Nutcracker syndrome as the main cause of left renal vein thrombus and pulmonary thromboembolism

Abstract

Introduction: Left renal vein thrombus complicating nutcracker syndrome is relatively rare. To the best of our knowledge, there have been only four previous case reports. Furthermore, there have been no reports of pulmonary thromboembolism caused by nutcracker syndrome. Herein, we report a rare case of pulmonary thromboembolism caused by nutcracker syndrome and its clinical management. Case presentation: A 40-year-old man was admitted to our hospital with acute left flank pain. Computed tomography angiography revealed compression of the left renal vein between the aorta and the superior mesenteric artery with a left renal vein thrombus. Furthermore, computed tomography revealed bilateral pulmonary thromboembolism. Rivaroxaban was administered as an anticoagulant. Twenty days after initiation, computed tomography revealed complete resolution of pulmonary thromboembolism and left renal vein thrombus, and repeated computed tomography showed no recurrence. Conclusion: This case report highlights nutcracker syndrome as a likely cause of pulmonary thromboembolism.