Nutcracker syndrome

Case contributed by Dr Martin Perez Romagnoli

Presentation

Left lumbar pain, intermittent macroscopic hematuria and pelvic congestion syndrome

Patient Data

Age: 18 years
Gender: Female
Ultrasound

Images show a reduction of aortomesenteric angle. Compression of the distal segment of the left renal vein (labeled VRI) and the dilation of the left gonadal vein.

CT

Stenosis of the left renal vein between the superior mesenteric artery and the aorta with proximal dilatation of the left renal vein.

Case Discussion

Nutcracker syndrome is a rare condition. It should be considered when patients present with pain in the left flank and intermittent macroscopic hematuria or pelvic congestion syndrome.

Duplex scanning and CT angiography show compression of the left renal vein.
To date, surgery remains the gold standard in its treatment.

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