Case: 22 year old male student from Taiwan is admitted to ICU with severe left flank pain and hematuria. According to patient he has episodes of bloody urine since childhood but this time this is associated with flank pain on left side. Previously, he was ruled out for any cancer or kidney disease, but was told he may need some kind of stent!


Answer: Nutcracker syndrome 

Nutcracker syndrome is a compression of the left renal vein between the aorta and proximal superior mesenteric artery. This is primarily a disease of children but also been found in Asian adults. The hematuria can be asymptomatic or may be associated with left flank pain. Diagnosis is usually quick via radiological workup and can be treated with either stent or surgical intervention.

References: 

1.  Zhang H, Li M, Jin W, et al. The left renal entrapment syndrome: diagnosis and treatment. Ann Vasc Surg 2007; 21:198. 

2. Hanna HE, Santella RN, Zawada ET Jr, Masterson TE. Nutcracker syndrome: an underdiagnosed cause for hematuria? S D J Med 1997; 50:429.