Incidental posterior nutcracker syndrome in a right renal cell carcinoma patient: A case report.

INTRODUCTION AND

IMPORTANCE

Nutcracker syndrome is an uncommon vascular disorder characterized by the compression of the left renal vein between the aorta and surrounding structures. Posterior Nutcracker Syndrome (PNCS) is the rarest form of this disorder, marked by the entrapment of the left renal vein between the abdominal aorta and the vertebral column. PNCS has varied clinical presentations ranging from asymptomatic to feared complications, including pelvic engorgement and left renal thrombosis. Clinicians need to be able to differentiate asymptomatic PNCS, as it can have implications on patient management.

CASE PRESENTATION: We report a case of a 60-year-old Ethiopian patient with a complaint of right-sided flank pain of three months duration associated with a significant weight loss. Upon evaluation of the patient with advanced imaging, a right renal mass with incidental diagnosis of posterior nutcracker syndrome was made. The patient underwent a right radical nephrectomy and showed improvement of symptoms with no reported flank pain or other abnormality on follow-up.

CLINICAL DISCUSSION: PNCS is a rare vascular disorder that is often diagnosed incidentally when patients undergo imaging investigation for other abnormalities. It has diverse clinical pictures ranging from asymptomatic to feared complications. As noted in our patient, this disorder is mostly asymptomatic and diagnosed incidentally in patients who undergo advanced imaging investigation for other conditions.

CONCLUSION

PNCS is a rare vascular disorder that is mostly asymptomatic and often diagnosed incidentally. Diagnosis is highly dependent on advanced imaging modalities and is often reached incidentally. The management of PNCS is primarily conservative, with surgical interventions reserved for patients with ongoing symptoms.