Young woman with nutcracker syndrome without main clinic manifestation: Hematuria-Case report

Abstract

Introduction: The nutcracker syndrome occurs due to the compression of the left renal vein between the aorta and the superior mesenteric artery. The diagnosis of the syndrome is often difficult and under diagnosed. The main clinical manifestations are hematuria and pelvic or back pain.

Presentation of case: A 25 years old female patient with severe abdominal pain in the lower abdomen without hematuria. Diagnosis with nutcracker syndrome after performing computed tomography. Presented the first episode of pain with 17 years old and was diagnosed at age 25.

Discussion: In the nutcracker syndrome anatomical changes do not generate specific symptoms, causing the disease to be underdiagnosed. In this syndrome, there is increased pressure on the left renal vein, generating several signs and symptoms, and hematuria is one of present. Our patient did not have hematuria. Because of common symptoms, it makes nutcracker syndrome difficult diagnosis, confusing with other diseases, especially with nephrolithiasis. It is usually diagnosed after exclusion of other diseases.

Conclusion: The diagnosis of nutcracker syndrome is done after exclusion of other causes of chronic pelvic pain. In most cases, macroscopic and microscopic hematuria are present but was unobserved in this case. Making it more difficult diagnosis.

Keywords: Abdominal pain; Case report; Diagnosis; Hematuria; Nutcracker syndrome.

Fig. 1

Sequence tomographic images showing the left renal vein compression by the aorta and superior mesentericartery.

Fig. 2

Evidence of pelvic varices.

Fig. 3

Dilation of gonadal vein.