title: Pulsatile Mass Sensation with Intense Abdominal Pain; Atypical Presentation of the Nutcracker Syndrome.
abstract: BACKGROUND
  Patients with Nutcracker syndrome generally present with nonspecific abdominal pain, with the left renal vein (LRV) lodged between the aorta and the superior mesenteric artery. In rare cases this can result in atypical gastrointestinal symptoms, making the diagnosis of Nutcracker syndrome challenging.
  
  
  METHODS
  A 28-year-old female patient presented with complaints of severe abdominal pain and palpable pulsatile abdominal mass located in the left epigastric area. Computed tomography angiography revealed that the LRV was lodged in the aortomesenteric region with a dilated left ovarian vein and pelvic varicose veins. The upper gastrointestinal endoscopy and colonoscopy were normal. The patient was diagnosed as Nutcracker syndrome and discharged to be treated with analgesics.
  
  
  CONCLUSIONS
  Nutcracker syndrome can be seen with atypical gastrointestinal and vascular symptoms. Computed tomography angiography is a reliable and robust technique to prove the diagnosis of nutcracker syndrome.
authors.affiliation: Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Kadiköy, Istanbul, Turkey; Department of Radiology, Ümraniye Training and Research Hospital, Ümraniye, Istanbul, Turkey (Present).
authors.forename: Ahmet
authors.initials: A
authors.lastname: Aslan
authors.affiliation: Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Kadiköy, Istanbul, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Barutca
authors.affiliation: Department of Cardiovascular Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Kadiköy, Istanbul, Turkey.
authors.forename: Cemal
authors.initials: C
authors.lastname: Kocaaslan
authors.affiliation: Department of Gastrointestinal Surgery, Göztepe Training and Research Hospital, Medical School of Istanbul Medeniyet University, Kadiköy, Istanbul, Turkey.
authors.forename: Süleyman
authors.initials: S
authors.lastname: Orman
authors.affiliation: Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Kadiköy, Istanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Şahin
keywords: Abdominal Pain; Aortic Aneurysm, Abdominal; Hematuria; Multidetector Computed Tomography; Renal Nutcracker Syndrome