Nutcracker syndrome

Case contributed by Jörgen Strömberg
Diagnosis certain


Macroscopic hematuria.

Patient Data

Age: 70 years
Gender: Male

There is a bundle of varicose veins (arising from the left testicular vein) medial to the left kidney. When tracing the left renal vein along its course to the vena cava, you will find the vein markedly compressed when passing between the superior mesenteric artery and the aorta.

As incidental findings, this patient also turned out to have two accessory spleens, as well as a duplex left collecting system fusing at the pelviureteric junction.

Case Discussion

The exam was carried out to look for a cause of macroscopic hematuria.

The nutcracker syndrome has been associated with macroscopic hematuria, and since no other cause of hematuria (such as renal or urothelial malignancy) was found, we propose that it is the cause of the hematuria.

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