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  Indian J Med Microbiol
 

Figure 2: (a). Diagnostic left renal vein venogram showed an abnormal indentation at the aorto-mesenteric portion of left renal vein (white triangles) and slowing of contrast flow into the proximal portion of left renal vein, indicating narrowing of left renal vein due to compression by the superior mesenteric artery. (Left kidney outline annotated by white dash line). (b) Pressure measurements performed with catheter tip located at inferior vena cava and (c) with catheter tip located at distal left renal vein. Venous pressure at inferior vena cava was 4 mm Hg and that at distal left renal vein was 9 mm Hg, indicating a pressure gradient of 5 mm Hg, which was diagnostic of nutcracker syndrome. Note that in (b) the catheter tip was positioned beyond the expected compression area by the superior mesenteric artery. Dynamic ultrasound performed (d) in the standing position showed narrowed aortomesenteric angle (13.8°; normal 38°–65°) and (e) with deep inspiration showed normal aortomesenteric angle measuring 47°

Figure 2: (a). Diagnostic left renal vein venogram showed an abnormal indentation at the aorto-mesenteric portion of left renal vein (white triangles) and slowing of contrast flow into the proximal portion of left renal vein, indicating narrowing of left renal vein due to compression by the superior mesenteric artery. (Left kidney outline annotated by white dash line). (b) Pressure measurements performed with catheter tip located at inferior vena cava and (c) with catheter tip located at distal left renal vein. Venous pressure at inferior vena cava was 4 mm Hg and that at distal left renal vein was 9 mm Hg, indicating a pressure gradient of 5 mm Hg, which was diagnostic of nutcracker syndrome. Note that in (b) the catheter tip was positioned beyond the expected compression area by the superior mesenteric artery. Dynamic ultrasound performed (d) in the standing position showed narrowed aortomesenteric angle (13.8°; normal 38°–65°) and (e) with deep inspiration showed normal aortomesenteric angle measuring 47°