ISSN 2756-3855
International Journal of Urology and Nephrology Vol. 2 (3), pp. 055-058, November, 2014. © International Scholars Journals
Case Report
A rare cause of renal infarct: Paradoxical embolism through the patent foramen ovale
İskender Ekinci1, Shute Ailia Dae1, Emin Asoğlu2, Musa Atay3, Gauhar Rakhymzhan4, Rumeyza Kazancıoğlu4 and Reha Erkoç4
1Bezmialem Vakif University, Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey.
2Bezmialem Vakif University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
3Bezmialem Vakif University, Faculty of Medicine, Department of Radiology, Istanbul, Turkey.
4Bezmialem Vakif University, Faculty of Medicine, Department of Nephrology, Istanbul, Turkey.
*Corresponding author. E-mail: [email protected]. Tel: 0539 556 25 72
Accepted 1 August, 2014
Abstract
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 contrast-enhanced 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.
Key words: Renal infarction, paradoxical embolism, patent foramen ovale, flank pain, transesophageal echocardiography.