Localized solitary left renal vein thrombus complicating nutcracker syndrome: a case report and review of the literature

Abstract Background: Nutcracker syndrome (NCS) refers to compression of the left renal vein (LRV) between the aorta and superior mesenteric artery (SMA), which results in renal venous hypertension and its resultant clinical manifestations. Left renal vein thrombus (LRVT) complicating NCS is relatively rare. To the best of our knowledge, there are only four case reports of LRVT complicating NCS. Furthermore, there are no reports of pulmonary thromboembolism (PTE) caused by NCS. Herein, we describe a rare case of NCS causing LRVT and PTE and its clinical management. Case Presentation: A 40-year-old man was admitted to our hospital with acute left flank pain. Computed tomography angiography (CTA) revealed compression of the LRV between the aorta and the SMA with an LRVT. Furthermore, CTA revealed bilateral PTE. Rivaroxaban was administered as an anticoagulant. Twenty days after initiation, CTA revealed complete resolution of PTE and LRVT, and repeat CTA at 3 and 6 months showed no recurrence. Conclusions: This case report demonstrates that NSC may be a possible cause of LRVT and PTE. We review the reported cases of NCS complicated by LRVT and discuss the imaging modalities for NCS.

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Serial ganglion impar blocks in a patient with nutcracker syndrome refractory to left renal vein transposition: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02398-6 ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Shawn Banon ◽

Ioannis Skaribas

Keyword(s):

Case Report ◽

Renal Vein ◽

Left Renal Vein ◽

Nutcracker Syndrome ◽

Ganglion Impar

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Left Renal Vein Reconstruction After Right Nephrectomy and Inadvertent Left Renal Vein Ligation: A Case Report and Review of the Literature

Vascular and Endovascular Surgery ◽

10.1177/1538574406290293 ◽

2006 ◽

Vol 40 (5) ◽

pp. 421-424 ◽

Cited By ~ 1

Author(s):

Anathea C. Powell ◽

George Plitas ◽

Bart E. Muhs ◽

Michael Stifelman ◽

Thomas S. Maldonado

Keyword(s):

Case Report ◽

Renal Vein ◽

Left Renal Vein ◽

Review Of The Literature

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Traumatic fistula between the aorta and the left renal vein: Case report and review of the literature

Journal of Vascular Surgery ◽

10.1016/0741-5214(89)90090-6 ◽

1989 ◽

Vol 9 (6) ◽

pp. 812-816 ◽

Cited By ~ 9

Author(s):

Michel Batt ◽

Reda Hassen-Khodja ◽

Jean M. Bayada ◽

Jean M. Gagliardi ◽

Bruno Daune ◽

...

Keyword(s):

Case Report ◽

Renal Vein ◽

Left Renal Vein ◽

Review Of The Literature

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Nutcracker Syndrome Masquerading as Renal Colic in an Adolescent Athlete: A Case Report

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.6.52140 ◽

2021 ◽

Vol 5 (4) ◽

pp. 415-418

Author(s):

Ron Waldrop ◽

Paul Henning

Keyword(s):

Abdominal Pain ◽

Case Report ◽

Superior Mesenteric Artery ◽

Renal Vein ◽

Mesenteric Artery ◽

Renal Colic ◽

Left Renal Vein ◽

Flank Pain ◽

Distance Runner ◽

Nutcracker Syndrome

Introduction: Abdominal pain and flank pain cause a significant proportion of emergency department (ED) visits. The diagnosis often remains unclear and is frequently associated with repeat visits to the ED for the same complaint. A rare cause of left upper abdominal and flank pain is compression of the left renal vein between the aorta and the superior mesenteric artery known as nutcracker syndrome. Diagnostic findings on ultrasound include increased left renal vein diameter proximal and peak blood flow velocity increase distal to the superior mesenteric artery. We describe such a patient presenting to an ED repeatedly with severe pain mimicking renal colic before the final diagnosis and intervention occurred. Case Report: A 16-year-old female, long-distance runner presented four times complaining of intractable left upper quadrant abdominal pain radiating to the left flank after exercise. On each visit urinalysis revealed proteinuria and hematuria, and on two visits abdominal computed tomography revealed no kidney stone or dilatation of the collecting system. Ultimately, she was referred to vascular surgery where Doppler ultrasonography was used to diagnose left renal vein compression. Transposition of the left renal vein improved Doppler diameter and flow measurements and eliminated symptoms. Conclusion: Emergency physicians must maintain a large list of possible diagnoses during the evaluation of abdominal and flank pain with a repetitive and uncertain etiology. Nutcracker syndrome may mimic other causes of abdominal and flank pain such as renal colic and requires appropriate referral.

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