Korean J Radiol.  2012 Jun;13(3):345-349. 10.3348/kjr.2012.13.3.345.

Posterior Nutcracker Syndrome Associated with Interrupted Left Inferior Vena Cava with Azygos Continuation and Retroaortic Right Renal Vein

• Luo XL
• Qian GN
• Xiao H
• Zhao CL
• Zhou XD

• KMID: 1372855
• DOI: http://doi.org/10.3348/kjr.2012.13.3.345

Abstract

Various anatomic anomalies have been considered the causes of nutcracker syndrome (NCS). Posterior NCS refers to the condition, in which vascular narrowing was secondary to the compression of the retroaortic left renal vein while it is crossing between the aorta and the vertebral column. Here, we report an unusual case of posterior NCS associated with a complicated malformation of the interrupted left inferior vena cava with azygos continuation and retroaortic right renal vein, diagnosed by both color Doppler ultrasonography and CT angiography.

Keyword

Nutcracker syndrome; Left renal vein; Inferior vena cava

MeSH Terms

Adult
Azygos Vein/*abnormalities
Diagnosis, Differential
Female
Humans
Renal Nutcracker Syndrome/*radiography/*ultrasonography
Renal Veins/*abnormalities
Tomography, X-Ray Computed
Vena Cava, Inferior/*abnormalities

Figure

• 

  Fig. 1 Complicated malformation of left inferior vena cava presenting as nutcracker syndrome in 42-year-old woman. Axial sonogram shows (A) right renal vein (RRV) (arrowhead) crossing retroaortically to area of left-sided infrarenal inferior vena cava (L-IVC) (long arrow) and no tubular structure parallel to aorta (short arrow) at right side, and (B) two tubular structures at left of aorta at level of left renal vein (LRV). (C) Spectral Doppler sonogram shows the narrowing portion of L-IVC (short arrow) with turbulent high-velocity blood flow between aorta and vertebral column. (D) Axial sonogram reveals that hepatic veins (arrowhead) do not flow to right-sided suprarenal inferior vena cava (R-IVC) (long arrow) but run to right atrium (RA). Ao = aorta Axial CT angiogram is performed and demonstrates (E) right renal vein (RRV) (arrowhead) crossing retroaortically to left-sided infrarenal inferior vena cava (L-IVC) (long arrow) and (F) dilatation of both L-IVC (long arrow) and distal left renal vein (LRV) (short arrow), with the narrowing portion of RRV between aorta and lumber vertebral column. Tortuous paravertebral collateral veins can be seen in right lumbar area (arrowhead). (G) Coronal oblique image shows a dilated L-IVC receiving both LRV (short arrow) and RRV (arrowhead) and running to R-IVC retroaortically. The tortuously paravertebral collateral veins in right lumbar region are also seen (long arrow). (H) Schematic anatomy illustration shows multiple anomalies with the LIVC. Ao = aorta, R-IVC = right-sided suprarenal inferior vena cava

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