Posterior “nutcracker” phenomenon: hemodynamic relevant aorto‐retroaortal renal vein fistula leading to fatal right heart failure

Abstract

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.