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Incidental Detection of Nutcracker Phenomenon on Multidetector CT in an Asymptomatic Population: Prevalence and Associated Findings

Grimm, Lars J. MD, MHS; Engstrom, Bjorn I. MD; Nelson, Rendon C. MD; Kim, Charles Y. MD

Journal of Computer Assisted Tomography: May/June 2013 - Volume 37 - Issue 3 - p 415–418
doi: 10.1097/RCT.0b013e3182873235
Cardiovascular Imaging

Objective: To determine the prevalence of nutcracker phenomenon (left renal vein compression by the superior mesenteric artery) and secondary anatomic findings using multidetector computed tomographic (CT) angiography in an asymptomatic population.

Methods: Ninety-nine consecutive CT angiograms for potential renal transplant donors (mean age, 39.0 years; 42 males) without variant renal vein anatomy were reviewed retrospectively. The diameters of the maximal left renal vein, left renal vein between the aorta and superior mesenteric artery, and draining gonadal and lumbar veins were measured. Sex, age, hematuria, proteinuria, and abdominal or flank pain were recorded.

Results: Twenty-three patients had 50% to 70% stenosis, and 4 patients had greater than 70% stenosis of the left renal vein. Dilated gonadal and lumbar veins were found in 16 and 28 patients, respectively. Four patients had hematuria. These findings were not significantly associated with left renal vein compression.

Conclusions: Nutcracker phenomenon and dilated veins originating from the left renal vein are common incidental CT findings and nonspecific for the diagnosis of nutcracker syndrome.

From the Department of Radiology, Duke University Medical Center, Durham, NC.

Received for publication November 20, 2012; accepted January 10, 2013.

Reprints: Charles Y. Kim, MD, Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710 (e-mail: charles.kim@duke.edu).

There are no grants, disclosures, or other assistance to acknowledge.

© 2013 by Lippincott Williams & Wilkins