Clinical Presentation

A 37-year-old woman presents with chronic pelvic pain and hematuria.

(A) Contrast-enhanced computed tomographic (CT) scan shows compression of the left renal vein (arrow) as it passes behind the superior mesenteric artery (SMA: arrowhead). (B) Pelvic image shows multiple dilated veins on both sides (arrows).

Differential Diagnosis

• Nutcracker syndrome (NS): Indicated by the symptoms and constriction of the left renal vein by the SMA.
  
• Pelvic congestion syndrome (PCS): Secondary to incompetent ovarian vein produces identical pelvic findings without renal vein obstruction.