Nutcracker syndrome (annotated CT)

Case contributed by Dr Fabien Ho

Presentation

Intermittent chronic left flank pain. No macroscopic haematuria reported.

Patient Data

Age: 25 years
Gender: Male

Left gonadal vein is enlarged, and a collateral veinous pathway links the left renal vein to the splenic vein.
No sign of thrombosis, but entrapment of the left renal vein with significant stenosis between the superior mesenteric artery and the aorta, with a narrow angle <45°.

Case Discussion

The patient did not notice any macroscopic hematuria. No other obvious cause for intermittent chronic left flank pain in this athletic patient.

The differential diagnoses include left renal vein thrombosis or anatomical variants such as retroaortic or circumaortic left renal vein.

Duodenal compression can be associated, which is not the case here.

PlayAdd to Share

Case information

rID: 61367
Published: 29th Jun 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Excluded
Institution: CHU de la Reunion

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.