title: Young woman with nutcracker syndrome without main clinic manifestation: Hematuria-Case report.
abstract: BACKGROUND
  The nutcracker syndrome occurs due to the compression of the left renal vein between the aorta and the superior mesenteric artery. The diagnosis of the syndrome is often difficult and under diagnosed. The main clinical manifestations are hematuria and pelvic or back pain.
  
  
  METHODS
  A 25 years old female patient with severe abdominal pain in the lower abdomen without hematuria. Diagnosis with nutcracker syndrome after performing computed tomography. Presented the first episode of pain with 17 years old and was diagnosed at age 25.
  
  
  CONCLUSIONS
  In the nutcracker syndrome anatomical changes do not generate specific symptoms, causing the disease to be underdiagnosed. In this syndrome, there is increased pressure on the left renal vein, generating several signs and symptoms, and hematuria is one of present. Our patient did not have hematuria. Because of common symptoms, it makes nutcracker syndrome difficult diagnosis, confusing with other diseases, especially with nephrolithiasis. It is usually diagnosed after exclusion of other diseases.
  
  
  CONCLUSIONS
  The diagnosis of nutcracker syndrome is done after exclusion of other causes of chronic pelvic pain. In most cases, macroscopic and microscopic hematuria are present but was unobserved in this case. Making it more difficult diagnosis.
authors.affiliation: Rede Dor - Hospital São Luiz Unidade Jabaquara, São Paulo, SP 2016, Brazil. Electronic address: Luisfnovaes@hotmail.com.
authors.forename: Luis Felipe Couto
authors.initials: LFC
authors.lastname: Novaes
authors.affiliation: Rede Dor - Hospital São Luiz Unidade Jabaquara, São Paulo, SP 2016, Brazil.
authors.forename: Leonardo Neves
authors.initials: LN
authors.lastname: da Silva Saguia
authors.affiliation: Rede Dor - Hospital São Luiz Unidade Jabaquara, São Paulo, SP 2016, Brazil.
authors.forename: Carlos Alberto
authors.initials: CA
authors.lastname: Di Migueli
authors.affiliation: Rede Dor - Hospital São Luiz Unidade Jabaquara, São Paulo, SP 2016, Brazil.
authors.forename: Marco Aurélio
authors.initials: MA
authors.lastname: de Castro Perin
authors.affiliation: Rede Dor - Hospital São Luiz Unidade Jabaquara, São Paulo, SP 2016, Brazil.
authors.forename: Felipe Alago
authors.initials: FA
authors.lastname: Loprete
authors.affiliation: Rede Dor - Hospital São Luiz Unidade Jabaquara, São Paulo, SP 2016, Brazil.
authors.forename: Nayara Pereira
authors.initials: NP
authors.lastname: Santana
authors.affiliation: Rede Dor - Hospital São Luiz Unidade Jabaquara, São Paulo, SP 2016, Brazil.
authors.forename: Eli Leiser Nagiel
authors.initials: ELN
authors.lastname: Chervin
authors.affiliation: Rede Dor - Hospital São Luiz Unidade Jabaquara, São Paulo, SP 2016, Brazil.
authors.forename: Luis Augusto Mello
authors.initials: LAM
authors.lastname: Sinisgalli
authors.affiliation: Rede Dor - Hospital São Luiz Unidade Jabaquara, São Paulo, SP 2016, Brazil.
authors.forename: Mario Perez
authors.initials: MP
authors.lastname: Gimenez
keywords: Abdominal pain; Case report; Diagnosis; Hematuria; Nutcracker syndrome