Is hypertension a manifestation of the nutcracker phenomenon/syndrome? Case report and brief review of the literature

Abstract

Hypertension has been rarely reported in patients with the nutcracker phenomenon/syndrome. We describe a young male adult where a computed tomography angiography provided evidence of left renal vein dilatation, probably due to its compression through the angle between the aorta and the superior mesenteric artery, during the evaluation for secondary hypertension. As there were no other signs for secondary hypertension, we proceeded with a venography of the inferior vena cava and the renal veins that revealed mild anatomical findings compatible with the so called nutcracker phenomenon/syndrome. Blood levels of renin and aldosterone and renocaval pressure gradient from these sites were between normal limits. As there were coexisting anatomical and clinical findings (hypertension), nutcracker syndrome might have been claimed. However, no causal links could be established and these findings should be considered only as a coincidence.

Keywords: aldosterone; hypertension; nutcracker syndrome; renin; venography.

Figure 1. Computed Tomography Angiography (CTA) reconstruction image. The left renal vein appears dilated in her proximal part before crossing the aorta.