Antenatal bilateral renal vein and vena cava thrombosis in dichorionic twin pregnancy

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Introduction: Antenatal renal vein thrombosis is a rarely described diagnostic finding, with variable consequences on kidney function. Case Report: We present the unusual case of a dichorionic twin pregnancy in 34 weeks of gestation with one affected fetus, showing already intrauterine a bilateral hyperechoic kidneys with a left kidney increased in size and cardiotocographic signs of fetal distress, while dichorionic male co-twin was healthy. At birth, there was no heartbeat of the affected fetus despite resuscitation. Clinical examination of the stillborn showed that both kidneys were bulky. At autopsy, it was a stillborn boy, with enlarged hemorrhagic kidneys, and thrombosis of the renal and adrenal veins, extending to the inferior vena cava, with no sign of fetal hydrops except for a moderate pleural effusion. Histological examination confirmed the presence of hemorrhagic infarction by massive bleeding with thrombosis of both renal veins and suprarenal vena cava. The postnatal thrombophilia investigations revealed a heterozygous mutation in the MTHFR gene with no associated hyperhomocysteinemia. Conclusion: There are still many unresolved issues regarding antenatal vein thrombosis. Diagnostic possibilities Moez Kdous1, Marwene Brahem1, Oussema Khlifi1, Mohamed Khrouf1, MoniaFerchiou1, FethiZhioua1 Affiliations: 1Department of Obstetric and Gynecology, Aziza Othmana Hospital, Tunis, Tunisia. Corresponding Author: Moez Kdous, Department of Obstetric and Gynecology, Aziza Othmana Hospital,Kasba, Tunis Postal Code: 1008, Tunisia; Ph: 00216 21 852 683; Fax: 00216 71 260 327; Email: moezkdous@yahoo.fr Received: 13 March 2015 Accepted: 09 September 2015 Published: 09 December 2015 and prognostic probabilities still show large discrepancies.