An easily missed diagnosis: flank pain and nutcracker syndrome

Abstract

A 27-year-old woman presented to her primary care doctor's office with left flank pain. CT of the abdomen showed an isolated left renal vein thrombus. The clot was initially attributed to her oral contraceptive use; however, closer inspection of CT images revealed nutcracker phenomenon (compression of the renal vein between the superior mesenteric artery and abdominal aorta). Intravascular ultrasound imaging confirmed the diagnosis. Nutcracker syndrome is a rare condition, which if left untreated may cause damage to the left kidney. Although under diagnosed, there are several treatment options available ranging from simple surveillance to surgical resolution.

Nutcracker Syndrome Complicated by Left Renal Vein Thrombosis

“…Renal vein thrombosis associated with NCS is a rare entity, and only 2 cases were found in a review of the literature [1, 2]. …”

Nutcracker syndrome; a rare cause of hematuria

“…Early diagnosis is important to avoid unnecessary diagnostic procedures and complications such as LRV thrombosis and damage to the left kidney in untreated patients (9,10). Clinical manifestations are the main diagnostic options (6) and no validated diagnostic criteria exist (11).…”

Nutcracker syndrome associated with celiacomesentric trunk anomaly: case report

“…2 Since static images will not be able to confirm hemodynamic significance or differentiate between NCP and NCS, the correlation between imaging evidence of LRV compression and clinical symptoms remains a challenge. 4,14 In this particular case, the inclusion of a CTA in the setting of hematuria was invaluable in locating the source of aberrant vasculature from the CMT. NCS is a rare condition, which if left untreated may cause thrombosis of the LRV and damage to the left kidney.…”

“…NCS is a rare condition, which if left untreated may cause thrombosis of the LRV and damage to the left kidney. 12,14 Although underdiagnosed, there are several treatment options. 14 The patients diagnosed with NCS should be managed according to their age and clinical symptoms.…”

“…12,14 Although underdiagnosed, there are several treatment options. 14 The patients diagnosed with NCS should be managed according to their age and clinical symptoms. Usually, patients younger than 18 years of age are more frequently treated conservatively, since a majority of such patients will show complete remission in their clinical symptoms including hematuria because of the development of collateral veins and increase in BMI, which is an important factor in the changing renal hemodynamics.…”