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

Renato Farina, Pietro Valerio Foti, Lorena Nicolosi, Antonio Basile

Affiliation and address for correspondence
J Ultrason 2023; 23: e101–e105
DOI: 10.15557/JoU.2023.0018

Aim of the study: In this article, we describe a rare case of the nutcracker syndrome caused by combined compression of the left anteroaortic and retroaortic renal veins. Case description: A 42-yearold woman presented with microhematuria and left flank pain. The patient underwent computed tomography and Doppler ultrasound which showed the left renal veins with anteroaortic and retroaortic courses, with signs of compression. Compression of the anteroaortic renal vein was caused by a narrowing of the aortomesenteric space, whereas compression of the retroaortic renal vein was caused by a narrowing of the aortovertebral space. Conclusions: NCS is a rare disease, poorly understood and difficult to diagnose mainly due to the non-specificity of symptoms. Imaging is essential for diagnosis, and the combination of ultrasound and computed tomography allows for better classification of the disease. Increased disclosure of these cases can significantly contribute to a reduction of false negatives.

nutcracker syndrome; ultrasound; cardiovascular abnormalities; computed tomography; magnetic resonance imaging