An easily missed diagnosis: flank pain and nutcracker syndrome

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 (compres...

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Bibliographic Details
Published in:BMJ case reports 2013-05, Vol.2013, p.bcr2013009447
Main Authors: Mahmood, Syed Kashif, Oliveira, George R, Rosovsky, Rachel P
Format: Article
Language:English
Subjects:
Abdomen
Adult
Anticoagulants - therapeutic use
Coronary vessels
Diagnosis, Differential
Female
Flank Pain - etiology
Hematology
Heparin, Low-Molecular-Weight - therapeutic use
Humans
Molecular weight
Pain
Rare Disease
Renal Veins - pathology
Thrombosis
Thrombosis - diagnosis
Thrombosis - diagnostic imaging
Thrombosis - drug therapy
Thrombosis - pathology
Tomography, X-Ray Computed
Treatment Outcome
Ultrasonography
USA/Canada
Veins & arteries
White
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Description
Summary: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.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2013-009447