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Vascular/Cardiac » Visceral vascular
Left renal vein thrombosis
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Presentation A 37 year old woman with a history of systemic lupus erythematosus came in for an abdominal ultrasound.
 
 
 
Caption: Midline transverse image of the abdomen
Description: The left renal vein is seen crossing the midline and draining into the IVC. It is distended and shows echogenic material within it. The IVC appears normal.
 
 
 
Caption: Transverse power Doppler image
Description: There is no flow seen within the left renal vein.
 
 
 
Caption: Transverse power Doppler image
Description: This image also demonstrates no flow within the left renal vein. The IVC appears normal.
 
 
 
Caption: Spectral waveform of the vessel in question
Description: The renal vein shows no flow within as demonstrated by the absence of a normal venous waveform.
 
 
 
Caption: Spectral analysis of renal vein at the hilum
Description: There is turbulence noted within the proximal renal vein at the hilum.
 
Differential Diagnosis Thrombus in the left renal vein
 
Final Diagnosis Thrombus in the left renal vein stopping short of the IVC
 
Discussion Patients with Systemic lupus erythematosus are at an increased risk for venous thrombosis. This is essentially due to the presence of antiphospholipid antibodies [lupus anticoagulant]. Persistent activation of the platelets is one of the pathogenetic mechanisms implicated. Both arterial and venous thrombosis may occur and systemic [cerebral involvement very common] as well as peripheral vessels are involved.

In a patient with lupus, the appearance of sudden unexplained flank pain should raise suspicion for renal vessel thrombosis, of which renal vein thrombosis is more common than the arterial one. If severe and untreated, renal infarction may occur.

Another case is illustrated [click here to view] demonstrating the development of thrombosis in the inferior vena cava in a patient with lupus.
 
Case References 1. Emily Somers, Laurence Magder, et al. Antiphospholipid Antibodies and Incidence of Venous Thrombosis in a Cohort of Patients with Systemic Lupus Erythematosus. http://jrheum.com/abstracts/abstracts02/2531.html.
2. Martinez-Berriotxoa A, Ruiz-Irastorza G, et al. Homocysteine, antiphospholipid antibodies and risk of thrombosis in patients with systemic lupus erythematosus. Lupus. 2004; 13(12):927-33.
3. Kuzmanovska DB, Sahpazova EM, et al. Renal infarction in a child with systemic lupus erythematosus. Pediatr Nephrol. 2004 Jun; 19(6):685-7. Epub 2004 Apr 03.
4. Ekdahl KN, Bengtsson AA, et al. Thrombotic disease in systemic lupus erythematosus is associated with maintained systemic platelet activation. Br J Haematol. 2004 Apr; 125(1):74-8.
 
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