Nutcracker syndrome with pelvic congestion syndrome: A case report

Nutcracker syndrome is a rare clinical entity characterized by external compression of left renal vein (LRV) disturbing the outflow of blood into inferior venacava. We present a case of a 35-year-old female who presented to gynecology outpatient department (OPD) with abdominal pain of right lower quadrant initially which later shifted to left flank associated with dysmenorrhea. Laboratory investigations revealed microscopic hematuria and anemia. Imaging with computed tomography revealed decreased aorto-mesenteric angle with dilatation of left renal vein, left ovarian vein, pelvic veins on left side and cross collateral venous dilatation on right side of pelvis suggesting nutcracker morphology leading to pelvic congestion syndrome. This case demonstrates atypical clinical presentation of NCS with shifting pain.