{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T22:40:43Z","timestamp":1773787243754,"version":"3.50.1"},"reference-count":23,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,4,16]],"date-time":"2023-04-16T00:00:00Z","timestamp":1681603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Anterior nutcracker syndrome is defined as the compression of the left renal vein (LRV) between the superior mesenteric artery (SMA) and the aorta, whereas posterior nutcracker syndrome refers to the compression of the retroaortic LRV between the aorta and the vertebral column\u2014the presence of the circumaortic left renal vein may predispose to \u201ccombined nutcracker syndrome\u201d. May\u2013Thurner syndrome consists of obstruction of the left common iliac vein caused by the crossing right common iliac artery. We report a unique case of combined nutcracker syndrome associated with May\u2013Thurner syndrome. Case presentation: A 39-year-old Caucasian female came to our radiology unit for triple-negative breast cancer computed tomography (CT) staging. She complained of pain in hermid-back and low-back regions and intermittent abdominal pain in the left flank region. Multidetector computed tomography (MDCT) incidentally revealed a circumaortic left renal vein draining to the inferior vena cava, with bulbous dilatation of both the antero-superior and posterior-inferior branches, which was associated with pathological serpiginous dilation of the left ovarian vein with varicose pelvic veins. Axial CT imaging of the pelvis also showed compression of the left common iliac vein by the overlying right common iliac artery consistent with May\u2013Thurner syndrome without signs of venous thrombosis. Conclusion: Contrast-enhanced CT is the best imaging modality for suspected vascular compression syndromes. CT findings showed a combination of anterior and posterior nutcracker syndrome in the left circumaortic renal vein, associated with May\u2013Thurner syndrome, which has not previously been described in the literature.<\/jats:p>","DOI":"10.3390\/diagnostics13081433","type":"journal-article","created":{"date-parts":[[2023,4,17]],"date-time":"2023-04-17T01:34:15Z","timestamp":1681695255000},"page":"1433","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Anterior and Posterior Nutcracker Syndrome Combined with May\u2013Thurner Syndrome: First Report of This Unique Case"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9637-1970","authenticated-orcid":false,"given":"Francesco","family":"Tiralongo","sequence":"first","affiliation":[{"name":"Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Federica","family":"Galioto","sequence":"additional","affiliation":[{"name":"U.O.C. Diagnostica per Immagini P.O. \u201cS. Marta e S. Verera\u201d Acireale, ASP Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0735-5720","authenticated-orcid":false,"given":"Giulio","family":"Distefano","sequence":"additional","affiliation":[{"name":"Institute of Internal Medicine, Medicine Department, Vittoria Hospital, ASP Ragusa, 97100 Ragusa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefano","family":"Palmucci","sequence":"additional","affiliation":[{"name":"Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Basile","sequence":"additional","affiliation":[{"name":"Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies \u201cGF Ingrassia\u201d, University Hospital Policlinico \u201cG. Rodolico-San Marco\u201d, University of Catania, 95123 Catania, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salvatore","family":"Di Rosa","sequence":"additional","affiliation":[{"name":"U.O.S.D. Radiologia, P.O. \u201cG. Di Maria\u201d Avola, ASP Siracusa, 96100 Siracusa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Granata, A., Distefano, G., Sturiale, A., Figuera, M., Foti, P.V., Palmucci, S., and Basile, A. (2021). From nutcracker Phenomenon to Nutcracker Syndrome: A Pictorial Review. Diagnostics, 11.","DOI":"10.3390\/diagnostics11010101"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1148\/rg.341125010","article-title":"Multidetector CT of Vascular Compression Syndromes in the Abdomen and Pelvis","volume":"34","author":"Lamba","year":"2014","journal-title":"RadioGraphics"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/0002-9610(87)90172-3","article-title":"Lliocaval compression syndrome","volume":"154","author":"Taheri","year":"1987","journal-title":"Am. J. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1016\/S0041-1345(02)04026-5","article-title":"Anterior and posterior nutcracker syndrome: A report on 11 cases","volume":"35","author":"Osman","year":"2003","journal-title":"Transpl. Proc."},{"key":"ref_5","unstructured":"Singla, R., Sharma, T., and Gupta, R. (2023, January 12). Retro-Aortic Left Renal Vein with Left Suprarenal Vein Draining into Inferior Vena Cava. Available online: https:\/\/www.semanticscholar.org\/paper\/Retro-aortic-left-renal-vein-with-left-suprarenal-Singla-Sharma\/e9542e3e8f2f43d6487468af0b804a1a9590887b."},{"key":"ref_6","unstructured":"De Visschere, P., De Man, R., Rosseel, F., Crolla, D., Verstraete, K., and Villeirs, G. (2015, October 22). Combined Anterior and Posterior Nutcracker Phenomenon in Circumaortic Left Renal Vein. Vienna: EuroRad. Available online: http:\/\/www.eurorad.org\/case.php?id=6962."},{"key":"ref_7","first-page":"e114","article-title":"Anterior and Posterior Nutcracker Syndrome Accompanying Left Circumaortic Renal Vein in an Adolescent. Case Report","volume":"114","author":"Bilgici","year":"2016","journal-title":"Arch. Argent. Pediatr."},{"key":"ref_8","first-page":"1237","article-title":"Left crossed fused renal ectopia L-shaped kidney type, with double nutcracker syndrome (anterior and posterior)","volume":"55","author":"Pupca","year":"2014","journal-title":"Romanian J. Morphol. Embryol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jvscit.2022.01.011","article-title":"Endovascular treatment of a patient with nutcracker syndrome and pelvic varices involving anterior and posterior renal veins","volume":"8","author":"Belczak","year":"2022","journal-title":"J. Vasc. Surg. Cases Innov. Tech."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1016\/j.clinimag.2012.09.012","article-title":"Evaluation of the left renal vein variations and inferior vena cava variations using helical computed tomography","volume":"37","author":"Dilli","year":"2012","journal-title":"Clin. Imaging"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1007\/s00276-014-1403-6","article-title":"Classification of the renal vein variations: A study with multidetector computed tomography","volume":"37","author":"Zhu","year":"2015","journal-title":"Surg. Radiol. Anat."},{"key":"ref_12","first-page":"77","article-title":"Circumaortic renal collar","volume":"50","author":"Rathod","year":"2004","journal-title":"J. Postgrad. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"886","DOI":"10.1016\/j.ejvs.2017.02.015","article-title":"Nutcracker Syndrome: An Update on Current Diagnostic Criteria and Management Guidelines","volume":"53","author":"Ananthan","year":"2017","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_14","unstructured":"Baltimore, M.D. (1937). Method of Anatomy, Williams & Wilkins."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Tiralongo, F., Distefano, G., Palermo, M., Granata, A., Giurazza, F., Vacirca, F., Palmucci, S., Venturini, M., and Basile, A. (2021). Liquid and Solid Embolic Agents in Gonadal Veins. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081596"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"552","DOI":"10.4065\/mcp.2009.0586","article-title":"Nutcracker phenomenon and nutcracker syndrome","volume":"85","author":"Kurklinsky","year":"2010","journal-title":"Mayo Clin. Proc."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1007\/s00247-006-0145-y","article-title":"Nutcracker syndrome in children with gross haematuria: Doppler sonographic evaluation of the left renal vein","volume":"36","author":"Cheon","year":"2006","journal-title":"Pediatr. Radiol."},{"key":"ref_18","unstructured":"(2023, March 20). Surgical and Endovascular Interventions for Nutcracker Syndrome\u2014PubMed, Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/25220323\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1177\/1531003509338402","article-title":"Nutcracker syndrome: When should it be treated and how?","volume":"21","author":"Menard","year":"2009","journal-title":"Perspect. Vasc. Surg. Endovasc. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.jvir.2007.05.017","article-title":"Percutaneous nitinol stent implantation in the treatment of nutcracker syndrome in young adults","volume":"18","author":"Basile","year":"2007","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1177\/000331975700800505","article-title":"The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins","volume":"8","author":"May","year":"1957","journal-title":"Angiology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1055\/a-0959-6230","article-title":"Prevalence of May-Thurner Syndrome in Patients with Deep Vein Thrombosis at a Large Medical Referral Center","volume":"191","author":"Heller","year":"2019","journal-title":"Rofo"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1055\/s-0040-1721704","article-title":"Variceal Veins Embolization and Left Renal Vein Stenting in a Patient with Combined Nutcracker and May\u2013Thurner Syndrome","volume":"31","author":"Aghdasi","year":"2022","journal-title":"Int. J. Angiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/8\/1433\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:16:53Z","timestamp":1760123813000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/8\/1433"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,16]]},"references-count":23,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["diagnostics13081433"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13081433","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,16]]}}}