A 38-year-old female presented with a 1.5 year history of le | Figure 1

A 38-year-old female presented with a 1.5 year history of left upper abdominal pain radiating to the left flank, nausea, early satiety, acid reflux, daily vomiting and significant weight loss.

This case reminds pain management specialists should include nutcracker syndrome in the differential when the symptoms indicate, and not assume atypical left flank pain is chronic myofascial or due to lower rib pathology.