The anterior nutcracker syndrome is defined by the compression of the left renal vein between the aorta and superior mesenteric artery, usually related to the occurrence of hematuria. We report the case of an uncommon complication of the nutcracker syndrome. A 75-year-old woman was referred to our institution for left flank pain without hematuria. Multiphasic computer tomography urography showed a condition of left renal vein entrapment between the aorta and superior mesenteric artery with the development of left gonadal vein varicosities at the level of the renal hilum; a pyeloureteral junction compression with dilation of the pyelocalyceal system coexisted. To our knowledge, this is the first report of the association between nutcracker syndrome and pyeloureteral junction obstruction.

1.
Ali-El-Denib B, Osman Y, Shehab El-Din AB, et al: Anterior and posterior nutcracker syndrome: a report on 11 cases. Transplant Proc 2003;35:851-853.
2.
Cuellar i Calabria H, Quiroga Gomez S, Sebastia Cerqueda C, et al: Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance. Eur Radiol 2005;15:1745-1751.
3.
Venkatachalam S, Bumpus K, Kapadia SR, et al: The nutcracker syndrome. Ann Vasc Surg 2011;25:1154-1164.
4.
Grimm LJ, Engstrom BI, Nelson NC, et al: Incidental detection of nutcracker phenomenon on multidetector CT in an asymptomatic population: prevalence and associated findings. J Comput Assist Tomogr 2013;37:415-418.
5.
Resorlu M, Sariyildirim A, Resorlu B, et al: Association of congenital left renal vein anomalies and unexplained hematuria: multidetector computed tomography findings. Urol Int 2015;94:177-180.
6.
Waseem M, Upadhyay R, Prosper G: The nutcracker syndrome: an underrecognized cause of hematuria. Eur J Pediatr 2012;171:1269-1271.
7.
Ishidoya S, Chiba Y, Sakai K, Orikasa S: Nutcracker phenomenon: a case with surgical treatment and its diagnostic criteria. Hinyokika Kiyo 1994;40:135-138.
8.
Wang L, Yi L, Yang L, et al: Diagnosis and surgical treatment of nutcracker syndrome: a single-centre experience. Urology 2009;73:871-876.
9.
Ahmed K, Sampath R, Khan MS: Current trends in the diagnosis and management of renal nutcracker syndrome: a review. Eur J Vasc Endovasc Surg 2006;31:410-416.
10.
Li P, Shao P, Qin C, et al: Retroperitoneal laparoscopic extravascular stent placement for renal nutcracker syndrome: initial experience. Urol Int 2014;92:396-399.
11.
Shao P, Li P, Ju X, Qin C, Yin C: Retroperitoneal laparoscopic reimplantation of the left renal vein for nutcracker syndrome. Urol Int 2015;94:74-78.
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