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Venous thromboembolism with renal infarct due to paradoxical embolism
  1. Nishant Aggarwal1,
  2. Dana Rector1,2,
  3. Nicholas Lazar1 and
  4. Florian Bukovec1
  1. 1Internal Medicine, Beaumont Health System, Royal Oak, Michigan, USA
  2. 2Oakland University William Beaumont School of Medicine, Oakland University, Rochester, Michigan, USA
  1. Correspondence to Dr Nishant Aggarwal; nishantaggarwal34{at}


Paradoxical thromboembolism has variable presentation depending on site of embolisation. An African-American man in his 40s presented with severe abdominal pain, watery stools and exertional dyspnoea. At presentation, he was tachycardic and hypertensive. Labwork showed elevated creatinine with unknown baseline. Urinalysis showed pyuria. A CT scan was unremarkable. He was admitted with working diagnosis of acute viral gastroenteritis and prerenal acute kidney injury and supportive care was instituted. On day 2, the pain migrated to left flank. Renal artery duplex ruled out renovascular hypertension but showed a lack of distal renal perfusion. MRI confirmed a renal infarct with renal artery thrombosis. Transoesophageal echocardiogram confirmed a patent foramen ovale. Simultaneous arterial and venous thrombosis require hypercoagulable workup, including investigation for malignancy, infection or thrombophilia. Rarely, venous thromboembolism can directly cause arterial thrombosis by ‘paradoxical thromboembolism’. Given the rarity of renal infarct, high index of clinical suspicion is necessary.

  • Venous thromboembolism
  • Haematology (drugs and medicines)
  • Haematology (incl blood transfusion)
  • Pulmonary embolism
  • Acute renal failure

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  • Contributors NA, DR, NL and FB were involved in the patient’s care in the hospital. NA and DR wrote the initial draft which was edited by NA, NL and FB. Figure 6 was created by NA using

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.