Tiralongo Francesco, Galioto Federica, Distefano Giulio, Palmucci Stefano, Basile Antonio, Di Rosa Salvatore
Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University Hospital Policlinico "G. Rodolico-San Marco", University of Catania, 95123 Catania, Italy.
U.O.C. Diagnostica per Immagini P.O. "S. Marta e S. Verera" Acireale, ASP Catania, 95123 Catania, Italy.
Diagnostics (Basel). 2023 Apr 16;13(8):1433. doi: 10.3390/diagnostics13081433.
Anterior nutcracker syndrome is defined as the compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta, whereas posterior nutcracker syndrome refers to the compression of the retroaortic LRV between the aorta and the vertebral column-the presence of the circumaortic left renal vein may predispose to "combined nutcracker syndrome". May-Thurner syndrome consists of obstruction of the left common iliac vein caused by the crossing right common iliac artery. We report a unique case of combined nutcracker syndrome associated with May-Thurner syndrome.
A 39-year-old Caucasian female came to our radiology unit for triple-negative breast cancer computed tomography (CT) staging. She complained of pain in hermid-back and low-back regions and intermittent abdominal pain in the left flank region. Multidetector computed tomography (MDCT) incidentally revealed a circumaortic left renal vein draining to the inferior vena cava, with bulbous dilatation of both the antero-superior and posterior-inferior branches, which was associated with pathological serpiginous dilation of the left ovarian vein with varicose pelvic veins. Axial CT imaging of the pelvis also showed compression of the left common iliac vein by the overlying right common iliac artery consistent with May-Thurner syndrome without signs of venous thrombosis.
Contrast-enhanced CT is the best imaging modality for suspected vascular compression syndromes. CT findings showed a combination of anterior and posterior nutcracker syndrome in the left circumaortic renal vein, associated with May-Thurner syndrome, which has not previously been described in the literature.
前胡桃夹综合征定义为肠系膜上动脉（SMA）与腹主动脉之间对左肾静脉（LRV）的压迫，而后胡桃夹综合征是指主动脉与脊柱之间对主动脉后左肾静脉的压迫——主动脉周围左肾静脉的存在可能易导致“联合胡桃夹综合征”。May-Thurner综合征由右侧髂总动脉交叉压迫左侧髂总静脉所致。我们报告一例与May-Thurner综合征相关的联合胡桃夹综合征的独特病例。
一名39岁的白种女性因三阴性乳腺癌计算机断层扫描（CT）分期来到我们的放射科。她主诉中背部和下背部疼痛以及左侧胁腹间歇性腹痛。多排螺旋计算机断层扫描（MDCT）偶然发现一条主动脉周围左肾静脉引流至下腔静脉，其前后分支均呈球样扩张，并伴有左侧卵巢静脉病理性蜿蜒扩张及盆腔静脉曲张。骨盆的轴向CT成像还显示右侧髂总动脉压迫左侧髂总静脉，符合May-Thurner综合征，且无静脉血栓形成迹象。
增强CT是疑似血管压迫综合征的最佳成像方式。CT表现显示左主动脉周围肾静脉存在前、后胡桃夹综合征合并May-Thurner综合征，此前文献中未见描述。
