NUTCRACKER´S SYNDROME: CASE REPORT

Abstract

Nutcracker Syndrome (NCS) is a rare vascular condition resulting from a compression of the left renal vein (RV) between the abdominal aorta (AA) and the superior mesenteric artery (SMA), resulting in manifestations such as hematuria, flank pain, proteinuria, varicocele in men and pelvic congestion syndrome in women. Therefore, differentiating NCS, which presents clinical symptoms, from Nutcracker's Phenomenon, an asymptomatic venous compression, is crucial for appropriate treatment. In this article, we describe the case of a 37-year-old female patient hospitalized with low back pain, dysuria, and fever who was diagnosed with NCS by contrast-enhanced computed tomography (CT). The diagnosis of the syndrome is challenging due to the nonspecific clinical presentation, which ranges from mild hematuria to severe abdominal pain. Contrast-enhanced CT is the preferred method to confirm compression and stenosis of VRE, and its treatment may range from conservative measures, in mild cases, surgical interventions in severe situations. The therapeutic decision must be individualized, considering symptoms, anatomy and response to treatment. Although it is considered rare, NCS should be ruled out in patients with flank pain and hematuria, and its early diagnosis is essential to prevent serious complications such as venous thrombosis or loss of renal function.