Double nutcracker syndrome in a patient with circumaortic venous ring: a rare case report

Farina, Renato; Foti, Pietro Valerio; Nicolosi, Lorena; Basile, Antonio

doi:10.15557/jou.2023.0018

Abstract

Aim of the study

In this article, we describe a rare case of the nutcracker syndrome caused by combined compression of the left anteroaortic and retroaortic renal veins. Case description: A 42-year-old woman presented with microhematuria and left flank pain. The patient underwent computed tomography and Doppler ultrasound which showed the left renal veins with anteroaortic and retroaortic courses, with signs of compression. Compression of the anteroaortic renal vein was caused by a narrowing of the aortomesenteric space, whereas compression of the retroaortic renal vein was caused by a narrowing of the aortovertebral space.

Conclusions

NCS is a rare disease, poorly understood and difficult to diagnose mainly due to the non-specificity of symptoms. Imaging is essential for diagnosis, and the combination of ultrasound and computed tomography allows for better classification of the disease. Increased disclosure of these cases can significantly contribute to a reduction of false negatives.

References

Farina R, Iannace FA, Foti PV, Conti A, Inì C, Libra F et al.: A case of nutcracker syndrome combined with Wilkie syndrome with unusual clinical presentation. Am J Case Rep 2020; 21: e922715. DOI: 10.12659/AJCR.922715.
Open DOI Search in Google Scholar Back to article
Farina R, Foti PV, Coronella M, Pennisi I, Libra F, Di Mari A: Superior mesenteric artery syndrome (Wilkie Syndrome) with unusual clinical onset: Description of a rare case. Radiol Case Rep 2021; 16(10): 2998–3002. DOI: 10.1016/j. radcr.2021.07.004.
Open DOI Search in Google Scholar Back to article
Gozzo C, Farina R, Foti PV, Iannace FA, Conti A, Pennisi I: Posterior nutcracker syndrome: a case report. J Med Case Rep 2021; 15(1): 42. DOI: 10.1186/s13256-020-02617-0.
Open DOI Search in Google Scholar Back to article
Alonso-Arroyo V, Velasco JJ, Pérez-Bertólez S, Molina ME, Marugan-de-Miguelsanz JM, Sanchez-Abuin A et al.: Pelvic venous congestion secondary to a circumaortic Renal Collar in an adolescent female: report of a case. European J Pediatr Surg Rep 2021; 9(1): e56–e60. DOI: 10.1055/s-0041-1730998.
Open DOI Search in Google Scholar Back to article
Al Qefari GB, Alduraibi KI, Almansour AA, Alghamdi A, Alsubhi MA: Nutcracker phenomenon: a rare incidental finding. Cureus 2022; 14(12): e32822. DOI: 10.7759/cureus.32822.
Open DOI Search in Google Scholar Back to article
Labropoulos N, Borge M, Pierce K, Pappas PJ: Criteria for defining significant central vein stenosis with duplex ultrasound. J Vasc Surg 2007, 46(1): 101–107.
Search in Google Scholar Back to article
Kolber MK, Cui Z, Chen CK, Habibollahi P, Kalva SP: Nutcracker syndrome: diagnosis and therapy. Cardiovasc Diagn Ther 2021; 11(5): 1140–1149. DOI: 10.21037/cdt-20-160.
Open DOI Search in Google Scholar Back to article
Velasquez CA, Saeyeldin A, Zafar MA, Brownstein AJ, Erben Y: A systematic review on management of nutcracker syndrome. J Vasc Surg Venous Lymphat 12 Disord 2018; 6(2): 271–278. DOI: 10.1016/j.jvsv.2017.11.005.
Open DOI Search in Google Scholar Back to article
Rista E, Llambro M, Lazaj J, Aliu D, Saliaj K: Endovascular treatment of nutcracker syndrome. Kidney Int. 2022; 102(4): 942. DOI: 10.1016/j.kint.2022.04.038.
Open DOI Search in Google Scholar Back to article
Budrys P, Baranauskas A, Davidavicius G: Intravascular ultrasound guidance is associated with a favorable one-year target vessel failure rate and no residual myocardial ischemia after the percutaneous treatment of very long coronary artery lesions. J Cardiovasc Dev Dis 2022; 9(12): 445. DOI: 10.3390/jcdd9120445.
Open DOI Search in Google Scholar Back to article

Double nutcracker syndrome in a patient with circumaortic venous ring: a rare case report

Abstract

Aim of the study

Conclusions

Paradigm

My account