Nutcracker syndrome

Case contributed by Dr Heba Abdelmonem


Left loin pain. Urine analysis shows microscopic hematuria.

Patient Data

Age: 55 years
Gender: Male

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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Case information

rID: 62917
Published: 8th Sep 2018
Last edited: 9th Sep 2018
Inclusion in quiz mode: Included
Institution: Zagazig University Hospital

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