Posterior nutcracker syndrome:acase report

Journal of Medical Case Reports

Renato Farina¹  Isabella Pennisi¹  Serafino Santonocito¹  Stefano Palmucci¹  Cecilia Gozzo¹  Francesco Aldo Iannace¹  Andrea Conti¹  Antonio Basile¹  Pietro Valerio Foti¹ 

[1] Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, Via Santa Sofia 78, 95123, Catania, Italy;

关键词: Nutcracker syndrome;    Doppler ultrasound;    Cardiovascular abnormalities;    Multidetector computed tomography;   

DOI  :  10.1186/s13256-020-02617-0

来源: Springer

【 摘 要 】

BackgroundPosterior 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.Case presentationA 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.ConclusionsDoppler 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 patientscould have serious consequences for their health.

【 授权许可】

CC BY