Posterior Nutcracker Syndrome: A Case Report

Posterior Nutcracker Syndrome (PNCS) is a rare vascular disorder caused by the compression of the left renal vein between the aorta and the vertebral column, leading to venous hypertension and potential complications such as hematuria, flank pain, and pelvic congestion. We report the case of a 36-year-old female with a history of rheumatoid arthritis, presenting with chronic left flank pain and mild hematuria. Imaging revealed a duplicated left renal vein with stenosis of the retro-aortic segment, confirming the diagnosis of PNCS. Given the absence of significant renal or vascular complications, conservative management with clinical monitoring was chosen. This condition remains underdiagnosed due to its variable clinical presentation, and imaging techniques such as CT angiography and Doppler ultrasound are essential for diagnosis. Treatment depends on symptom severity, with conservative management preferred in mild cases and surgical or endovascular intervention required for severe cases with persistent hematuria or refractory pain. PNCS should be considered in the differential diagnosis of unexplained left-sided abdominal pain and hematuria, particularly in young patients, as early recognition is crucial to prevent complications such as venous thrombosis and irreversible renal damage.