A patient suffering from flank pain, varicocele, and hematuria evaluated at the ultrasound (US) laboratory of the Nephrology and Dialysis Unit. The axial grayscale sonogram demonstrates the anatomical relationships between the left renal vein, aorta, and superior mesenteric artery, with stenosis at the aorto-mesenteric angle (beck sign) and dilation of the hilar section of the left renal vein with a ratio of nutcracker phenomenon. A: aorta, SMA: superior mesenteric artery, LRV: left renal vein, IVC: inferior vena cava, VB: vertebral body, white asterisk: beck sign.