Posterior Nutcracker Phenomenon in a Patient with Left Atrial Isomerism

Abstract

Background Nutcracker phenomenon (NCP) can occur due to various anatomical anomalies. Anterior and posterior NCP are defined in the literature. Posterior NCP combined with left atrial isomerism is a rare condition.

Case description We present a rare case of an asymptomatic posterior NCP involving the azygos vein in a patient with a complex cardiovascular pathology with left atrial isomerism, left ventricular outflow tract obstruction, interrupted inferior vena cava, and azygos continuation.

Conclusion Detection of the NCP especially involving such a rare anatomical anomaly as an azygos continuation has a crucial importance for diagnostic and surgical procedures.

Keywords

congenital heart disease - magnetic resonance imaging - pediatric - cardiovascular surgery

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Informed Consent

Informed consent was waived off because this study included no personal information about the patient.

• References

• 1 Fröber R, Eichhorn K, Schleußner E, Schlembach D. Left Isomerism Sonographic Findings and Post Mortal Autopsy in a Female Foetus. Austin J Anat. 2015; 2: 1043
• 2 Wang TD, Tseng CD, Lee YT. Left isomerism in a middle-aged woman with early-onset atrial fibrillation. Int J Cardiol 1997; 58 (03) 269-272
• 3 Pepes S, Zidere V, Allan LD. Prenatal diagnosis of left atrial isomerism. Heart 2009; 95 (24) 1974-1977
• 4 Shiraishi I, Ichikawa H. Human heterotaxy syndrome–from molecular genetics to clinical features, management, and prognosis–. Circ J 2012; 76 (09) 2066-2075
• 5 Kim YJ, Kwon SH, Ahn SE, Kim SJ, Shin JS, Oh JH. Interrupted inferior vena cava with hemiazygos continuation in an adult with a persistent left superior vena cava and left single coronary artery: a case report. J Korean Soc Radiol 2016; 74: 394-398
• 6 Luo XL, Qian GN, Xiao H, Zhao CL, Zhou XD. Posterior nutcracker syndrome associated with interrupted left inferior vena cava with azygos continuation and retroaortic right renal vein. Korean J Radiol 2012; 13 (03) 345-349
• 7 Kurklinsky AK, Rooke TW. Nutcracker phenomenon and nutcracker syndrome. Mayo Clin Proc 2010; 85 (06) 552-559