*20 year-old female with haematuria.
What is the most likely diagnosis?
Answer
Answer: Nutcracker syndrome
Case Discussion:
Ultrasound and Doppler ultrasound images show the grossly distended proximal left renal vein and increased peak velocity at distal left renal vein secondary to the compression of the left renal vein between the superior mesenteric artery and aorta.
Nutcracker syndrome is a vascular compression disorder, and refers to the compression of the left renal vein between the superior mesenteric artery and aorta. The clinical manifestation of the nutcracker syndrome is intermittent macroscopic haematuria and left flank pain.
Radiographic findings are similar on USG, Doppler, CT, MR or conventional angiography:
• Reduced aorta: SMA angle (The normal angle between aorta and SMA is approximately 45° (38-65°).
• Left renal vein stenosis
• Collateral pathways
References:
1. Takebayashi S, Ueki T, Ikeda N et-al. Diagnosis of the nutcracker syndrome with color Doppler sonography: correlation with flow patterns on retrograde left renal venography. AJR Am J Roentgenol. 1999;172 (1): 39-43.