The Nutcracker-like Phenomenon Secondary to Severe Scoliosis

Introduction:Nutcracker syndrome refers to symptomatic compression of the left renal vein, most commonly between the aorta and the superior mesenteric artery, while the term nutcracker phenomenon is reserved for asymptomatic cases. Owing to non-specific clinical manifestations, the condition is frequently underdiagnosed and often identified incidentally on imaging. We report a novel cause of nutcracker phenomenon related to severe scoliosis. Case Report:A 65-year-old woman presented with transient visual disturbances and speech difficulties, prompting brain MRI for suspected stroke. While no ischemic lesions were identified, angiographic sequences revealed a small right subclavian aneurysm, leading to further thoracoabdominal CT evaluation. CT demonstrated severe scoliosis with marked displacement of abdominal vascular structures. The gastroduodenal artery and portal vein were displaced inferiorly and found to compress the left renal vein. Associated dilatation of the proximal left renal vein and left ovarian vein indicated increased venous pressure. As the patient was asymptomatic, a diagnosis of nutcracker phenomenon was made, and no specific treatment was initiated. Discussion:Although numerous anatomical variants causing left renal vein compression have been described, this represents the first reported case of nutcracker-like phenomenon secondary to scoliosis-induced vascular distortion involving the gastroduodenal artery and portal vein. Conclusion:Severe spinal deformities can result in atypical vascular compression syndromes. Awareness of such mechanisms is important when interpreting cross-sectional imaging, particularly in asymptomatic patients with incidental venous findings.