Nutcracker syndrome (annotated CT)
Intermittent chronic left flank pain. No macroscopic haematuria reported.
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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°.
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.