Nutcracker Syndrome in Pregnancy: Case Report

Abstract

Nutcracker syndrome during pregnancy is an uncommon condition, with few cases reported in the literature. It occurs as a consequence of unilateral renal venous hypertension due to mechanical compression of the left renal vein secondary to changes due to increased intra-abdominal pressure caused by the pregnant uterus and increased aortic diameter; it manifests as persistent asymptomatic hematuria and may be associated less frequently with left flank pain. The diagnosis is made upon clinical suspicion, after exclusion of other more frequent causes of hematuria during pregnancy and resolution of the clinical picture after delivery; studies such as lumbar venography are contraindicated in pregnancy. We describe the case of a 26-year-old patient with a 23-week pregnancy who presented macroscopic left ureteral hematuria associated with left flank pain with spontaneous resolution in the puerperium, confirming the diagnosis of nutcracker syndrome.