Pulsatile Mass Sensation with Intense Abdominal Pain; Atypical Presentation of the Nutcracker Syndrome

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. CASE REPORT: 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.