Introduction
A constellation of symptoms secondary to left renal vein (LRV) compression was first described in the 1950s and coined “Nutcracker syndrome” in 1972. Compression of the LRV is most often anterior, between the superior mesenteric artery (SMA) and abdominal aorta. NCS also occurs from posterior compression of the LRV between the aorta and vertebral column. [3] Patients typically present with chronic left flank, pelvic, or abdominal pain. Other symptoms include hematuria, nausea, vomiting, weight loss, and pelvic congestion syndrome. Failure to diagnose NCS in the presence of these non-specific symptoms often leads to referrals to years of ineffective pain treatment, including referral to pain specialists, opioids, and nerve stimulators.
This review examined case reports and case series of NCS over the past 10 years to highlight which symptoms are most common, the diagnostic workup, and proper management of NCS.
Overall, we include 40 case reports and series in addition to our own series. [4-43]