Nutcracker Phenomenon (NCP) and Nutcracker Syndrome (NCS)

Two terms NCP and NCS should not be used interchangeably. NCP is just an anatomical feature of compression of LRV between the AA and SMA, and NCS is a clinically-manifest variant of NCP. When a patient with NCP has otherwise unexplainable symptoms and signs such as hematuria, proteinuria, and/or left flank pain, we may make a diagnosis of NCS. Symptoms are complex with substantial variations and the diagnosis is difficult and often delayed. The spectrum of symptoms includes lumbar pain, pelvic or perineal pain, dyspareunia, bladder symptoms, headache, and stuffy nose. Also, various symptoms and signs of orthostatic disturbance or intolerance such as tachycardia, chronic fatigue, headache, abdominal pain, or fainting may be accompanied.