Abstract

skender Ekinci, Shute Ailia Dae, Emin Aso

Renal infarction is a rare clinical problem and the diagnosis is frequently missed or delayed because of its nonspecific symptoms. The two major causes of renal infarction are thromboembolism and in-situ thrombosis. Paradoxical embolism is defined as a systemic arterial embolism requiring the passage of a venous thrombus into the arterial circulatory system through a right-to-left shunt. Renal infarction secondary to paradoxical embolism has rarely been described. Here we present a case of renal infarction due to paradoxical embolism through the patent foramen ovale. A 26-year-old woman presented to the emergency room with a four-day history of left flank pain. The level of lactate dehydrogenase was detected five times higher than the upper limit of normal with no rise in serum aminotransferases. A contrastenhanced computed tomography scan revealed renal infarction and perinephric mild fluid in the left kidney. An electrocardiogram showed sinus rhythm and the thrombosis panel was negative. A transesophageal echocardiography showed a patent foramen ovale with a right-to-left shunt. Although we have not found the source of embolism, paradoxical embolism through to PFO was strongly suspected. The patient was treated by anticoagulant therapy at a curative dose and the outcome was favorable.