Which two structures compress the left renal vein in nutcracker syndrome?

Which two structures compress the left renal vein in nutcracker syndrome?

• A. Aorta and inferior vena cava
• B. Kidney hilum and renal artery
• C. Aorta and superior mesenteric artery
• D. Superior mesenteric artery and inferior vena cava

Answer: (C)

Nutcracker syndrome involves the left renal vein being pinched as it passes between two arteries—the aorta and the superior mesenteric artery. When the angle between these two structures narrows, the vein is compressed, causing venous congestion from the left kidney. Therefore, the two structures responsible are the aorta and the superior mesenteric artery. This is the classic anterior nutcracker pattern. A posterior variant exists when the vein is compressed between the aorta and the vertebral column, but that’s not the typical scenario. The other options don’t describe the common compression site, since the left renal vein is not generally compressed between the kidney hilum and renal artery or between SMA and IVC in this condition.

Nutcracker syndrome involves the left renal vein being pinched as it passes between two arteries—the aorta and the superior mesenteric artery. When the angle between these two structures narrows, the vein is compressed, causing venous congestion from the left kidney. Therefore, the two structures responsible are the aorta and the superior mesenteric artery.

This is the classic anterior nutcracker pattern. A posterior variant exists when the vein is compressed between the aorta and the vertebral column, but that’s not the typical scenario. The other options don’t describe the common compression site, since the left renal vein is not generally compressed between the kidney hilum and renal artery or between SMA and IVC in this condition.