Posterior nutcracker phenomenon

A 26-year-old woman was referred to us because of her hypertension and microscopic haematuria. Her past medical and family histories were unremarkable and the physical examination was not contributory. The urinary analysis revealed numerous red blood cells without dysmorphic changes. The laboratory tests revealed haemoglobin 13.6 g/dl, haematocrit 39%, white blood cell count 4300/mm, blood urea nitrogen 16mg/dl and creatinine 0.7mg/dl. The excretory urogram was normal and the ultrasonography revealed normal-sized kidneys. Multidetector computed tomography (MDCT) that was carried out to exclude nutcracker phenomenon revealed a dilated left renal vein after it passed between the aorta and the vertebra (Figure 1a). In the inferior MDCT image of the same patient, a prominent left ovarian vein implicating the formation of collateral circulation (Figure 1b) was seen. MDCT volume rendering of the same patient illustrated compressed left renal vein distended distally as well as the dilated ovarian vein by the blood drained from the left renal vein (Figure 2), constituting the high renal venous pressure.