Varicocele and nutcracker syndrome: Sonographic findings

Varicocele is a vascular lesion commonly associated with infertility. Its etiology is only partly
understood; hence, the purpose of the study was to establish its correlation with intrinsic anatomic
differences and nutcracker syndrome. Methods. A total of 93 patients with varicocele and 76 patients
without varicocele were enrolled. The diagnosis of varicocele was based on physical examination, followed
by sonographic evaluation of the hilar portion and aortomesenteric portion (AMP) of the left
renal vein (LRV). The anteroposterior diameter in millimeters and peak flow in centimeters per second
in each region were measured. Results. A total of 28 patients with the nutcracker syndrome were
identified in the study group (30.10%), and 2 were identified in the control group (2.63%). The mean
diameters of the hilar portion and AMP of the LRV were significantly different in varicocele-affected
patients compared with the control group (P < .0001 for both). The mean peak velocities in the hilar
portion and AMP were significantly different in patients with varicocele (P < .0001). Patients with varicocele
and nutcracker syndrome did not have a significant difference in either the hilar or AMP diameter
compared with patients with varicocele without nutcracker syndrome. They had a significant
difference in both the hilar and AMP peak flow velocity (P = .0001 for both). Conclusions. Our findings
indicate that nutcracker syndrome is a frequent finding in varicocele-affected patients and should
be routinely excluded as a possible cause of varicocele. In addition, intrinsic anatomic differences in the
AMP and hilar portion of the LRV could be directly responsible for the onset of varicocele. Key words:
nutcracker syndrome; renal hemodynamics; sonography; varicocele.