Presentation
Chronic, recurrent lower abdominal dull pain and heaviness increased with movement, posture, and activities, along with mild dysmenorrhea, dysuria, and dyspareunia.
Patient Data
Multiple dilated, tortuous para-uterine veins, measuring 55 mm in width, are predominantly seen on the left side, with congestion of the left gonadal vein, which has a diameter of approximately 8 mm. (The supine position during scanning usually underestimates the degree of venous dilation.) This dilated gonadal vein drains into the left renal vein, which also shows further segmental dilation (10 mm) at the mid-part of its course, where there is a reduced aorto-mesenteric angle and entrapment of the left renal vein (Nutcracker phenomenon).
Case Discussion
There is no history of hematuria in this patient, preserving the displacement, cause, and result of pelvic congestion and Nutcracker syndromes, rather than indicating a concomitant presentation.
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