{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T16:45:46Z","timestamp":1726505146695},"reference-count":15,"publisher":"California Digital Library (CDL)","issue":"4","license":[{"start":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T00:00:00Z","timestamp":1630022400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Abdominal pain and flank pain cause a significant proportion of emergency department (ED) visits. The diagnosis often remains unclear and is frequently associated with repeat visits to the ED for the same complaint. A rare cause of left upper abdominal and flank pain is compression of the left renal vein between the aorta and the superior mesenteric artery known as nutcracker syndrome. Diagnostic findings on ultrasound include increased left renal vein diameter proximal and peak blood flow velocity increase distal to the superior mesenteric artery. We describe such a patient presenting to an ED repeatedly with severe pain mimicking renal colic before the final diagnosis and intervention occurred. \nCase Report: A 16-year-old female, long-distance runner presented four times complaining of intractable left upper quadrant abdominal pain radiating to the left flank after exercise. On each visit urinalysis revealed proteinuria and hematuria, and on two visits abdominal computed tomography revealed no kidney stone or dilatation of the collecting system. Ultimately, she was referred to vascular surgery where Doppler ultrasonography was used to diagnose left renal vein compression. Transposition of the left renal vein improved Doppler diameter and flow measurements and eliminated symptoms. \nConclusion: Emergency physicians must maintain a large list of possible diagnoses during the evaluation of abdominal and flank pain with a repetitive and uncertain etiology. Nutcracker syndrome may mimic other causes of abdominal and flank pain such as renal colic and requires appropriate referral.<\/jats:p>","DOI":"10.5811\/cpcem.2021.6.52140","type":"journal-article","created":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T06:03:52Z","timestamp":1637301832000},"page":"415-418","source":"Crossref","is-referenced-by-count":2,"title":["Nutcracker Syndrome Masquerading as Renal Colic in an Adolescent Athlete: A Case Report"],"prefix":"10.5811","volume":"5","author":[{"given":"Ron","family":"Waldrop","sequence":"first","affiliation":[{"name":"USA Health Systems, Department of Pediatric Emergency Medicine, Mobile, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Henning","sequence":"additional","affiliation":[{"name":"USA Health Systems, Department of Emergency Medicine, Mobile, Alabama"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2021,8,27]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Hijaz NM and Friesen CA. Managing abdominal pain in pediatric patients: current perspectives. Pediatric Health Med Ther. 2017;8:83-91","DOI":"10.2147\/phmt.s120156"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Kurklinsky AK and Rooke TW; Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc. 2010;85(6):552\u20139.","DOI":"10.4065\/mcp.2009.0586"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Pournasiri Z. The nutcracker syndrome as a rare cause of chronic abdominal pain: a case report. J Compr Ped.\u00a02016;7(3):39-41.","DOI":"10.17795\/compreped-39741"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Said M, Gloviczki P, Kalra M, et al. Renal nutcracker syndrome: surgical options. 2013. Semin Vasc Surg. 2013;26(1):35-42.","DOI":"10.1053\/j.semvascsurg.2013.04.006"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Arthurs OJ, Mehta U, Set PAK. Nutcracker and SMA syndromes: What is the normal SMA angle in children? J Rad. 2012;81(8):e854-61.","DOI":"10.1016\/j.ejrad.2012.04.010"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Ozcakar Z, Birsin Y, Inkaya F, et al. Nutcracker syndrome manifesting with severe proteinuria: a challenging scenario in a single-kidney patient. Pediatric Nephrol. 2011;26(6):987-90.","DOI":"10.1007\/s00467-011-1793-1"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Hohenfellner M, Steinbach F, Schultz-Lampel D, et al. Nutcracker syndrome: new aspects of pathophysiology, diagnosis, and treatment. J Urol. 1991;146(3):685-8.","DOI":"10.1016\/s0022-5347(17)37893-x"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Fitoz S, Ekim M, Ozcakar ZB, et al. Nutcracker syndrome in children: the role of upright position examination and superior mesenteric artery  angle measurement in the diagnosis. 2007. J Ultrasound Medicine. 2007;26(5):573-80.","DOI":"10.7863\/jum.2007.26.5.573"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Alaygut D, Bayram M, Soylu A, et al. Clinical course of children with nutcracker syndrome. Urology. 2013;82(3):686-90.","DOI":"10.1016\/j.urology.2013.03.048"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Kavukcu S, Kasap B, Goktay Y, et al. Doppler sonographic indices in diagnosing the nutcracker phenomenon in a hematuric adolescent. J Clin Ultrasound. 2004;32(1):37-41.","DOI":"10.1002\/jcu.10222"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Park SJ, Lim JW, Cho BS, et al. Nutcracker syndrome in children with orthostatic proteinuria: diagnosis on the basis of Doppler sonography. J Ultrasound Med. 2002;21(1):39\u201345.","DOI":"10.7863\/jum.2002.21.1.39"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Mazzoni MB, Kottanatu L, Simonetti GD, et al.  Renal vein obstruction and orthostatic proteinuria: a review. Nephrol Dial Transplant. 2011;26(2):562-5.","DOI":"10.1093\/ndt\/gfq444"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Miro I, Serrano A, Perez-Ardavin J. Eighteen years of experience with pediatric nutcracker syndrome: the importance of the conservative approach 2020. J Ped Urology. 2020;16(2):218.e1-218.e6.","DOI":"10.1016\/j.jpurol.2019.12.003"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Cheon JE, Kim WS, Kim IO, et al. Nutcracker syndrome in children with gross haematuria: Doppler sonographic evaluation of the left renal vein. Pediatric Radiology. 2006;36(7);682\u20136.","DOI":"10.1007\/s00247-006-0145-y"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Ma Z, Liu X, Ning Y, et al. Nutcracker phenomenon in combination with glomerular nephritis in isolated hematuria patients. Int Urol Nephrol. 2013;45(3):809-16.","DOI":"10.1007\/s11255-012-0265-2"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T06:05:48Z","timestamp":1637301948000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/1dt718r8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,27]]},"references-count":15,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,11,10]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2021.6.52140","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"type":"electronic","value":"2474-252X"},{"type":"print","value":"2474-252X"}],"subject":[],"published":{"date-parts":[[2021,8,27]]}}}