The Nutcracker syndrome is an infrequently recognized cause of pain and haematuria that is diagnosed by selective venography and left renal vein and inferior vena cava pullback pressure measurements. The diagnosis may be suspected, however, on cross-sectional imaging with ultrasound, computed tomography, or magnetic resonance imaging particularly when a left renal source of haemorrhage has been visualized at cystoscopy. Once diagnosed, definitive surgical treatment of the syndrome is almost always effective in alleviating symptoms.