Diameter Of Left Renal Vein Research Articles

Effect of left renal vein compression stenosis on functional status of left kidney in patients with pelvic venous disorders

ObjectiveWe evaluated the effect of left renal vein (LRV) compression stenosis on the functional state of the left kidney in patients with pelvic venous disorders (PeVDs). MethodsWe examined 162 female patients with PeVD and diagnosed LVR compression stenosis using duplex ultrasound (DUS) in 40. Patients with clinical manifestations of PeVD (n = 26) had symptoms and signs of pelvic venous congestion but without pain in the left flank of the abdomen, typical for nutcracker syndrome (NS). The remaining patients were asymptomatic (n = 14). The parameters measured with DUS included the angle of the superior mesenteric artery (SMA) with the aorta, the LRV diameter (Dhilum/Dstenosis) ratio, and LRV velocity (Vstenosis/Vhilum) ratio. All the patients underwent laboratory testing (complete blood count, urinalysis, and biochemical blood testing) and dynamic renal scintigraphy to assess the secretory and evacuation functions of the renal tubular system. ResultsThe laboratory tests revealed no abnormalities, including no hematuria or proteinuria, in either group. The Dhilum/Dstenosis and Vstenosis/Vhilum ratios varied from 2.8 to 5.2 and from 2.9 to 8.3, respectively, and did not differ between the symptomatic and asymptomatic patients. All 40 patients with LRV compression stenosis were diagnosed with left gonadal vein reflux with a mean duration of 4.7 ± 0.6 seconds and 2.2 ± 0.6 seconds in the symptomatic and asymptomatic patients, respectively (P = .005). Eight patients had signs of NS on DUS, including five in the symptomatic group (SMA angle, 34.8° ± 2.7°; Dhilum/Dstenosis ratio, 5.2 ± 0.2; and Vstenosis/Vhilum ratio, 5.7 ± 0.4) and three in the asymptomatic group (SMA angle, 35° ± 2.8°; Dhilum/Dstenosis ratio, 5; and Vstenosis/Vhilum ratio, 5 ± 0.5). The groups did not differ significantly in the DUS parameters. Scintigraphy did not reveal any cases of secretory or evacuation dysfunction of the left kidney, including in the patients with DUS signs of NS. The maximum uptake time, elimination half-life, and effective renal plasma flow were within the normal ranges. ConclusionsLRV compression stenosis without hematuria has no significant effects on the functional state of the left kidney, irrespective of the disease severity. In patients with PeVDs, dynamic renal scintigraphy provides an objective assessment of left kidney function.

The utility of magnetic resonance angiography in children with nutcracker syndrome

Background/aim The presented study aimed to evaluate the utility of magnetic resonance angiography (MRA) in the pediatric population with nutcracker syndrome.Materials and methods Patients with suggestive clinical symptoms and laboratory findings and got the diagnosis of nutcracker syndrome with Doppler ultrasonography between January 2011–2019 were included in the study. In addition, children who had renal MRA due to hypertension were evaluated as the control group. MRA images of all patients were examined retrospectively by three radiologists at different levels of experience, and the superior mesenteric artery angle, aorta-mesenteric distance, left renal vein diameter both in the regions of aorta-mesenteric, and renal hilum were recorded. ResultsForty-five patients diagnosed with nutcracker syndrome were included in the study. The mean age of patients was 12 (4–16) and 30 (67%) were female. As the control group, 25 patients with hypertension who had MRA were included and they had a mean age of 12 (1–18) and 19 (76%) were male. The mean superior mesenteric artery angle was 26.5 ° (16–73 ± 12) in the patient group and 57.8 ° (25–139, ± 33) in the control group (p < 0.001); the mean aorta-mesenteric distance was 3.3 mm (1.7–6.5, ± 1.1) in the patient group and 8 mm (3.4–32, ± 5.9) in the control group (p < 0.001). MRA measurements of three radiologists were consistent with each other.ConclusionMRA imaging can be applied as an alternative diagnostic method for Doppler ultrasonography and multidetector CT examinations by radiologists with different experience levels in pediatric patients with nutcracker syndrome.

Nutcracker Syndrome Masquerading as Renal Colic in an Adolescent Athlete: A Case Report.

IntroductionAbdominal pain and flank pain cause a significant proportion of emergency department (ED) visits. The diagnosis often remains unclear and is frequently associated with repeat visits to the ED for the same complaint. A rare cause of left upper abdominal and flank pain is compression of the left renal vein between the aorta and the superior mesenteric artery known as nutcracker syndrome. Diagnostic findings on ultrasound include increased left renal vein diameter proximal and peak blood flow velocity increase distal to the superior mesenteric artery. We describe such a patient presenting to an ED repeatedly with severe pain mimicking renal colic before the final diagnosis and intervention occurred.Case ReportA 16-year-old female, long-distance runner presented four times complaining of intractable left upper quadrant abdominal pain radiating to the left flank after exercise. On each visit urinalysis revealed proteinuria and hematuria, and on two visits abdominal computed tomography revealed no kidney stone or dilatation of the collecting system. Ultimately, she was referred to vascular surgery where Doppler ultrasonography was used to diagnose left renal vein compression. Transposition of the left renal vein improved Doppler diameter and flow measurements and eliminated symptoms.ConclusionEmergency physicians must maintain a large list of possible diagnoses during the evaluation of abdominal and flank pain with a repetitive and uncertain etiology. Nutcracker syndrome may mimic other causes of abdominal and flank pain such as renal colic and requires appropriate referral.

Renal vein measurement using ultrasonography in patients with cirrhotic ascites and congestive heart failure.

Ascites can cause compression of the inferior vena cava (IVC), leading to increased renal venous pressure and renal congestion. Previously, the left renal vein diameter in liver cirrhosis patients with ascites was measured using computed tomography, showing that enlargement of the left renal vein diameter affects the prognosis. Herein, the diameter and flow velocity of the renal veins were measured using ultrasonography. Abdominal ultrasonography was performed on 186 patients. The patients were divided into four groups: normal liver (n = 102), liver cirrhosis (LC) without ascites (n = 37), LC with ascites (n = 30), and congestive liver (n = 17). Ultrasonographic measurements for diameter and flow velocity of the IVC, left renal vein main trunk, and segmental renal vein were performed. The left renal vein diameter increased in the following order: normal liver, LC, LC with ascites, and congestive liver groups (P < 0.001). IVC flow velocity was lower and left renal vein diameter was larger in the congestive liver and LC with ascites groups. These results suggest that the two groups have different pathological conditions, but the mechanism of renal congestion is similar. In patients with LC, IVC compression due to ascites might cause blood stagnation and renal congestion. The left renal vein and IVC can be measured using ultrasonography. It might help in furthering our understanding of the pathophysiology of renal congestion in these patients.

Diagnostic accuracy of the jetting sign and a dilatation ratio of left renal vein in CT urography for detecting anterior nutcracker syndrome

To investigate the diagnostic value of computed tomography (CT) urography findings of anterior nutcracker syndrome (NCS). The study included patients with left renal vein (LRV) compression at the aortomesenteric portion at CT urography who underwent renal venography or cystoscopy. Patients with a renocaval pressure gradient of ≥3 mmHg on renal venography or bloody urine jetting from the left ureteral orifice on cystoscopy were defined as the NCS group; the remaining patients comprised the non-NCS group. CT findings were analysed using the jetting of contrast medium flow from the LRV to the inferior vena cava (jetting sign), aortomesenteric distance, presence of collateral veins, and a dilatation ratio of LRV diameter at the aortomesenteric portion (arterial phase/delayed phases). Clinical findings, including age, gender, and body-mass-index, were also analysed. CT features and clinical findings were compared between the NCS and non-NCS groups. Diagnostic performance of CT parameters was assessed using receiver operating characteristic curve analysis. A total of 70 patients (21 men, mean age 44.4±17.2 years) with NCS (n=13) and non-NCS (n=57) were included. Younger age (<40 years), presence of the jetting sign, and a lower dilatation ratio of LRV diameter between the arterial and delayed phases (<1.7) were found to be significant independent factors for predicting the NCS group (OR 24.5, 18.9, 19.4, respectively, p<0.05 for all). The combination of the presence of the jetting sign and a dilatation ratio of LRV diameter of <1.7 obtained the highest AUC of 0.88. The jetting sign and the dilatation ratio of LRV diameter between the arterial and delayed phases can both be very useful in the diagnosis of anterior nutcracker syndrome during CT urography.

CT findings after left renal vein division during abdominal aortic surgery.

The rationale behind left renal vein division (LRVD) is the assumption that adequate collateral draining channels will develop. To describe computed tomography (CT) findings after LRVD during aortic surgery. Among 61 consecutive patients who underwent LRVD during aneurysm repair or revascularization for aortic occlusive disease between January 2003 and December 2017, 51 patients (40 men, mean age 71.4 ± 8.4 years) were enrolled. Contrast-enhanced CT images were analyzed to evaluate collateral drainage, patency, left renal vein diameter, and left renal parenchymal thickness. A total of 115 radiologic reports were reviewed to check whether these findings were accurately mentioned. The median time period of the first postoperative follow-up CT was 36 days (range 7-1351 days). The gonadal vein (n = 47) was the most common collateral draining channel, followed by the retroperitoneal veins (n = 42) and adrenal vein (n = 33). Thrombosis occurred in five patients between postoperative days 7 and 17 in the remnant renal vein (n = 3), remnant renal vein plus gonadal and adrenal veins (n = 1), and gonadal vein (n = 1). There was a significant decrease in renal vein diameter (-0.48 ± 2.12 mm, P = 0.006). There was no significant difference in parenchymal thickness (-0.25 ± 1.27 mm, P = 0.193). Neither LRVD nor any associated findings were correctly stated on radiologic reports. Postoperative contrast-enhanced CT can delineate collateral draining channels and complications following LRVD. However, these findings tend to be either missed or misinterpreted.

Prevalence of left renal vein compression (nutcracker phenomenon) signs on computed tomography angiography of healthy individuals

ObjectiveWe evaluated the frequency of significant left renal vein (LRV) compression, also called the nutcracker phenomenon (NCP), in a normal asymptomatic population. MethodsThe present retrospective descriptive anatomic study analyzed the data from high-definition renal computed tomography (CT) angiography of living kidney donors. A total of 324 CT examinations were evaluated for signs of LRV compression, including the beak sign, aortomesenteric angle <41°, LRV diameter ratio ≥4.9, and beak angle ≥32°. The presence of pelvic varicose veins and the left gonadal vein in the proximal and mid-portion (considered dilated if >0.5 cm) were also evaluated. Anthropometric and laboratory (urine erythrocyte count) data were collected from the medical records. Statistical inference was calculated using Fisher's exact test and Student's t test. ResultsThe mean aortomesenteric angle was 53.1° in women and 58.7° in men (P = .044). The beak sign and beak angle were present in 15.3% and 9.8%, respectively, and both had a greater prevalence in the women (P = .01). An aortomesenteric angle <41° was identified in 30.5%, with a greater prevalence in women (P < .01). The diameter ratio was positive in 0.7% of the cases, with no difference between the sexes. A left gonadal vein >0.5 cm was more prevalent in women in both the proximal and the mid-portions (P < .01). Although analysis stratified by positive criteria (3 or 4) showed no difference between the sexes, a positive correlation was found with younger age (P < .01). The limitations included the absence of a nutcracker syndrome (NCS) population; the lack of a renocaval pressure gradient, because of the need for intervention; the absence of other types of imaging studies, such as duplex ultrasound scan; and the absence of female parity data. ConclusionsThe NCP and NCS CT criteria were present with a high frequency in healthy individuals. Women and younger individuals showed a greater prevalence of compression findings in the aortomesenteric axis. Revision of the current NCP and NCS criteria with a distinct categorization between sex, age, and body mass index is recommended to better evaluate LRV compressive events.

Renal vein dilation predicts poor outcome in patients with refractory cirrhotic ascites.

Renal venous hypertension is known to be associated with worsening of renal function in patients with decompensated heart failure. Intra-abdominal hypertension including cirrhotic ascites also leads to renal venous hypertension. We aimed to clarify the effect of renal venous hypertension on cirrhotic ascites. Two hepatologists measured the left renal vein diameter in 142 consecutive patients with refractory cirrhotic ascites using non-contrast computed tomography. The renal vein diameter was measured at the renal vein main trunk and upstream of the confluence of collateral veins. The inter-observer agreements were high for the measurements of the left renal vein (r = 0.918, P < 0.001). The median overall survival for patients with renal vein diameter≥11mm was less than that for patients with renal vein diameter <11mm (P < 0.001; 2.5 vs. 32.0months). One-year survival rates were 15.3% versus 66.4%. Multivariate analysis revealed renal vein diameter≥11mm (hazard ratio, 2.94; P < 0.001; 95% confidence interval, 1.67-5.20) and a high Model for End-stage Liver Disease score combined with serum sodium level (MELD-Na) (hazard ratio, 3.39; P < 0.001; 95% confidence interval, 2.00-5.74) were significant independent predictors of mortality. Renal vein dilation is a risk factor of mortality in patients with refractory cirrhotic ascites, independent of the MELD-Na score.

Retroperitoneal laparoscopic extravascular stent placement for nutcracker syndrome

Objective To report our experience of retroperitoneal laparoscopic extravascular stent placement for nutcracker syndrome. Methods The clinical data of 12 nutcracker syndrome patients (10 males and 2 females; mean age 26 years) who underwent retroperitoneal laparoscopic extravascular stent placement from March 2014 to Febuary 2016 were retrospectively reviewed. The main symptoms were gross hematuria in 8 patients(one with proteinuria)and flank pain was noted in 1 patient. Three male patients had left-sided secondary varicoceles. Ultrasonography and computed tomography showed the left renal vein clamped by the superior mesenteric artery and the aorta. The anteroposterior diameter of the left renal vein in the renal hilum was three-fold than the aortomesenteric area, and the peak velocity ratio of the aortomesenteric area was much faster than the renal hilum.Twelve patients underwent laparoscopic extravascular stent placement under general anesthesia.The preaortic fibrous tissue between the aorta and the superior mesenteric artery was released intraoperatively.Renal vein became flat when the superior mesenteric artery was elevated.The 6-8 cm extravascular stent was set on the surface of the renal vein to prevent the compression. Results Stenting was successfully accomplished in all 12 patients. Mean operative time was 62 min (50-125 min), estimated blood loss was 35 ml(20-100 ml), and the hospital stay after operation was 8 days(6-12 days). Three patients had a transient orthostatic intolerance, and they were cured by conservative treatment. With a mean follow up of 14 months (5-30 months), symptoms of hematuria and flank pain resolved in 7/8 and 1/1, respectively. Varicoceles were cured in all three patients. One case got partial relief because of recurrent hematuria due to excessive exercise. Ultrasonography showed that extravascular stent was in the right place, and the angle between abdominal aorta and superior mesenteric artery became normal. The inner diameter of left renal vein was decreased, and the narrow segment was diminished in diameter meanwhile the blood outflow was smooth. Conclusions Retroperitoneal laparoscopic extravascular stent placement in the renal vein is a safe and effective approach for nutcracker syndrome. Key words: Nutcracker syndrome; Retroperitoneoscopy; Left renal vein; Extravascular stent; Hematuria.

Discriminating renal nutcracker syndrome from asymptomatic nutcracker phenomenon using multidetector computed tomography.

To retrospectively evaluate the ability of computed tomographic (CT) findings to discriminate nutcracker syndrome (NCS) from asymptomatic nutcracker phenomenon (NCP) and to investigate the diagnostic value of CT findings in diagnosis of NCS. From January 2014 to April 2015, 216 patients who underwent initial urographic CT were included. Initially, 216 patients were categorized as "nutcracker" or "normal," based on the following CT criteria: (1) the presence of beak sign and (2) hilar-aortomesenteric left renal vein diameter ratio >4. Patients who satisfied both of these criteria were diagnosed with nutcracker. The nutcracker was then divided into "NCS" and "asymptomatic NCP" based on the presence of characteristic symptoms. CT findings in sagittal and axial scans of corticomedullary phase were evaluated. Multivariate analysis was used to identify significant factors among 30 NCS, 51 asymptomatic NCP, and 135 normal patients. Diagnostic performance and threshold using receiver operating characteristic (ROC) curve were calculated. A total of 131 males and 85 females, with mean age of 38.6years (range 18-89years), were included. Multivariate analysis demonstrated superior mesenteric artery (SMA)-aortic angle (p<0.001) and visualization of a dilated collateral vein with reflux (p=0.001) were independent factors for distinguishing NCS from asymptomatic NCP. The combination of SMA-aortic angle <25° and visualization of a dilated collateral vein with reflux provided the greatest diagnostic accuracy (area under the ROC curve, 0.841). The combination of SMA-aortic angle and visualization of a dilated collateral vein with reflux in multidetector CT can be useful to differentiate NCS from asymptomatic NCP.

The roles of the liver and pancreas in renal nutcracker syndrome

IntroductionTo assess the frequency and significance of presence of the liver and pancreas at the left renal vein (LRV) level in patients with suspected renal nutcracker syndrome (NCS). Materials and methodsWe included 101 patients with hematuria who underwent urography three-dimensional CT between April 2009 and November 2013. These patients were divided into NCS (n=25) and non-NCS (n=76) patients according to the following CT criteria: (1) the presence of beak sign and (2) hilar-aortomesenteric left renal vein diameter ratio >4. Patients were grouped according to the presence of the liver and pancreas at the LRV: group LP (both liver and pancreas), group L (only liver), group P (only pancreas), and group O (neither liver nor pancreas). The difference in the frequencies of groups was analyzed between NCS and non-NCS patients. Multivariate analysis was used to determine the independent factors between NCS and non-NCS patients. ResultsThe frequencies of group LP, group L, group P, and group O in NCS vs. non-NCS were 88% vs. 5.3% (p<0.001), 4.0% vs. 2.6% (p=0.75), 4.0% vs. 11.8% (p=0.45), 4.0% vs. 80.3% (p<0.001), respectively. Multivariate analysis demonstrated that group was a predictor for differential diagnosis between NCS and non-NCS (p=0.022), and group LP was an independent factor for the presence of NCS (odds ratio, 43.8; 95% confidence interval, 3.8–500.3; p<0.002; reference, group O). ConclusionThe presence of the liver and pancreas at the level of the LRV was frequently found in NCS and was the independent factor for NCS.

Renal Vein Stenting via the Right Internal Jugular Approach With a Provocative Valsalva Maneuver to Reduce the Risk of Stent Migration

An adult male with nutcracker syndrome was treated successfully by placement of a self-expanding stent in the left renal vein via a right internal jugular vein approach with a provocative Valsalva maneuver. Previous case reports have described renal vein stenting for this condition via common femoral vein approach. However, this study proposes the right internal jugular vein approach as a safer method for the treatment of nutcracker syndrome since the stent can be easily captured along the guidewire if undersized. This technique is based on the realization that the left renal vein diameter may increase by 50% to 58% during the Valsalva maneuver.

Comparison of findings of spontaneous splenorenal shunt in color Doppler sonography with multislice CT scan (64 slices) in liver transplant candidates

BackgroundLiver transplantation is the only definite treatment for end stage liver disease and it has high costs for the medical system so decreasing its complication and increasing its effectiveness is crucial. One of the factors that affect liver transplantation is the presence of spontaneous splenorenal shunt. Its diagnosis is mainly overlooked in pre-liver transplant patients. Main modality for its diagnosis is multislice CT scan however this is more expensive than sonography. Also, it exposes the patients to ionizing radiation. Considering the advantages of color Doppler ultrasound, studies to determine the sensitivity and specificity for detection of spontaneous splenorenal shunt is essential. Materials and methodsIn our study 70 cirrhotic patients who were referred by liver transplant surgeons for evaluation of abdomen by CT and sonograhy were assessed for presence of spontaneous splenorenal shunt, left adrenal varix and left renal vein diameter and velocity and sensitivity and specificity of both modalities were checked. Patients in whom left renal vein could not evaluated by sonography and patients with splenectomy and nutcracker syndrome were excluded. ResultsIn the point of 10mm diameter of left renal vein in CT scan there was 78.6% sensitivity and 67.9% specificity for the presence of spontaneous splenorenal shunt. Left adrenal varix in CT had sensitivity of 71.4%, specificity of 100%, and positive predictive value of 100% and negative predictive value of 70% and varix below spleen in CT had sensitivity of 54.8%, specificity of 96.4%, and positive predictive value of 95.8% and negative predictive value of 58.7% for the presence of spontaneous splenorenal shunt.In the point of 8mm diameter of left renal vein in sonography there was 66.7% sensitivity and 85.7% specificity for the presence of spontaneous splenorenal shunt. For the velocity of more than 35cm/s of left renal vein in sonography there was 61.9% sensitivity and 82.1% specificity for the presence of spontaneous splenorenal shunt. Left adrenal varix in sonography had sensitivity of 45.2%, specificity of 96.4%, positive predictive value of 95% and negative predictive value of 54% for the presence of spontaneous splenorenal shunt. ConclusionThere was moderate agreement between CT scan and sonography for detection of spontaneous splenorenal shunt. CT scan is choice for detection of SSRS but sonography is somehow useful.It means that if sonograhy is positive it is sufficient, if negative, then CT should be performed. This is due to low sensitivity of sonography.

Diagnostic value of computed tomographic findings of nutcracker syndrome: Correlation with renal venography and renocaval pressure gradients

To evaluate the diagnostic values of CT findings of nutcracker syndrome (NCS). Twenty seven subjects that underwent CT and renal venography, were divided into three groups based on the venographic renocaval pressure gradient (PG) and collateral veins of the left renal vein (LRV): non-compensated NCS patients with PG≥3 mm Hg (group 1, n=12), partially compensated NCS patients with borderline PG (1<3 mm Hg) and collateral veins (group 2, n=6), and control group with low PG (0-1 mm Hg) without collateral veins (group 3, n=9). The CT findings were analyzed with regard to abrupt narrowing of the LRV with an acute angle (beak sign), aortomesenteric angle between the superior mesenteric artery and aorta on sagittal images, and LRV diameter ratio (hilar-aortomesenteric). Beak sign of the LRV was found in 91.7% (11/12) of group 1, 50% (3/6) of group 2, and in 11.1% (1/9) of group 3 with the significant difference between groups 1 and 3 (P<.05, χ2 test). Mean values of all quantitative CT parameters differed significantly only between groups 1 and 3 (P<.05, one-way ANOVA test). For differentiating the non-compensated NCS from the control group, the beak sign showed 91.7% sensitivity and 88.9% specificity. Of the various CT parameters, the beak sign and LRV diameter ratio of ≥4.9 showed the greatest diagnostic accuracy (AUC 0.903, ROC analysis). Beak sign of the LRV and CT findings can be useful in diagnosing the non-compensated NCS.

Association of left renal vein variations and pelvic varices in abdominal MDCT

The aim of this study was to determine whether left renal vein (LRV) variation is associated with pelvic varices and left ovarian vein (LOV) reflux. Routine abdominal multidetector-row computed tomography scans of 324 women without symptoms of pelvic congestion syndrome were analyzed. Presence and type of LRV variants (circumaortic [CLRV] or retroaortic [RLRV]) were recorded. Diameters of the LRV, ovarian veins (OVs), and parauterine veins were measured and a specific LRV diameter ratio was calculated for each patient. Presence and severity of pelvic varices and LOV reflux were noted. Pelvic varices were detected in 59 (18%) of the total of 324 women, in 7 (37%) of the 19 women with RLRVs, in 7 (29%) of the 24 women with CLRVs, and in 45 (16%) of the 281 women with normal LRVs. The frequency of pelvic varices in the women with LRV variation was significantly higher than that in the group with normal LRV anatomy (33 vs. 16%; p=0.009). The frequency of pelvic varices in the women with RLRVs was also significantly higher than that in the group with normal LRV anatomy (p=0.02). LRV diameter ratio was correlated with presence of pelvic varices and presence of LOV reflux (p=0.0001 for both). This study revealed an association between pelvic varices and LRV variations in a population of predominantly multiparous women.

Reflux in the Left Ovarian Vein: Analysis of MDCT Findings in Asymptomatic Women

The aim of this study was to clarify the CT features of ovarian vein reflux in asymptomatic women and to determine the possible cause of the reflux. One hundred ten multiparous or uniparous and 41 nulliparous asymptomatic women were examined on MDCT. Degree, pathway, and associated findings of ovarian vein reflux were evaluated. We measured the diameters of the left renal vein (LRV), the ovarian veins, and the parauterine veins. Ratios of LRV diameters (lateral-aortomesenteric) were obtained. These data were then compared between the women with reflux and those without reflux. Reflux was found in 44% (48/110) of parous and 5% (2/41) of nulliparous women. Reflux flowed into the right ovarian vein through the parauterine and uterine veins in 25 women. Twenty-four of these 25 women were multiparous. In these cases, the parauterine veins showed varicose dilation (5.9 +/- 1.6 mm [mean +/- SD]). There was a statistically significant difference in left ovarian vein diameter (8.3 +/- 2.1 mm vs 4.9 +/- 1.3 mm, p < 0.0001) between parous women with reflux and those without reflux, respectively. The LRV diameter ratio (lateral-aortomesenteric) was also statistically significant (3.6 +/- 1.3 vs 1.7 +/- 0.7, p < 0.0001) between the same two groups. Reflux into the left ovarian vein is seen up into the contralateral ovarian plexus by passing through the dilated parauterine and uterine veins. This CT finding is common in asymptomatic multiparous women. Narrowing of the LRV at its aortomesenteric portion can be one of the causes of such reflux.