Nutcracker syndrome

Case contributed by Ryan Thibodeau
Diagnosis probable


Abdominal pain and acute opsoclonus and involuntary movements. Evaluate for malignancy.

Patient Data

Age: 15 years
Gender: Female

The left renal vein is seen coursing between the aorta and superior mesenteric artery with an 8 mm length of focal narrowing (axial, sagittal). The renal vein proximal and distal to the area of narrowing is similar in size as to the right renal vein; in which both appear prominent. There are dilated vascular structures posteromedial to the left kidney, which most likely are venous. There are also multiple dilated vascular structures in the left pelvis, with dilated vascular structure extending from the left adnexa into the right adnexa/pelvis. The enhancing vascular structures within the pelvis most likely represent veins, however, this is somewhat indeterminate due to opacified iliac arteries without opacification of the iliac/femoral veins. There appears to be an opacified prominent left gonadal vein.

Case Discussion

This is a suspected case of "nutcracker syndrome" in which the left renal vein is compressed between the aorta and superior mesenteric artery.

Eric Mishkin, MD
Travis Bevington, MD

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