Presentation
Referred by her gynecologist for a pelvic ultrasound to investigate a vulvar varicose vein. Previous hysterectomy and bilateral oophorectomy.
Patient Data
The transabdominal and transvaginal pelvic ultrasounds were unremarkable. There was no obvious dilatation of the pelvic veins on transvaginal ultrasound.
B-mode ultrasound of the left renal vein (LRV) suggested a near 90% decrease in diameter as it crossed between the superior mesenteric artery and aorta. A sharp take-off of the SMA and marked compression of the LRV were demonstrated in the longitudinal axis. Antegrade flow in the LRV was demonstrated by color Doppler assessment. Aliasing was seen at the site of compression. Low velocity, continuous forward flow was seen within the LRV proximal to the point of compression. A 16-fold increase in peak systolic velocity was seen within the LRV at the point of compression.
Case Discussion
The pelvic ultrasound and brief look over the abdomen did not reveal any compressive masses. Examination of the left renal vein suggested nutcracker phenomenon. The left kidney appeared normal. The patient was scanned in the supine position only as this was not a formal examination of the abdominal vessels.
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