Standardized Protocol for Assessing Left Renal Vein Compression Using Diagnostic Ultrasound

Abstract

Left renal vein (LRV) compression, also known as nutcracker syndrome, is a vascular compression disorder characterized by narrowing of the LRV between the aorta and superior mesenteric artery. This may result in venous hypertension and enlarged collateral formation. Clinically, nutcracker syndrome presents with a range of symptoms including hematuria, pelvic pain, and flank discomfort. Currently, there is no universally accepted duplex ultrasound protocol to evaluate for LRV compression, leading to variability in diagnostic accuracy and delay in treatment. We propose a standardized imaging protocol for duplex assessment of LRV compression that integrates patient positioning, grayscale, color, and spectral Doppler measurements. Implementation of this structured approach at our institution has enhanced diagnostic consistency, improved patient selection for further imaging or intervention, and facilitated earlier diagnosis.