Nutcracker syndrome refers to the compression of the left renal vein
between the aorta and the superior mesenteric artery, which results in elevated left renal vein
pressure and possible collateral vein development.
The study case showed a high-grade carcinoma morphologically resembling urothelial carcinoma in a kidney biopsy specimen of a young male with renal vein
At surgery, there was no residual thrombus in the left main renal vein
Left renal vein
is draining into the hypoplastic segment of IVC (Fig.
3,6) Many cases have been documented to feature some sort of angiolymphatic invasion, (10) with involvement of the inferior vena cava, renal vein
, and tumor thrombus frequently reported.
Computed tomography (CT) demonstrated a focal enhancing ovoid density adjacent to the right renal hilum continuous with the right renal vein
This was still within normal limits for a patient in the supine position, with the upper limit of normal being <440 pmol/l; however, this was much higher than the level in the right renal vein
Since we did not perform renal vein
renin analysis, we cannot comment on whether hypertension which was poorly controlled with combined antihypertensive medications can be associated with this anomaly.
1) Leiomyosarcoma arising from a renal vein
is very uncommon with around 30 cases reported in the literature.
Venography demonstrated a similar-caliber left IVC terminating in the left renal vein
and then communicating with the common suprarenal IVC (Figure 4).
At the level of the kidney, the left renal vein
joined the left vena cava which then passed to the right and joined the right vena cava.
Moreover, atypical features such as vena cava or renal vein
involvement have also been reported in EAMLs.