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The novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2 and associated with a wide spectrum of clinical manifestations ranging from asymptomatic carrier states to fulminant respiratory distress and multiple organ dysfunction. The intravascular arterial and venous thrombotic phenomena are one of the most prevalent and devastating consequences and tend to occur in patients with a severe disease state. Here we present a 45-year-old male with a medical history of essential hypertension (HTN) who presented with severe left flank pain accompanied by dry cough and fever for five days. He was found to have acute kidney injury (AKI) with concomitant renal infarction in computed tomography angiography (CTA) in the setting of a COVID-19 infection. He was eventually managed with novel oral anticoagulation (NOAC) and was discharged after a short hospital stay. Follow-up thereafter showed stable baseline renal function with no relevant symptoms., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Medical Research Center of Hamad Medical Corporation issued approval (MRC-04-24-049). Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Baghi et al.)

A 67-year-old female patient, who underwent a recent right lobectomy for pT2a N2 lung adenocarcinoma and adjuvant chemotherapy with Vinorelbine and Cisplatin, was admitted in April 2020 to the emergency department for nausea and abdominal pain. The clinical evaluation revealed a slightly positive right costovertebral angle tenderness and signs suspicious of right lower leg deep vein thrombosis. The blood tests revealed a white cell count of 26.07 X 109/L; hemoglobin 13.8 g/dl; INR 1.17; C-reactive protein 170 mg/L and creatinine 1.0 mg/dl. The Figure 1A shows an axial frame of the arterial phase of contrasted CT-scan in which is clearly visible the hypoperfusion of the right kidney compared to the left. Only few sporadic areas of the right parenchyma pick up contrast, differently from the left kidney parenchyma which appears totally contrasted. Similarly, Figure 1B shows a coronal image of the abdomen in which is visible the hypoperfusion of the right kidney, especially in the upper pole. The patient was started on Fondaparinux 5 mg/day and Piperacillin/Tazobactam 4.5 g x 3/day. Few days after the admission the patient developed fever (38.9°C), dyspnea (Sp02 90%) and tested positive for SARS-CoV-2. She died due to COVID-19. Although respiratory failure is the main characteristic of COVID-19, some authors indicate an increased risk for acute kidney injury (AKI). The pathophysiologic mechanisms leading to AKI in patients affected by SARS-CoV-2 are not completely clear but may include direct cytopathic effects of the virus on kidney tubular and endothelial cells or indirect damage caused by virus-induced cytokine release. Furthermore, thromboembolic events in COVID-19 patients are proven. Data suggest that the differential diagnosis of acute kidney injury in patients with COVID-19 infection should include kidney infarction. In this era of fear, patients and doctors should be aware of the fact that medical consultation should not be avoided or delayed in the absence of respiratory symptoms.

Aortic dissection (AD) is a life-threatening medical emergency with a high mortality rate if misdiagnosed; therefore, an urgent and precise diagnosis is crucial for prompt treatment. This article presents a rare case report of AD with an atypical clinical presentation that led to delayed diagnosis and a complicated clinical course. Herein, we aim to contribute to the existing literature by providing insights into the varied presentations of AD and offering valuable lessons for clinicians faced with similar diagnostic scenarios. A 64-year-old female with an extended history of hypertension and other comorbidities presented to the emergency department with a one-day duration of right-sided loin pain and fever. Her blood investigations demonstrated evidence of leukocytosis and high c-reactive protein (CRP) levels. She was preliminarily treated as a case of acute pyelonephritis since, initially, clinical and radiographic evidence did not yield an alternative diagnosis. Despite antibiotics, her condition deteriorated, and her urine output became less than 0.5 mL/kg/hour for six consecutive hours. Additionally, the obtained urine culture was negative on the third day of admission, which made the medical team repeat her history taking and clinical examination, revealing a previously overlooked weight loss. This red flag prompted the medical team to conduct thorough chest and abdominal imaging studies in search of any hidden malignancy, especially when her thyroid function test returned normal. Surprisingly, a contrast-enhanced abdominal CT scan demonstrated an infarcted right kidney by thromboembolism that originated from the partially obstructive thrombus in the proximal abdominal aorta, which was later confirmed to be a type B AD by a CT angiogram. A multidisciplinary team guided her treatment, which included carefully controlling her blood pressure, using anticoagulants, and closely monitoring the patient. The take-home messages of this case report underscore the critical importance of recognizing atypical clinical presentations of AD, overcoming diagnostic challenges through comprehensive approaches, tailoring treatments to individual patient needs, and advocating for a multidisciplinary and patient-centered approach to enhance overall clinical outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ibraheem et al.)

Acute renal infarction due to emboli represents a very rare but significant threat for kidney loss, and the clinical presentation is challenging. The differential diagnosis of massive renal thrombi includes all other causes of abdominal pain, and they can be easily misdiagnosed as renal colic due to nephrolithiasis. Although there are a few case reports regarding the possibility that cardiac emboli may cause acute kidney infarction, intracardiac thrombi within the ventricular cavity diagnosed by echocardiography as a cause of such renal artery occlusion have never been reported in patients with cardiomyopathy. Herein, we describe a 39-year-old male with a history of ischemic dilated cardiomyopathy. He was admitted to our hospital with left upper abdominal pain and vomiting. After serial examinations and tests, the diagnosis of acute renal infarction due to intracardiac thrombus embolization as a result of severely reduced cardiac function was made. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) is a contagious life-threatening infection caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recent findings indicate an increased risk for acute kidney injury during COVID-19 infection. The pathophysiologic mechanisms leading to acute kidney injury in COVID-19 infection are unclear but may include direct cytopathic effects of the virus on kidney tubular and endothelial cells, indirect damage caused by virus-induced cytokine release, and kidney hypoperfusion due to a restrictive fluid strategy. In this report of 2 cases, we propose an additional pathophysiologic mechanism. We describe 2 cases in which patients with COVID-19 infection developed a decrease in kidney function due to kidney infarction. These patients did not have atrial fibrillation. One of these patients was treated with therapeutic doses of low-molecular-weight heparin, after which no further deterioration in kidney function was observed. Our findings implicate that the differential diagnosis of acute kidney injury in COVID-19-infected patients should include kidney infarction, which may have important preventive and therapeutic implications., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

The article presents the case study of a 31-year-old man who experienced severe loin pain in the left lower abdomen while performing a workout of the abdominal muscles in a fitness club. Abdominal computed tomography (CT) scan and angiography revealed a dissection and thrombotic occlusion of the left renal artery. Multi-step lysis was performed guaranteeing a potential restoration of the function of the affected kidney and will also prevent arterial hypertension.