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The transabdominal and transvaginal pelvic ultrasounds were unremarkable. There was no obvious dilatation of the pelvic veins on transvaginal ultrasound.
B-mode ultrasound of the left renal vein (LRV) suggested a near 90% decrease in diameter as it crossed between the superior mesenteric artery and aorta. A sharp take-off of the SMA and marked compression of the LRV were demonstrated in the longitudinal axis. Antegrade flow in the LRV was demonstrated by colour Doppler assessment. Aliasing was seen at the site of compression. Low velocity, continuous forward flow was seen within the LRV proximal to the point of compression. A 16-fold increase in peak systolic velocity was seen within the LRV at the point of compression.