Renal vein thrombosis with inferior vena cava extension and pulmonary embolism in a patient with acute pyelonephritis: a case report and updated literature review.
Ratna Sutanto, Koesbandono, Marshita Masui et al.
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Case in brief
A previously healthy 29-year-old man presented with two weeks of left flank pain and fever. Contrast-enhanced CT showed acute left pyelonephritis and extensive renal vein thrombosis extending into the suprarenal inferior vena cava. Pulmonary embolism developed during hospitalization despite initiation of anticoagulation. Cultures did not establish a causative organism, and thrombophilia screening was negative. He improved with antimicrobial therapy and anticoagulation alone, without invasive intervention.
What made this case unusual
The thrombus extended from the renal vein into the suprarenal inferior vena cava, and pulmonary embolism occurred during hospitalization despite anticoagulation—an important complication in the setting of acute pyelonephritis.
Diagnostic / clinical pearl
Consider renal vein thrombosis when suspected pyelonephritis is accompanied by deterioration despite appropriate therapy or atypical clinical or imaging features; assess thrombus extent and possible embolization.
Why it matters
Infection and thrombosis may coexist without a clear temporal or causal relationship, so diagnosis and management should be individualized to the clinical presentation, infection severity, thrombus extent, and imaging findings.