Nutcracker phenomenon presenting as left varicocele.

A 27-year-old man with good past health presented with a left varicocele. He had no urinary symptoms and urine microscopy did not show haematuria. Subsequent ultrasound scan showed a grossly distended left renal vein. The crosssectional view of magnetic resonance imaging (MRI) showed compression of the left renal vein between the superior mesenteric artery and the aorta, before the vein joins the inferior vena cava (Fig 1). This compression caused the marked dilatation of the distal left renal vein with associated venous hypertension (nutcracker phenomenon). The coronal view showed dilated vasculature over the upper pole of the left kidney (Fig 2), which was caused by the venous hypertension. The patient subsequently underwent laparoscopic varicocelectomy and conservative treatment was adopted for the left renal vein compression.