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We report a case of acute aortic dissection leading to compression of the left renal vein (LRV), thereby resulting in the nutcracker phenomenon. A 49-year-old previously healthy woman presented with intermittent gross hematuria and mild left flank pain of five days' duration. Laboratory examinations were within normal limits, except for the elevated C-reactive protein. Cystoscopy revealed bleeding from the left ureteral orifice. Contrast-enhanced computed tomography demonstrated acute Type B aortic dissection and compression of LRV between the enlarged aorta and superior mesenteric artery with an associated dilatation of the left gonadal vein as a collateral circulation.

Renal calculi in patients with renal angiomyolipomas are difficult to treat because of the hemorrhagic potential of these tumors. We describe the case of a 65-year-old man having tuberous sclerosis complex-associated multifocal renal angiomyolipomas with a large renal calculus. The patient presented with left flank dullness and a previous history of spontaneous angiomyolipoma rupture. Intravenous pyelography revealed a 43 × 16 mm calculus in the pelvis and lower calyx of the left kidney. The calculus was successfully removed by retrograde flexible ureterorenoscopy and holmium-YAG lithotripsy. Flexible ureterorenoscopy is an effective, minimally invasive therapy for patients at high risk of renal hemorrhage.