Nutcracker syndrome

Case contributed by Dr Jonathan Robert Wylie

Presentation

Abdominal pain

Patient Data

Age: 35
Gender: Male
CT

The only positive finding on this CT to investigate abdominal pain was compression of the left renal vein between the aorta and the superior mesenteric artery. The solid upper abdominal organs were normal.

Case Discussion

This case highlights the importance of thorough vascular assessment when searching for causes of chronic abdominal pain in younger patients. The left renal vein is compressed between the aorta and superior mesenteric artery. With clinical signs (including left flank pain and macroscopic haematuria from rupture of small intrarenal veins), this can be termed nutcracker syndrome.

A similar but separate condition is when the acute angle formed between the aorta and the origin of the superior mesenteric artery compresses the third part of the duodenum causing early satiety, vomiting and abdominal pain. This rare gastrointestinal condition is known as SMA syndrome or Wilkie's syndrome. This and nutcracker syndrome can occur simultaneously, but are not exclusively found together. 

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Case information

rID: 53285
Case created: 10th May 2017
Last edited: 3rd Jul 2017
System: Vascular
Inclusion in quiz mode: Included

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