Posterior "nutcracker" phenomenon: hemodynamic relevant aorto-retroaortal renal vein fistula leading to fatal right heart failure.
A rare complication of an aneurysm of the abdominal aorta is the so-called "posterior nutcracker phenomenon", which describes compression of a retroaortal renal vein between the abdominal aorta and the vertebral column. The clinical presentation is flank pain and hematuria, which are usually caused by a renal (respectively ureteral) calculus or neoplasia. Another rare differential diagnosis for these very common clinical symptoms is an aorto-left renal vein fistula (ALRVF), which is a spontaneous vascular fistula, usually also associated with an aortic aneurysm, infrequently a result of abdominal trauma.
Breitwieser
C
C
Department of Radiology, Charité-Universitaets-Medizin Berlin, Campus Mitte, Humboldt-Universitaet, Berlin, Germany. christoph.breitwieser@charite.de
Asbach
P
P
Sachs
M
M
Rogalla
P
P
Rodenwaldt
J
J
D000368:Aged; D001011:Aorta / Q000473:pathology*; D017544:Aortic Aneurysm, Abdominal / Q000150:complications*; D001164:Arteriovenous Fistula / Q000209:etiology*; D017809:Fatal Outcome; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008297:Male; D012082:Renal Veins / Q000473:pathology*