Unusual causes of left renal vein compression along its course: MDCT findings in patients with nutcracker and pelvic congestion syndrome

Abstract

The aim of this study was to describe the multidetector computed tomography (MDCT) findings of unusual locations of left renal vein compression in patients with nutcracker and pelvic congestion syndrome. We retrospectively searched our picture archiving and communication system database for the patients with left renal vein compression. We excluded the patients with well-known forms of nutcracker syndrome. We found four patients and retrieved the CT images of them with left renal vein compression secondary to unusual causes. All patients underwent abdominal MDCT either by 16-MDCT or 64-MDCT. Mean age of the patients was 48 years (range 21-67 years). All patients were female (n = 4). Evaluation of axial and curved planar reformatted images allowed diagnosis of unusual causes of compression. Left renal vein was found to be compressed between aorta and splenic vein, aorta and pancreas, duodenum and aorta or solely by right diaphragmatic crus. Contrary to general belief, left renal vein can be compressed along its course between different structures other than aorta and superior mesenteric artery. MDCT findings can demonstrate unusual sites of compression that should be known in patients suspected of nutcracker syndrome.