Acute renal infarction from a cardiac thrombus.

BACKGROUND

A 53-year-old man presented to hospital 2 hours after the abrupt onset of left upper abdominal pain. He was treated with analgesics and discharged after 4 hours of observation, but presented to another hospital 2 hours later with severe left abdominal pain. His past medical history included ischemic dilated cardiomyopathy due to recurrent myocardial infarction.

INVESTIGATIONS: Physical examination, electrocardiography, laboratory investigations, contrast-enhanced computed tomography, and transesophageal echocardiography.

DIAGNOSIS: Renal artery thromboembolism resulting from dilated cardiomyopathy, severely reduced cardiac function and an intracardiac thrombus.

MANAGEMENT: Anticoagulation with unfractionated heparin followed by enoxaparin and warfarin.