Nutcracker Syndrome and its Exceptional Occurrence with Pulmonary Tuberculosis: A Case Report

Nutcracker syndrome (NCS), also known as left renal vein (LRV) entrapment syndrome, is a condition resulting due to compression of LRV between the aorta and superior mesenteric artery (SMA), with dilatation of the distal portion of LRV. We present a case of an elderly female presenting with left lumbar pain for 1 year. Initial investigations revealed microscopic hematuria and mild ascites. Further investigations revealed compression of LRV between the aorta and SMA, with aorto-SMA angle reduced up to 12°, suggesting a diagnosis of NCS. Along with this, cystic bronchiectasis with multiple centrilobular nodules with tree-in-bud pattern was seen in bilateral lung fields, suggestive of pulmonary tuberculosis. Ziehl-Neelsen (ZN) staining and cartridge-based nucleic acid amplification test (CBNAAT) confirmed our diagnosis of NCS with pulmonary tuberculosis.