Posterior nutcracker syndrome: a case report

Posterior nutcracker syndrome is defined by the compression of the left renal vein between the abdominal aorta and a lumbar vertebral body. It can be clinically manifest with intermittent hematuria, gonadal or spermatic reflux resulting in varicocele. Ultrasound is the first-line imaging which requi...

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Bibliographic Details
Published in:Journal of medical case reports 2021-02, Vol.15 (1), p.42-42, Article 42
Main Authors: Gozzo, Cecilia, Farina, Renato, Foti, Pietro Valerio, Iannace, Francesco Aldo, Conti, Andrea, Pennisi, Isabella, Santonocito, Serafino, Palmucci, Stefano, Basile, Antonio
Format: Article
Language:English
Subjects:
Abdomen
Aged
Aneurysms
Cardiovascular abnormalities
Case Report
Case reports
Compression therapy
Congenital diseases
Coronary vessels
CT imaging
Doppler ultrasound
Hematuria
Hepatitis B, Chronic
Humans
Liver diseases
Male
Medical imaging
Middle Aged
Multidetector computed tomography
Nutcracker syndrome
Pain
Patients
Renal Nutcracker Syndrome - complications
Renal Nutcracker Syndrome - diagnostic imaging
Renal Veins - diagnostic imaging
Thrombosis
Ultrasonic imaging
Varicocele
Varicocele - diagnostic imaging
Veins & arteries
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Summary:Posterior nutcracker syndrome is defined by the compression of the left renal vein between the abdominal aorta and a lumbar vertebral body. It can be clinically manifest with intermittent hematuria, gonadal or spermatic reflux resulting in varicocele. Ultrasound is the first-line imaging which require  more accurate study  with contrast-enhanced computed tomography. Management can be conservative in younger patients with mild hematuria due to the high spontaneous remission rate and invasive with open surgical and endovascular interventions. We describe a very rare case with compression of the left renal vein due to an osteophyte of the spine. A 62-year-old Caucasic male came to our radiology department for chronic hepatitis B virus (HBV)-related liver disease follow-up and mild scrotal pain. The ultrasound examination revealed a compression of the left retro-aortic renal vein in the aorto-vertebral space caused by an osteophyte. Duplex Doppler ultrasound revealed flow congestion in the left renal vein and renal failure; power Doppler ultrasound showed left varicocele. Doppler ultrasound is the first-line imaging and allows the detection of all the typical signs of posterior nutcracker: left renal vein stenosis, flow congestion and renal failure. Nutcracker syndrome should be suspected in older patients with left varicocele associated with hematuria. Failure to diagnose and treat these patients could have serious consequences for their health.
ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-020-02617-0