Unusual reason of nutcracker syndrome of the renal vein: a case report

Abstract 52-year-old female patient who presented with painless hematuria, was admitted to the urology outpatient clinic. After the initial ultrasound examination, she underwent cystoscopy. Urine cytology and pathology were benign. So, she referred to the nephrology clinic. Her renal functions were normal, and she had no proteinuria. Urinary sediment revealed 10-15 isomorphic erythrocytes. Diagnosis of glomerulonephritis was excluded. According to her medical history and records it was learned that she had undergone Whipple operation three years ago. Considering surgery history, doppler ultrasound was planned because of the possibility of renal vein compression. Renal vein doppler ultrasound revealed that the left renal vein diameter was 9.5 mm before the superior mesenteric artery, and it was 1.8 mm after the artery. Nutcracker syndrome of the renal vein was diagnosed. Since the kidney functions were normal and the patient was normotensive, follow-up was planned at 6- month intervals. Nutcracker syndrome is a rare syndrome that occurs when the renal vein is compressed in various anatomical regions, most commonly between the aorta and the superior mesenteric artery. It be produced by pancreatic neoplasms, para-aortic lymphadenopathy, retroperitoneal tumors, or strangulating fibrolymphatic tissue between the superior mesenteric artery and the aorta. However, there is no case reported in the literature because of previous Whipple surgery. By documenting this case, we aimed to remind that taking a good anamnesis and making relevant imaging methods, may attribute to diagnosis rare cases and save time for clinicians especially in cases with a grave result such as nephrectomy unless they diagnosed.