A 24-year-old woman presents with recurrent episodes of haematuria and left flank pain worse on standing. Doppler ultrasound shows narrowing of the left renal vein where it crosses the midline with a velocity gradient across the narrowed segment. Which vessels compress the left renal vein in this condition?

• A Left renal artery anteriorly and abdominal aorta posteriorly
• B Abdominal aorta anteriorly and vertebral body posteriorly
• C Coeliac trunk anteriorly and left crus of the diaphragm posteriorly
• D Superior mesenteric artery anteriorly and abdominal aorta posteriorly ✓

Explanation

The left renal vein normally travels from the left hilum to the inferior vena cava by passing through the angle between the aorta behind and the superior mesenteric artery in front, just below its origin at about the first lumbar vertebra. When this angle narrows, the vein is compressed, causing the anterior nutcracker phenomenon with haematuria, proteinuria and flank pain. The aorta lies behind the vein, not in front.

Reference: Gray's Anatomy, 42nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.