Bilateral renal and splenic infarction secondary to atrial fibrillation: A case report

Abstract

Background: Renal and splenic infarctions are uncommon medical conditions, and their diagnosis can often be challenging. We describe a rare case of bilateral renal and splenic infarction secondary to atrial fibrillation. Case report: A 58-year-old woman with a past medical history of hypertension and paroxysmal atrial fibrillation presented to the ED with epigastric pain, nausea, and multiple episodes of vomiting. Her electrocardiogram showed atrial fibrillation. However, upon review of her home medications, she was not taking any anticoagulants. Laboratory tests showed an elevated lactate dehydrogenase. Contrast-enhanced CT scan of her abdomen and pelvis revealed bilateral wedge-shaped areas of parenchymal hypo-enhancement in both kidneys and in the spleen. She was diagnosed with bilateral renal and splenic infarction and was admitted to the hospital. She was treated with IV heparin and discharged on long term anticoagulation after an uneventful stay. Why should an emergency physician be aware of this?: This case demonstrates a rare case of bilateral renal and splenic infarction secondary to atrial fibrillation and emphasizes the importance of maintaining a high clinical suspicion for solid organ infarction in patients with high risk of thromboembolic events, as early recognition and treatment are key in reducing morbidity and mortality.

Keywords

• Bilateral renal infarct
• Cortical rim sign
• Epigastric pain
• Atrial fibrillation
• Arrhythmia
• Cardiac embolus