Incidental Finding of a Retroaortic Left Renal Vein with Pelvic Venous Congestion Consistent with Posterior Nutcracker Syndrome: A Case Report

Authors

Antonia Berz Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne
Théo Sartoretti Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne
Rami Hajri Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne https://orcid.org/0000-0002-0081-3162
Guillaume Fahrni Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne https://orcid.org/0000-0003-1583-9602

DOI:

Abstract

Posterior nutcracker syndrome is a rare vascular disorder caused by compression of the retroaortic left renal vein between the aorta and the vertebral column. While many patients remain asymptomatic, it can lead to pelvic congestion in some cases.

We report the case of a 31-year-old woman undergoing routine oncologic staging following curative resection of a sigmoid adenocarcinoma. She was asymptomatic, with normal laboratory findings. Contrast-enhanced CT demonstrated compression of the retroaortic left renal vein, with a diameter ratio of 1:3.3. Prominent pelvic varices and a dilated left ovarian vein measuring up to 8 × 8 mm were also noted, consistent with posterior nutcracker syndrome. Due to the incidental nature of the findings and the absence of symptoms, conservative management was chosen.

This case highlights the incidental radiological detection of posterior nutcracker syndrome and underscores the diagnostic challenge posed by its frequently asymptomatic course and the absence of standardized diagnostic criteria.

31-year-old female with a retroaortic course of the left renal vein joining the inferior vena cava in the normal position (Type I). Findings: Axial contrast-enhanced CT in the portal venous phase shows a retroaortic left renal vein (orange arrows, image a, magnified in image b) compressed between the aorta and the vertebral body (anteroposterior diameter: 10 vs 3 mm, compression ratio of 1 : 3.3), consistent with posterior nutcracker syndrome. Technique: Axial CT, 150 mAs, 80 kV, 1.25 mm slice thickness, portal venous phase after intravenous injection of 80 ml of iodinated contrast agent (Iohexol 300 mg I/mL).

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Published

2025-12-24

Issue

Vol. 19 No. 12 (2025)

Section

Cardiac Imaging

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