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Unter falscher Flagge – das sogenannte Nussknackersyndrom

Ein Extrakt aus 30 Jahren persönlicher Erfahrung

Under false flag—the so-called nutcracker syndrome

An extract from 30 years of personal experience

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Zusammenfassung

Die Kompression der linken Nierenvene durch die Aorta oder die rechte Nierenarterie bei Überquerung der Mittellinie ist ein unterdiagnostiziertes Krankheitsbild, welches bislang als Nussknackersyndrom bezeichnet wird (de Schepper 1). Pathogenetisch bedeutsam ist die verstärkte Lordose der zumeist weiblichen Betroffenen. Dadurch wird die Aorta nach ventral gedrängt und somit die Nierenvene unter Spannung gesetzt und im mechanischen Sinne eines Stretchings komprimiert. Der Kompression durch die A. mesenterica superior kommt bei Hyperlordose eine untergeordnete Bedeutung zu. Zum besseren Verständnis schlagen wir daher die Bezeichnung „lordogenetische Nierenvenenkompression“ vor.

Linksseitige Schmerzen in der Flanke, im Ober- und Unterbauch, im Rücken, Kopf und Nacken sowie postprandial betonte Schmerzen im linken Hypochondrium sind die häufigsten klinischen Manifestationen. Zur Diagnostik und Quantifizierung der Kollateralisation stützen wir uns auf die Farbduplexsonographie mit seitengetrennter PixelFlux-Messung der Nierenperfusion. Wir behandeln durch Verlängerung der V. renalis oder Umhüllung der Vene durch eine PTFE(Polytetrafluoroethylen/Teflon®)-Manschette.

Abstract

Compression of the left renal vein by the aorta or the right renal artery by crossing the midline is an underdiagnosed disease condition, which has usually been designated as the nutcracker syndrome (de Schepper 1). The underlying cause in the mainly female patients is an increased lumbar lordosis. This shifts the aorta ventrally thus mechanically stretching and compressing the left renal vein. Compression by the superior mesenteric artery is of subordinate importance in hyperlordosis. To enhance its comprehension, we thus coined the term “lordogenetic left renal vein compression”. The most frequent clinical symptoms are left-sided pain in the flank region, upper and lower abdomen, back, head and neck as well as postprandial pain in the left hypochondrium. A thorough and detailed color duplex sonography with separate PixelFlux measurement of renal perfusion on each side is the method of choice for diagnostics and quantification of collateralization. Treatment is carried out by prolongation of the left renal vein or sheathing the left renal vein with an external PTFE (Polytetrafluoroethylen/Teflon®) cuff.

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Authors and Affiliations

  1. Praxis für spezielle Ultraschalldiagnostik, Rödelstraße 24, 04229, Leipzig, Deutschland

    Thomas Scholbach

  2. Clinic Bel Etage, Düsseldorf, Deutschland

    Wilhelm Sandmann

Authors
  1. Thomas Scholbach
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  2. Wilhelm Sandmann
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Correspondence to Thomas Scholbach.

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Interessenkonflikt

T. Scholbach hat gemeinsam mit seinem Sohn, Prof. Dr. rer. nat. Jakob Scholbach die PixelFlux-Software und das Verfahren der Parenchymperfusionsmessung entwickelt. Er ist beratend für die Firma Chameleon-Software tätig, die PixelFlux entwickelt und vertreibt. W. Sandmann gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Langversion unter: https://scholbach.de/under-false-flag-the-so-called-nutcracker-syndrome

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Scholbach, T., Sandmann, W. Unter falscher Flagge – das sogenannte Nussknackersyndrom. Gefässchirurgie 27, 7–14 (2022). https://doi.org/10.1007/s00772-021-00856-z

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  • DOI: https://doi.org/10.1007/s00772-021-00856-z

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