Pelvic Venous Congestion Secondary to a Circumaortic Renal Collar in an Adolescent Female: Report of a Case

Abstract

We report a 13-year-old girl who presented with a recurrent abdominal pain that started after her menarche. The abdominal palpation revealed tenderness over the left ovarian point. The laboratory study, ultrasonography, and abdominal X-ray were normal. The computed tomography and magnetic resonance imaging showed a double left renal vein with a retroaortic component, an increased left parauterine circulation, and ipsilateral ovarian vein engorgement. A diagnostic and therapeutic phlebography allowed a selective catheterization of a group of pelvic varicose veins draining to the left ovarian and to the internal iliac veins. There were no complications during the procedure and the symptoms disappeared 2 days later. Circumaortic left renal vein may cause hematuria, proteinuria, pelvic congestion syndrome, and massive hemorrhage during surgery. A conservative treatment is recommended for patients without gynecourological/renal symptoms or with mild hematuria. The endovascular treatment by gonadal venous embolization is safe and effective.

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

“…When the vein has a retroaortic course, the symptomatic compression can also be congenital or acquired and is generally caused by vertebral osteophytosis leading to aortovertebral space narrowing; the condition is referred to as the posterior nutcracker syndrome (PNCS) (3) . In very rare cases, the patients shows double left renal vein with anteroaortic and retroaortic course; this anatomical variant is known as "circumaortic venous ring" or "renal collar" (4) ; in these patients, compression of either one or both renal veins may occur. There are, therefore, five variants of NCS: ANCS and PNCS in patients with only one left renal vein, while in patients with double renal vein compression can affect only the anteroaortic vein, the retroaortic vein or both veins.…”