1805
An 18-year-old man comes to the clinic due to hematuria and intermittent left flank pain of several months duration. He has no history of trauma or sexually transmitted diseases and no associated fever or dysuria. Examination reveals a soft abdomen with normal bowel sounds and no localized tenderness. Urinalysis confirms 3+ blood but no white blood cells, crystals, or organisms. Contrast-enhanced CT scan shows no abnormalities in the ureters or kidneys but does reveal compression of the left renal vein between the superior mesenteric artery and the aorta. Which of the following is most likely to develop due to the vascular abnormality seen in this patient?
A.Esophageal varices
B.Left-sided ankle swelling
C.Periumbilical venous distension
D.Rectal varices
E.Varicocele
THE CORRECT ANSWER IS : E.
Varicocele
(85%)
EXPLANATION
he right renal vein is a relatively short structure and runs anterior to the right renal artery before joining the inferior vena cava (IVC). The right gonadal vein also drains directly to the IVC. In contrast, the left renal vein is significantly longer and runs posterior to the splenic vein before crossing the aorta beneath the superior mesenteric artery. The left gonadal vein joins the left renal vein upstream of where it crosses the aorta and does not enter the IVC directly.
The pressure within the left renal vein is often higher than on the right due to compression between the aorta and the superior mesenteric artery (“nutcracker effect”). Pressure in the left renal vein can also be elevated due to compression from a left-sided abdominal or retroperitoneal mass. Persistently elevated pressure in the left renal vein can cause flank or abdominal pain, along with gross or microscopic hematuria (left renal vein entrapment syndrome). Increased pressure in the left gonadal vein results in valve leaflet failure and varices of the testicular pampiniform plexus (varicocele).
(Choices A, C, and D) Esophageal varices, rectal varices, and periumbilical venous distension
