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Síndrome de Nutcracker : um caso clínico de hematúria recorrente
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O Fenómeno de Nutcracker resulta de uma alteração anatómica na qual a artéria mesentérica superior e a artéria aorta comprimem a veia renal esquerda. A revisão dos casos relatados sugere que esta condição é relativamente mais comum em mulheres, ocorrendo a maioria dos casos entre a segunda e quarta décadas de vida. No entanto, devido à variedade dos sintomas e ausência de consenso em relação aos critérios de diagnóstico, a prevalência exata do SNC é desconhecida.
Os sintomas geralmente incluem: hematúria, dor lombar ou abdominal, síndrome de congestão venosa pélvica nas mulheres, varicocelo do lado esquerdo nos homens e proteinúria ortostática.
A ecografia renal com Doppler da veia renal esquerda é o método de diagnóstico de primeira linha. O acompanhamento subsequente destes pacientes requer vigilância clínica e eventualmente recurso a terapêutica médica ou cirúrgica.
Nesta exposição apresentamos um caso clínico elucidativo desta patologia.
The Nutcracker Phenomenon results from an anatomical alteration in which the superior mesenteric artery and the aorta compress the left renal vein. A review of reported cases suggests that this condition is relatively more common in women, occurring most cases between the second and fourth decades of life. However, due to the variety of symptoms and lack of consensus regarding diagnostic criteria, the exact prevalence of NCS is unknown. The symptoms generally include: hematuria, flank or abdominal pain, pelvic congestion syndrome in women, left varicocele in men and orthostatic proteinuria. Renal ultrasound with Doppler of the left renal vein is the diagnostic method of choice. Subsequent monitoring of these patients requires medical supervision and possible use of medical or surgical treatment. In this exhibition we present an instructive case report of this pathology.
The Nutcracker Phenomenon results from an anatomical alteration in which the superior mesenteric artery and the aorta compress the left renal vein. A review of reported cases suggests that this condition is relatively more common in women, occurring most cases between the second and fourth decades of life. However, due to the variety of symptoms and lack of consensus regarding diagnostic criteria, the exact prevalence of NCS is unknown. The symptoms generally include: hematuria, flank or abdominal pain, pelvic congestion syndrome in women, left varicocele in men and orthostatic proteinuria. Renal ultrasound with Doppler of the left renal vein is the diagnostic method of choice. Subsequent monitoring of these patients requires medical supervision and possible use of medical or surgical treatment. In this exhibition we present an instructive case report of this pathology.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2015
Palavras-chave
Síndrome de Nutcracker Hematúria Pediatria