Case 30 Answer

Nice job everyone. Quick and lots of correct answers.

Answer: Nutcracker syndrome  (aka compression of left renal vein by SMA). I liked this case because it clearly shows the renal vein dilation but also delayed enhancement of that left kidney.   What is the result? Well not only can it cause hypertension via the renin-angiotension system, but also you can get collateral vessels yielding a cause of hematuria.

reference: http://radiopaedia.org/articles/nutcracker-syndrome