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A 63‐year‐old woman presented with acute sharp left flank pain of 2 days duration and came to our emergency unit for help. Initial investigations, including repeat cultures of urine and urine cytology, showed microscopic haematuria but were otherwise normal. Ultrasound of the urinary tract revealed mild right pelviectasis. The patient continued to have non‐colicky left flank and lower abdominal pain which was aggravated by a change in position. Past medical and family history was non‐contributory. Multidetector computed tomography (MDCT) showed a dilated left renal vein with abrupt narrowing between the aorta and superior mesenteric artery (fig 11).). After admission, Doppler ultrasound examination of the kidneys demonstrated an enlargement of the left renal vein proximal to the aorta–mesenteric junction. Nutcracker syndrome was diagnosed. Nutcracker syndrome is a rare but important clinical condition that should be considered in the patients with microscopic haematuria, left flank pain and mesoaortic compression of left renal vein revealed by MDCT.1
Competing interests: None declared.