronne, Giovanni M. Di Marco, Emanuela Lo Priore, `, Paolo Golino, Maria G. Russo, and Raffaele Calabro ` Rosa Mocerino, Chiara Cirillo, Paolo Calabro Department of Cardiology, Second University of Naples, via bianchi 5, Napoli, Italy Received 1 July 2009; accepted after revision 20 August 2008; online publish-ahead-of-print 26 September 2009
The figure is from a 17-year-old girl who was referred for a 12-month history of abdominal pain and intermittent haematuria. The patient’s family and past medical histories were unremarkable. Nutcracker syndrome is a rare cause of haematuria caused by compression of the left renal vein between the aorta and the superior mesenteric artery where it passes in the fork formed at the bifurcation of
these arteries. Compression causes venous hypertension and causes formation of renal venous collaterals and subsequent rupture of the septum between the veins and the collecting system, resulting in haematuria. This syndrome is rare but should be suspected in cases of haematuria in the absence of renal disease or any other cause haematuria.
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