Nutcracker syndrome

Nutcracker syndrome with left varicocele. 12 yr boy presented with left scrotal swelling.

Ultrasound findings

• Dilated pampiniform veins with maximum diameter of 3.6 mm. On colour Doppler reflux noted during Valsalva up to the distal segment. No spontaneous reflux.
• Dilated veins noted up to the deep inguinal ring region, draining into dilated left gonadal vein.
• Dilated left gonadal vein measuring 4.3 mm, draining into left renal vein.
• Narrowing of left renal vein noted between superior mesenteric artery and aorta with reduced SMA-aorta angle measuring 12.5° and SMA-aorta distance measuring 2.6 mm.
• Left renal vein proximal to the narrowed segment is dilated measuring 6.9 mm.
• No evidence of renal vein or gonadal vein thrombosis.
• Features suggestive of left varicocele secondary to Nutcracker syndrome.

Shared for knowledge sharing. Patient details have been removed. This is not medical advice.