Introduction:

Nutcracker syndrome (NCS) is a vascular anomaly which is rarely searched and diagnosed due to its low incidence and because of the difficulty to suspect on it among other frequent clinical manifestations.

Objective:

To examine clinical and imaging characteristics of patients diagnosed with NCS.

Methods:

Descriptive, retrospective and prospective study in patients admitted in “William Soler” University Pediatric Hospital in the period from January, 2013 to December, 2017. When it was suspected the presence of the syndrome, it was made an ultrasound looking for dilation of the left renal vein and the output angle of the superior mesenteric artery. In 7 patients it was made an angio-TAC. The epidemiologic, clinical, laboratory and imaging variables were reviewed.

Presentation of cases:

From the total of 9 patients diagnosed with a vascular anomaly;

6 (66,7%) were males. The mean age was 11,4 years (range 7-15 years). It was diagnosed front NCS in 7 patients (77.7%), back NCS in 1 patient (11.1%) and Wilkie syndrome with associated NCS in 1 patient (11.1%). 100% of the cases presented abdominal or lumbar pain related to hematuria (4 patients), foaming urine (4 patients) and left varicocele in 2 of the male patients (33.3%).

Conclusions:

Nutcracker syndrome should be searched in patients presenting frequent abdominal, lumbar or left side pain, recurrent hematuria or orthostatic proteinuria episodes. In males with left varicocele should be discounted this possibility. Nutcracker phenomenon can be also diagnosed when the patient is being investigated due to not related causes.

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