Q: 22 year old asian male is admitted to ICU with right flank pain and hematuria. One of the resident raised differential diagnosis of 'Nutcracker Syndrome'. Which one aspect of the history goes against the diagnosis of it?


Answer: Pain on the right side

The nutcracker syndrome (also called the left renal entrapment syndrome) is always on the left side. It may present as either painless hematuria or with left flank pain. It is mostly find in Asian population. It is due to compression of the left renal vein between the aorta and proximal superior mesenteric artery. Treatment includes left renal vein stent, transposition of the superior mesenteric artery or left renal vein, and autotransplantation of the left kidney.


References: 

1.  Zhang H, Li M, Jin W, et al. The left renal entrapment syndrome: diagnosis and treatment. Ann Vasc Surg 2007; 21:198. 

2.  Russo D, Minutolo R, Iaccarino V, et al. Gross hematuria of uncommon origin: the nutcracker syndrome. Am J Kidney Dis 1998; 32:E3. 

3. Shokeir AA, el-Diasty TA, Ghoneim MA. The nutcracker syndrome: new methods of diagnosis and treatment. Br J Urol 1994; 74:139.