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A case of spontaneous renal infarction secondary to an accessory renal artery thrombosis

To the Editor: A 43-year-old woman presented with sudden onset of severe left-sided abdominal pain and hypertension (blood pressure, 180/120 mmHg). She developed flash pulmonary oedema, which was confirmed on chest x-ray. Her urine microscopy results and creatinine levels were normal.

A computed tomography (CT) scan with contrast showed a thrombus in an accessory artery supplying the lower pole of the left kidney and a left renal infarction secondary to the vascular occlusion (Box).

Telemetry did not detect arrhythmia. Transoesophageal echocardiography did not show any evidence of a cardiac thrombus but did confirm normal left ventricular systolic and diastolic function. A screen was negative for autoimmune and inherited causes of thrombophilia.

Renal infarction is a rare cause of abdominal or flank pain. Presentation mimics that of nephrolithiasis or pyelonephritis, but there is no haematuria. Patients present with nausea and vomiting, abdominal or flank pain, hypertension, leukocytosis and a raised lactate dehydrogenase (LDH) level.13 Our patient had a white cell count of 13.0 × 10