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 aortoleft renal vein fistula (ALRVF), which is a spontaneous vascular fistula, usually also associated with an aortic aneurysm, infrequently a result of abdominal trauma.