Retroaortic left renal vein fistula masquerading as pelvic congestion syndrome: Case report

AbstractThe authors present an uncommon cause of pelvic congestion syndrome (PCS) secondary to anterior nutcracker syndrome, which was caused by aortomegaly. Positional flank and pelvic pain was the only presenting feature with no renal dysfunction. Early and significant decompression of left renal vein (LRV) via left ovarian vein resulted in preserved renal function with symptomatic pelvic varices. Endovascular management by left ovarian vein coiling and LRV stenting was done. They briefly review the etiopathology, imaging, treatment rationale, and management options for nutcracker and PCS.

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Unusual causes of left renal vein compression along its course: MDCT findings in patients with nutcracker and pelvic congestion syndrome

Surgical and Radiologic Anatomy ◽

10.1007/s00276-009-0548-1 ◽

2009 ◽

Vol 32 (4) ◽

pp. 323-327 ◽

Cited By ~ 6

Author(s):

Devrim Karaosmanoğlu ◽

Musturay Karcaaltincaba ◽

Deniz Akata ◽

Mustafa Ozmen

Keyword(s):

Renal Vein ◽

Left Renal Vein ◽

Pelvic Congestion Syndrome ◽

Pelvic Congestion

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Pelvic congestion syndrome and left renal compression syndrome - clinical features and therapeutic approaches

VASA ◽

10.1024/0301-1526/a000538 ◽

2016 ◽

Vol 45 (4) ◽

pp. 275-282 ◽

Cited By ~ 8

Author(s):

Christina Jeanneret ◽

Konstantin Beier ◽

Alexander von Weymarn ◽

Jürg Traber

Keyword(s):

Varicose Veins ◽

Left Renal Vein ◽

Standing Position ◽

Ovarian Vein ◽

Pelvic Congestion Syndrome ◽

Compression Syndrome ◽

Abstract Knowledge ◽

Increased Risk ◽

Definition Of ◽

Pelvic Congestion

Abstract. Knowledge of the anatomy of the pelvic, gonadal and renal veins is important to understand pelvic congestion syndrome (PCS) and left renal vein compression syndrome (LRCS), which is also known as the nutcracker syndrome. LRCS is related to PCS and to the presence of vulvar, vaginal and pudendal varicose veins. The diagnosis of the two syndromes is difficult, and usually achieved with CT- or phlebography. The gold standard is the intravenous pressure measurement using conventional phlebography. The definition of PCS is described as pelvic pain, aggravated in the standing position and lasting for more than 6 months. Pain in the left flank and microhaematuria is seen in patients with LRCS. Women with multiple pregnancies are at increased risk of developing varicose vein recurrences with pelvic drainage and ovarian vein reflux after crossectomy and stripping of the great saphenous vein. The therapeutic options are: conservative treatment (medroxyprogesteron) or interventional (coiling of the ovarian vein) or operative treatment (clipping of the ovarian vein). Controlled prospective trials are needed to find the best treatment.

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The desperate plea of women with the nutcracker syndrome

Phlebologie ◽

10.1055/s-0037-1622296 ◽

2010 ◽

Vol 39 (02) ◽

pp. 104-111

Author(s):

J. L. Villavicencio

Keyword(s):

Renal Vein ◽

Imaging Techniques ◽

Left Renal Vein ◽

Diagnostic Tools ◽

Nutcracker Syndrome ◽

Treatment Techniques ◽

Children And Young Adults ◽

Good Number ◽

Pelvic Congestion

Summary Objective: To increase awareness on the severe impact of the nutcracker syndrome in women with undiagnosed disease. Patients and methods: We reviewed the medical literature and analyzed six representative series with 73 patients with nutcracker syndrome. Women with left flank pain, dyspareunia, dysuria, dysmenorrhea, micro- or macrohaematuria and pelvic congestion symptoms, should be carefully investigated for evidence of meso aortic left renal vein compression. A good number of our colleagues do not believe in the existence of the nutcracker syndrome and send these patients in a long pilgrimage in search of someone who can help them to get relief to their pain. New and improved imaging techniques can assist in the diagnosis but retrograde reno-gonadal phlebography and renocaval gradient are the most reliable diagnostic tools. Results: Among an assortment of treatment techniques, renal vein transposition and endovenous stenting were the two most commonly used procedures. There are no long term studies on renal vein stenting in children and young adults. Its use in these cases should be carefully considered. The nutcracker syndrome may present with pelvic congestion symptoms and its diagnosis missed. The patient's age, severity of symptoms and haemo dynamic renal studies should guide the treatment. Conclusion: An increased awareness of the existence of the nutcracker syndrome may prevent many unfortunate undiagnosed women from spending many months and often years of suffering.

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Aneurysm of the communicating vein between the left renal vein and left ascending lumbar vein mimicking a retroperitoneal lymphadenopathy: A case report

Current Medical Imaging Formerly Current Medical Imaging Reviews ◽

10.2174/1573405616666201118141728 ◽

2020 ◽

Vol 16 ◽

Author(s):

Sevtap Arslan ◽

Yasin Sarıkaya ◽

Musturay Karcaaltincaba ◽

Ali Devrim Karaosmanoglu

Keyword(s):

Case Report ◽

Lymph Nodes ◽

Testicular Cancer ◽

Renal Vein ◽

Medical Center ◽

Left Renal Vein ◽

Severe Bleeding ◽

Lumbar Vein ◽

Ascending Lumbar Vein ◽

Communicating Vein

Introduction: Aneurysm of the communicating vein between the left renal vein and left ascending lumbar vein is extremely rare with only anecdotal reported cases. Unless detected and recognized promptly, this rare condition may give rise to severe bleeding in patients undergoing retroperitoneal surgery. It may also closely mimic enlarged retroperitoneal lymph nodes, paragangliomas, adrenal masses, or renal artery aneurysms. Case report: In this case study, we reported the imaging findings of this rare entity which was falsely diagnosed as enlarged retroperitoneal lymph node in an outside medical center, reported as to be consistent with metastatic disease, in a patient with newly diagnosed testicular cancer. Conclusion: The aneurysm of the communicating vein should be considered in the differential diagnosis in patients with testicular cancer and other disease processes where lymph nodes are commonly affected.

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