ABSTRACT
Nutcracker syndrome occurs when the left renal vein (LRV) is compressed between the superior mesenteric artery and the aorta, and this syndrome is often characterized by venous hypertension and related pathologies. However, invasive studies such as phlebography and measuring the reno-caval pressure gradient should be performed to identify venous hypertension. Here we present a case of Nutcracker syndrome where the LRV and intra-renal varicosities appeared homogeneously hyperintense on magnetic resonance (MR) fast-spin-echo T2-weighted imaging, which suggested markedly stagnant intravenous blood flow and the presence of venous hypertension. The patient was diagnosed and treated without obtaining the reno-caval pressure gradient. The discomfort of the patient lessened after treatment. Furthermore, on follow-up evaluation, the LRV displayed a signal void, and this was suggestive of a restoration of the normal LRV flow and a decrease in LRV pressure.
Subject(s)
Kidney Diseases/pathology , Magnetic Resonance Imaging/methods , Renal Veins/pathology , Vascular Diseases/pathology , Abdominal Pain/etiology , Adult , Constriction, Pathologic , Diagnosis, Differential , Follow-Up Studies , Humans , Kidney Diseases/complications , Kidney Diseases/surgery , Male , Renal Veins/surgery , Stents , Syndrome , Vascular Diseases/complications , Vascular Diseases/surgery , Young AdultABSTRACT
Primary mesenteric lipoma is rare, with fewer than 50 cases described in English-language literature, and those causing bowel obstructions are even more uncommon. The long stalk of the lipoma that caused secondary volvulus and rapid ischemic change in our patient is worth reporting because of its rarity and distinctive picture in emergency abdominal computed tomography.
