Presentation
Left loin pain. Urine analysis shows microscopic hematuria.
Patient Data
Abnormal focal narrowing of the left renal vein while crossing the aorto-superior mesenteric distance, that appears reduced. Sagittal images demonstrate the narrowing of the aorto-superior mesenteric angle.
Case Discussion
In the absence of any other causes to explain the patient's symptoms, Nutcracker syndrome was suggested in this patient due to the focal narrowing of the left renal vein while traversing through the aortic-superior mesnteric distance.
Nutcracker sign is abnormal compression of the left renal vein between the superior mesenteric artery and abdominal aorta, and usually manifests with loin pain and hematuria attributed increased renal venous pressure, resulting in rupture of small veins into the collecting system.
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