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Radiology Illustrated: Nutcracker Phenomenon and Nutcracker Syndrome (Hardcover, 1st ed. 2022)
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Radiology Illustrated: Nutcracker Phenomenon and Nutcracker Syndrome (Hardcover, 1st ed. 2022)
Series: Radiology Illustrated
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The nutcracker phenomenon (NCP) is an accentuated phenomenon of
normal subtle compression of the left renal vein (LRV) between the
abdominal aorta and superior mesenteric artery. The nutcracker
syndrome (NCS) is a syndrome caused by NCP, resulting in hematuria,
proteinuria, or left flank pain. The established diagnostic
criterion of NCP is a pressure gradient more than 3 mmHG across the
compression site, and NCS has been known to be rare, but probably
is not rare and in fact quite common. The most important reason why
NCS is known to be rare is that the diagnosis is difficult unless
invasive venous catheterization and pressure measurement confirm
the pressure gradient. Doppler ultrasound is useful in measuring
the flow velocity of LRV. From the velocity measured by Doppler
ultrasound, we may estimate the pressure gradient. Doppler
ultrasound of LRV needs technical skills and experience. Computed
tomography (CT) is a popular imaging technique for patients with
hematuria, and we need to be familiar with the findings of the NCP
at CT. There are variations of NCP associated with vascular anatomy
and posture of the patients. This book will illustrate the concepts
of NCP and NCS, findings at Doppler ultrasound and CT, and
variations of NCP.
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