A 14-year-old girl presented to the emergency department with epigastric and right upper quadrant abdominal pain. She stated that the pain had been intermittent with occasional flare-ups throughout the past year, but the symptoms had progressively worsened over the past month. Her symptoms were triggered by eating, especially high-fat foods, and were associated with nausea, vomiting, and diarrhea. Previous abdominal ultrasonography and hepatobiliary iminodiacetic acid scan imaging had not demonstrated a clear cause. Abdominopelvic computed tomographic scan revealed an enlarged right kidney and an atretic right renal vein secondary to thrombosis, as well as sclerosis with draining retroperitoneal venous varices (
image A, arrow).
Unilateral thrombosis accounts for more than 70% of cases of renal vein thrombosis, with more than 60% affecting the left vein.
1 A retrospective review found a lower likelihood of renal impairment in patients treated with heparin at the time of diagnosis.
2 The patient did not follow-up with the pediatric department for nephrology referral. Further workup would include evaluation for congenital, thrombophilic, autoimmune, and rheumatologic conditions.
3