title: Nutcracker phenomenon: An unusual presentation of acute aortic dissection.
abstract: We report a case of acute aortic dissection leading to compression of the left renal vein (LRV), thereby resulting in the nutcracker phenomenon. A 49-year-old previously healthy woman presented with intermittent gross hematuria and mild left flank pain of five days' duration. Laboratory examinations were within normal limits, except for the elevated C-reactive protein. Cystoscopy revealed bleeding from the left ureteral orifice. Contrast-enhanced computed tomography demonstrated acute Type B aortic dissection and compression of LRV between the enlarged aorta and superior mesenteric artery with an associated dilatation of the left gonadal vein as a collateral circulation.
authors.affiliation: Department of Urology, Toyama City Hospital, Toyama, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Kodama
authors.forename: Toru
authors.initials: T
authors.lastname: Noda
authors.forename: Isamu
authors.initials: I
authors.lastname: Motoi
keywords: Aortic dissection; hematuria; nutcracker phenomenon