Published in: Iranian Journal of Emergency Medicine
Authors: Abdolghader Pakniyat, et al.
Link: Read
📌 Clinical Summary
A 48-year-old man presented to the Emergency Department with sudden, severe left flank pain radiating to the lower abdominal quadrant. Initial management with intravenous ketorolac and morphine failed to relieve his pain, raising suspicion for an atypical cause of renal colic.
🧪 Key Investigations:
- Bedside Color Doppler Ultrasound revealed diminished flow in the left iliac artery.
- CT Angiography showed extensive thrombosis involving the left renal artery, iliac artery, popliteal artery, and thrombi in the left atrium.
⚠️ Despite no known history of cardiac symptoms, the patient had asymptomatic aortoiliac thrombosis with embolization to the renal artery—a rare cause of renal infarction.
🩺 Diagnosis
Acute renal infarction secondary to large-artery and cardiac thromboembolism, linked to:
- Left atrial thrombus
- Mitral valve disease
- Peripheral arterial thromboses (iliac and popliteal)
💡 Clinical Pearls
- Renal infarction is rare but must be considered when flank pain is severe, persistent, and unresponsive to standard therapy.
- Risk factors include atrial fibrillation, valvular heart disease, and aortic atherosclerosis.
- Color Doppler and CTA are crucial to detect arterial occlusions early.
- Misdiagnosis as renal colic is common; high suspicion is key to timely treatment.
🛠️ Treatment & Outcome
- Initiated systemic anticoagulation
- Underwent surgical thrombectomy
- Required mitral valve replacement
- Recovered well and was discharged after 14 days in normal sinus rhythm
📚 Reference
Pakniyat AG, et al. Renal Infarction Following Asymptomatic Aortoiliac Thrombosis as a Cause of Severe Flank Pain: A Case Report. Iranian Journal of Emergency Medicine.
🔗 Link
