Vascular compression of left renal vein: the nutcracker phenomenon

Description

A 75-year-old woman presented to the outpatient clinic with symptoms of upper abdominal pain radiating to the back. On evaluation with contrast-enhanced CT of the abdomen, she was found to have carcinoma of the body of pancreas. Incidentally, vascular compression of the left renal vein was seen between the superior mesenteric artery and the aorta (the nutcracker sign) (figure 1). In view of poor performance status, she underwent palliation with percutaneous splanchnic nerve radiofrequency ablation. Since she was asymptomatic for the vascular compression and serum creatinine was normal (1.2 mg/dL), she was observed for the same.

Figure 1

(A) Axial contrast-enhanced CT image showing mass lesion in the body of pancreas (asterisk) with dilated left renal vein, (B) magnified image showing compression of the left renal vein between the superior mesenteric artery and aorta with dilation of the proximal left renal vein (arrow).

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