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Case Reports in Vascular Medicine
Volume 2014 (2014), Article ID 579061, 4 pages
http://dx.doi.org/10.1155/2014/579061
Case Report

Unique Nutcracker Phenomenon Involving the Right Renal Artery and Portal Venous System

1University of Queensland School of Medicine, Herston Road, Herston, Brisbane, QLD 4006, Australia
2Department of Medical Imaging, Mater Misericordiae Hospital, Raymond Terrace, South Brisbane, QLD 4101, Australia

Received 23 April 2014; Accepted 16 June 2014; Published 1 July 2014

Academic Editor: Nilda Espinola-Zavaleta

Copyright © 2014 Maximilian Stephens et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The nutcracker phenomenon is usually caused by compression of the left renal vein by the superior mesenteric artery anteriorly and the aorta posteriorly, although variations of this anatomy have previously been reported. We observed a nutcracker phenomenon in a 42-year-old female who underwent portal venous phase computed tomography of the body for oncologic workup. She had no documented proteinuria or hematuria. Multiplanar reconstructions demonstrated an enhancing left renal vein draining into the left ovarian vein without draining into the inferior vena cava due to external compression immediately before the renocaval junction. The left renal vein was compressed between the right renal artery and the portal vein. This type of nutcracker has not been previously reported in the literature and represents a new variation.