Renal Artery Thrombus Presenting As Acute Flank Pain Mimicking Renal Colic

Authors

• Matthew Laghezza, Lynchburg UniversityFollow

Specialty

Emergency Medicine

Abstract

Renal artery thrombosis with renal infarction is an uncommon but clinically significant cause of acute flank pain that is frequently misdiagnosed due to its resemblance to more common conditions such as nephrolithiasis, pyelonephritis, or musculoskeletal strain. We report the case of a 56-year-old man who presented with intermittent right lower quadrant and flank pain, later accompanied by pleuritic chest discomfort. Initial contrast-enhanced computed tomography (CT) demonstrated geographic hypoenhancement of the right renal cortex. Subsequent computed tomography angiography (CTA) identified a nonocclusive thrombus in the main right renal artery with occlusion of a segmental branch. To further clarify the underlying etiology, magnetic resonance imaging (MRI) of the abdomen was performed, which revealed persistent segmental branch occlusion alongside findings highly suggestive of a focal renal artery dissection with a thrombosed false lumen. A comprehensive multidisciplinary evaluation successfully excluded cardioembolic and autoimmune causes. Anticoagulation was initiated with intravenous heparin, transitioned to low-molecular-weight heparin, and the patient was discharged with a plan for outpatient conversion to a direct oral anticoagulant. This case emphasizes the critical role of advanced vascular and tissue imaging, such as MRI, in patients with persistent flank pain and indeterminate initial findings. Timely recognition of spontaneous renal artery thrombosis and prompt initiation of anticoagulation are vital to halting thrombus progression and preserving long-term renal function.

Recommended Citation

Laghezza M. Renal Artery Thrombus Presenting As Acute Flank Pain Mimicking Renal Colic. University of Lynchburg Doctoral Project Assignment Repository. 2026; 8(2).