Article Text

Download PDFPDF
An easily missed diagnosis: flank pain and nutcracker syndrome
  1. Syed Kashif Mahmood1,
  2. George R Oliveira2,
  3. Rachel P Rosovsky3
  1. 1Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  2. 2Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Syed Kashif Mahmood, skmahmood{at}


A 27-year-old woman presented to her primary care doctor's office with left flank pain. CT of the abdomen showed an isolated left renal vein thrombus. The clot was initially attributed to her oral contraceptive use; however, closer inspection of CT images revealed nutcracker phenomenon (compression of the renal vein between the superior mesenteric artery and abdominal aorta). Intravascular ultrasound imaging confirmed the diagnosis. Nutcracker syndrome is a rare condition, which if left untreated may cause damage to the left kidney. Although under diagnosed, there are several treatment options available ranging from simple surveillance to surgical resolution.

View Full Text

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.