Nutcracker phenomenon

Case contributed by Brendan Cullinane


Referred by her gynaecologist for a pelvic ultrasound to investigate a vulvar varicose vein. Previous hysterectomy and bilateral oophorectomy.

Patient Data

Age: 65 years
Gender: Female

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 color 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.

Case Discussion

The pelvic ultrasound and brief look over the abdomen did not reveal any compressive masses. Examination of the left renal vein suggested nutcracker syndrome. The left kidney appeared normal. The patient was scanned in the supine position only as this was not a formal examination of the abdominal vessels.

PlayAdd to Share

Case information

rID: 21859
Published: 22nd Feb 2013
Last edited: 7th Sep 2019
System: Vascular
Inclusion in quiz mode: Included

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.