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Anterior and Posterior Nutcracker Syndrome Combined with May–Thurner Syndrome: First Report of This Unique Case

Background: Anterior nutcracker syndrome is defined as the compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta, whereas posterior nutcracker syndrome refers to the compression of the retroaortic LRV between the aorta and the vertebral column—the presen...

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Autores principales: Tiralongo, Francesco, Galioto, Federica, Distefano, Giulio, Palmucci, Stefano, Basile, Antonio, Di Rosa, Salvatore
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137930/
https://www.ncbi.nlm.nih.gov/pubmed/37189534
http://dx.doi.org/10.3390/diagnostics13081433
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author Tiralongo, Francesco
Galioto, Federica
Distefano, Giulio
Palmucci, Stefano
Basile, Antonio
Di Rosa, Salvatore
author_facet Tiralongo, Francesco
Galioto, Federica
Distefano, Giulio
Palmucci, Stefano
Basile, Antonio
Di Rosa, Salvatore
author_sort Tiralongo, Francesco
collection PubMed
description Background: Anterior nutcracker syndrome is defined as the compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta, whereas posterior nutcracker syndrome refers to the compression of the retroaortic LRV between the aorta and the vertebral column—the presence of the circumaortic left renal vein may predispose to “combined nutcracker syndrome”. May–Thurner syndrome consists of obstruction of the left common iliac vein caused by the crossing right common iliac artery. We report a unique case of combined nutcracker syndrome associated with May–Thurner syndrome. Case presentation: A 39-year-old Caucasian female came to our radiology unit for triple-negative breast cancer computed tomography (CT) staging. She complained of pain in hermid-back and low-back regions and intermittent abdominal pain in the left flank region. Multidetector computed tomography (MDCT) incidentally revealed a circumaortic left renal vein draining to the inferior vena cava, with bulbous dilatation of both the antero-superior and posterior-inferior branches, which was associated with pathological serpiginous dilation of the left ovarian vein with varicose pelvic veins. Axial CT imaging of the pelvis also showed compression of the left common iliac vein by the overlying right common iliac artery consistent with May–Thurner syndrome without signs of venous thrombosis. Conclusion: Contrast-enhanced CT is the best imaging modality for suspected vascular compression syndromes. CT findings showed a combination of anterior and posterior nutcracker syndrome in the left circumaortic renal vein, associated with May–Thurner syndrome, which has not previously been described in the literature.
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spelling pubmed-101379302023-04-28 Anterior and Posterior Nutcracker Syndrome Combined with May–Thurner Syndrome: First Report of This Unique Case Tiralongo, Francesco Galioto, Federica Distefano, Giulio Palmucci, Stefano Basile, Antonio Di Rosa, Salvatore Diagnostics (Basel) Case Report Background: Anterior nutcracker syndrome is defined as the compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta, whereas posterior nutcracker syndrome refers to the compression of the retroaortic LRV between the aorta and the vertebral column—the presence of the circumaortic left renal vein may predispose to “combined nutcracker syndrome”. May–Thurner syndrome consists of obstruction of the left common iliac vein caused by the crossing right common iliac artery. We report a unique case of combined nutcracker syndrome associated with May–Thurner syndrome. Case presentation: A 39-year-old Caucasian female came to our radiology unit for triple-negative breast cancer computed tomography (CT) staging. She complained of pain in hermid-back and low-back regions and intermittent abdominal pain in the left flank region. Multidetector computed tomography (MDCT) incidentally revealed a circumaortic left renal vein draining to the inferior vena cava, with bulbous dilatation of both the antero-superior and posterior-inferior branches, which was associated with pathological serpiginous dilation of the left ovarian vein with varicose pelvic veins. Axial CT imaging of the pelvis also showed compression of the left common iliac vein by the overlying right common iliac artery consistent with May–Thurner syndrome without signs of venous thrombosis. Conclusion: Contrast-enhanced CT is the best imaging modality for suspected vascular compression syndromes. CT findings showed a combination of anterior and posterior nutcracker syndrome in the left circumaortic renal vein, associated with May–Thurner syndrome, which has not previously been described in the literature. MDPI 2023-04-16 /pmc/articles/PMC10137930/ /pubmed/37189534 http://dx.doi.org/10.3390/diagnostics13081433 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Tiralongo, Francesco
Galioto, Federica
Distefano, Giulio
Palmucci, Stefano
Basile, Antonio
Di Rosa, Salvatore
Anterior and Posterior Nutcracker Syndrome Combined with May–Thurner Syndrome: First Report of This Unique Case
title Anterior and Posterior Nutcracker Syndrome Combined with May–Thurner Syndrome: First Report of This Unique Case
title_full Anterior and Posterior Nutcracker Syndrome Combined with May–Thurner Syndrome: First Report of This Unique Case
title_fullStr Anterior and Posterior Nutcracker Syndrome Combined with May–Thurner Syndrome: First Report of This Unique Case
title_full_unstemmed Anterior and Posterior Nutcracker Syndrome Combined with May–Thurner Syndrome: First Report of This Unique Case
title_short Anterior and Posterior Nutcracker Syndrome Combined with May–Thurner Syndrome: First Report of This Unique Case
title_sort anterior and posterior nutcracker syndrome combined with may–thurner syndrome: first report of this unique case
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10137930/
https://www.ncbi.nlm.nih.gov/pubmed/37189534
http://dx.doi.org/10.3390/diagnostics13081433
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