Exploring vascular shadows: Case report of young adult nutcracker syndrome

Nutcracker syndrome is defined as an uncommon vascular condition where the left renal vein is compressed between the superior mesenteric artery and aorta, causing renal vascular congestion. This can lead to renal dysfunction and symptoms such as hematuria, proteinuria and orthostatic hypotension. Its prevalence is low, approximately 1 in 2,500 people, and it has no prevalence by sex, which makes its diagnosis challenging due to clinical variability and lack of specific criteria. Therefore, the importance of early diagnosis and treatment to prevent serious complications is emphasized. The main objective of this report was to describe the natural history and the diagnostic-therapeutic approach of a case of Nutcracker Syndrome in a 25-year-old young patient who had been consulted for persistent pelvic pain. Transvaginal ultrasound identified pelvic varices and abdominal angiotomography and venography studies confirmed left renal vein compression with venous dilation, findings typical of nutcracker syndrome. The Doppler confirmed extrinsic compression and decreased venous flow. Given the absence of severe symptoms and clinical stability, management was conservative, with half-yearly controls and follow-up by nephrology, without the need for pharmacological or surgical treatment. This syndrome may resolve spontaneously or develop into complications such as persistent hematuria, proteinuria and chronic pelvic pain. Conservative treatment is appropriate in mild cases without renal involvement, but endovascular or surgical interventions should be considered in patients with severe or persistent symptoms.