Nutcracker syndrome: A rare cause of chronic pelvic pain and left back pain

Abstract

The Nutcracker Syndrome is a rare and often unrecognized cause of chronic pelvic pain and left back pain. These symptoms are due to the left renal vein compression between the aorta and the superior mesenteric artery (anterior nutcracker) or between the aorta and the spine (posterior nutcracker). The variety of clinical manifestations make the diagnosis difficult and commonly delayed. Therefore, imaging plays a key role in correcting the diagnosis by confirming the left renal vein stenosis and ruling out any differential diagnosis. Treatment options are discussed by a multidisciplinary team involving urologists, nephrologists and vascular surgeons for each patient. We report the case of 2 patients presenting chronic pelvic and lower back pain in whom clinical investigation and CT imaging findings were consistent with a nutcracker syndrome.