SHM Converge Scientific Abstract ePoster Gallery-When Clots Spill Over: Adrenal Hemorrhage Triggered by Renal Vein Thrombosis

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This case describes a 24-year-old man with systemic lupus erythematosus and poorly controlled lupus nephritis who presented with sudden severe left-sided abdominal pain, nausea, and vomiting. He was afebrile but mildly tachycardic and had left flank tenderness. Laboratory tests showed mild anemia, elevated aPTT, increased LDH, and proteinuria.<br /><br />Imaging revealed left renal vein thrombosis with a 22 × 17 mm left adrenal hemorrhage and thickened adrenal tissue on CT. MRI confirmed subacute adrenal hemorrhage and extension of the thrombus into the inferior vena cava. The patient was managed conservatively with continued anticoagulation, starting with heparin and transitioning to warfarin, along with intravenous pain control. Because the hemorrhage remained stable, no surgery was required. His lupus nephritis was treated with prednisone and mycophenolate mofetil.<br /><br />The report emphasizes that renal vein thrombosis is a rare but recognized complication of SLE, especially in patients with antiphospholipid syndrome or nephrotic syndrome. Adrenal hemorrhage is uncommon in adults but can occur in hypercoagulable states or due to venous congestion from renal vein thrombosis. The left adrenal gland is especially vulnerable because its venous drainage is directly connected to the left renal vein. MRI is important for confirming hemorrhage and excluding adrenal tumors or metastases.<br /><br />Overall, the case highlights the need to consider adrenal hemorrhage in patients with renal vein thrombosis who develop abdominal pain, particularly in the setting of SLE or other hypercoagulable disorders. Early diagnosis with advanced imaging is essential to guide treatment and prevent complications.

Asset Subtitle

Zainab Javeed

Meta Tag

Author List Asim Usman, Hafsa Khan, Mohammed Youssef, Sofiya Rehman, Zainab Javeed

Category Clinical Vignettes

Concept Renal Vein Thrombosis

Concept Adrenal Hemorrhage

Concept Anticoagulation

Concept Systemic Lupus Erythematosus

Concept Antiphospholipid Antibody Syndrome

Distinguished Non-Finalist

Presenter Organization Hunt Regional Medical Center/ Arkansas College of Osteopathic Medicine

Presenting Author Zainab Javeed

Track Adult

Keywords

systemic lupus erythematosus

lupus nephritis

renal vein thrombosis

adrenal hemorrhage

anticoagulation

inferior vena cava thrombosis

hypercoagulable state

magnetic resonance imaging

abdominal pain

antiphospholipid syndrome

Renal Vein Thrombosis

Adrenal Hemorrhage

Anticoagulation

Systemic Lupus Erythematosus

Antiphospholipid Antibody Syndrome