Wei Chen, Abstract Co-Author: Nothing to Disclose

Jian-ping Chu, Presenter: Nothing to Disclose

Jian-yong Yang, Abstract Co-Author: Nothing to Disclose

Wen-quan Zhuang, Abstract Co-Author: Nothing to Disclose

He-ping Li, Abstract Co-Author: Nothing to Disclose

Yong-hui Huang, Abstract Co-Author: Nothing to Disclose

Jia-ping Li, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate the efficacy of imaging techniques in detecting nutcracker phenomenon and to assess the therapeutic value and prognosis of interventional therapy in pediatric patients.

In total 24 cases of nutcracker phenomenon, from Jan. 2002 to Feb 2005, were retrospectively investigated. Diagnosis of nutcracker phenomenon was established by Doppler ultrasound, computed tomography, retrograde left renal venography and renocaval pressure measurement. Three pediatric patients with nutcracker phenomenon underwent endovascular stent placement and received successful follow-up for 3 years.

The features of nutcracker phenomenon were well shown on CT scan. The diameter of the left renal vein was measured at two points only in the supine position, one at the lateral portion of the left renal vein near the hilum, and the other as the left renal vein courses between the aorta and the superior mesenteric artery. Doppler ultrasonography demonstrated that the ratio of the left renal vein diameter at renal hilum to that at the narrow portions were 4.2 (p=0.005). The peak velocity of right renal vein was 1.56 times as fast as the peak velocity of left renal vein (p=0.006). Renal venography revealed obvious compression of the left renal vein between the superior mesenteric artery and the aorta. The mean pressure measurements of left renal vein and right renal vein were 11.66 mmHg and 7.5 mmHg, respectively. The venous pressure difference between left renal vein and right renal vein was 4.16 mmHg. The mean venous pressure of left renal vein decreased to 8.16 mmHg after endovascular stent placement. After treatment, no serious complications are noted and clinical symptoms completely subsided after two or three years’ follow-up.

Color Doppler sonography and venography combined with venous pressure measurements can provide valuable evidence for correct diagnosis, which is useful for effective endovascular treatment of nutcracker phenomenon. Moreover, long-term curative effect is promising. Endovascular stent placement could be a safe, reliable and minimally invasive technique for treatment of nutcracker phenomenon.

W.C.,J.C.,J.Y.,W.Z.,H.L.,Y.H.,J.L.: No financial relationship exists in each of the authors associated with this submission.

Chen, W, Chu, J, Yang, J, Zhuang, W, Li, H, Huang, Y, Li, J, et al, , Diagnosis and Interventional Therapy of Nutcracker Phenomenon in Pediatric Patients.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4412306.html