Abstract
Severe flank pain is a frequent complaint at the emergency department (ED). It is usually associated to other clinical symptoms like fever, dysuria, vomiting, diarrhea or radiation to the groin. Hereby, it may raise a lot of probable differential diagnosis that should be ruled out first depending on laboratory tests and imaging results. However, when flank pain is isolated and radiating to the groin without evidence of urolithiasis on abdominal CT scan, more rare diagnosis should be suggested such as renal vessels thrombosis with or without other vessel thrombosis in the pelvis. Thereafter, thrombophilic studies should be performed to elucidate the underlying etiology.
Highlights
Hypercoagulable state known as thrombophilia is the main factor predisposing to thromboembolic events
We present the case of a 44-yearold lady having simultaneously acute left renal and ovarian veins thrombosis presenting to emergency department (ED) for severe isolated left flank pain radiating to the left groin and heterozygous factor V Leiden on thrombophilic studies
We would like to stress on the importance of having a high index of suspicion of such diagnosis at ED based on medical history and primary investigations because a good management may result in salvage of organs by minimally invasive techniques, an early effective treatment and convenient anticoagulation in the future to prevent further complications
Summary
Hypercoagulable state known as thrombophilia is the main factor predisposing to thromboembolic events. She has left costovertebral angle (CVA) tenderness and left lower quadrant abdominal pain on deep palpation Her cardio-pulmonary auscultation is normal and she has no weight loss, no buccal ulcers, no malar rash or arthralgia, no lower limb edema, and no palpable peripheral lymph nodes. In her past medical history, she reported post-partum left lower limb deep venous thrombosis (DVT) three years ago that was treated with low molecular weight heparin (LMWH) for only 3 months and was followed one year later by a mild spontaneous superficial right arm vein thrombosis. Thrombophilic studies performed six weeks later revealed factor V heterozygous mutation (Factor V Leiden) and the patient was put on long life treatment with new oral anticoagulation agent rivaroxaban 20 mg per day
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