Presentation
Referred for an abdominal ultrasound for ? cholecystitis.
Patient Data
The proximal left renal vein (LRV) is grossly distended. There is an 8-fold decrease in the diameter of the LRV as it passes between the superior mesenteric and aorta. Aliasing is seen on color Doppler ultrasound within the stenosed area of the left renal vein.
Grossly elevated peak systolic velocities (PSV) were seen within the left renal vein stenosis. There was a 12-fold increase in PSV compared to the proximal segment. Antegrade flow was demonstrated in the proximal left renal vein.
The longitudinal image shows a sharp take-off of the superior mesenteric artery and suggests a 16-fold decrease in diameter of the left renal vein.
Case Discussion
Sonographic evidence of nutcracker phenomenon, an incidental finding in a patient referred to investigate cholecystitis. The ultrasound was otherwise unremarkable. The patient stated that he did not feel an ache in his scrotum and that his blood pressure was normal. No history of gross hematuria or left flank pain. Presence of microscopic hematuria unknown.
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