Year: 2024
Type: article
Study design: Case Report
Abstract: A 16-year-old female patient with no known medical history presented with complaints of abdominal pain, nausea, and vomiting that had been ongoing for 1 month. Hematuria was detected on her routine urine tests. An axial contrast-enhanced abdominal computed tomography (CT) scan revealed that the left renal vein had a narrow caliber between the aorta and the superior mesenteric artery (SMA). The diameter of the left renal vein at the compression level was measured at 2.7 mm, and at the pre-compression level, it was 8.6 mm (Figure 1A). The pre-compression/compression ratio of the compressed left renal vein was found to be ∼3.2. The angle between the aorta and SMA was measured at 22 degrees. With these findings, Nutcracker Syndrome was diagnosed. On the coronal CT scan, contrast stasis was observed in the left suprarenal vein. A thrombus was observed in the lumen of the segment where the left suprarenal vein drained into the left renal vein (Figure 1B). (A) In the axial contrast-enhanced CT image, measurements at the compression level (black arrow) and pre-compression level (blue arrow) of the left renal vein are shown. (B) In the contrast-enhanced CT image with Maximum Intensity Projection (MIP), contrast stasis (red arrow) in the left suprarenal vein and a thrombus (green arrow) at the level where the left suprarenal vein drains into the left renal vein are observed. Nutcracker Syndrome occurs due to the compression of the left renal vein between the aorta and the SMA. In Nutcracker Syndrome, a variety of symptoms may be present, including hematuria, orthostatic proteinuria, flank pain, abdominal pain, varicocele and fatigue.1 In the literature, Lavenson et al. have classified symptoms associated with adrenal gland injury into five groups. One of these groups includes epigastric pain, nausea and vomiting.2 In our case, the patient had complaints of abdominal pain, nausea and vomiting. Therefore, in patients presenting with such symptoms, although rare, adrenal damage due to suprarenal vein thrombosis should be considered in the differential diagnosis. While cases of left renal vein thrombosis secondary to Nutcracker Syndrome have been reported previously, there are no published cases in the literature of left suprarenal vein thrombosis secondary to Nutcracker Syndrome. If nausea and vomiting accompany Nutcracker Syndrome, left suprarenal vein thrombosis should be considered as a rare complication. Gökhan Polat (Writing—review & editing [supporting]) and Muhammet Sefa Acar (Writing—review & editing [supporting]) Conflict of interest: There are no conflicts of interest.
Source: QJM
Authors: Gökhan Polat, Muhammet Sefa Acar
Institution: Kutahya Saglik Bilimleri Universitesi
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4405737755