Presentation
Lower abdominal and scrotal pain.
Patient Data
The pampiniform plexus of veins & the inguinal segment of the spermatic vein on the left side are prominent measuring +/- 0.15 cm compared to 0.05 cm on the right side. There is associated significant reflux in both supine and standing positions.
The retroperitoneal segment of the left spermatic vein couldn’t be traced, yet the left renal vein appears dilated at the hilum measuring 0.7 cm and appears narrowed posterior to the superior mesenteric artery measuring 0.15 cm with a resultant compression ratio of 4.6.
Aorto-mesenteric distance and angle are reduced being 0.3 cm and 11 degrees, respectively.
Case Discussion
Nutcracker syndrome occurs due to compression of the left renal vein between the aorta and the superior mesenteric artery. It may present with flank pain, proteinuria and hematuria or uncommonly gonadal varices 1.
High clinical suspicion is required to reach the diagnosis in pediatric patients 2.
Management of nutcracker syndrome can be surgical or conservative, where the latter option was used in our case.
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