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Case Reports and Images in Obstetrics and Gynecology

 
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Case Report
 
Antenatal bilateral renal vein and vena cava thrombosis in dichorionic twin pregnancy
Moez Kdous1, Marwene Brahem1, Oussema Khlifi1, Mohamed Khrouf1, MoniaFerchiou1, FethiZhioua1
1Department of Obstetric and Gynecology, Aziza Othmana Hospital, Tunis, Tunisia.

Article ID: 100005Z08MK2015
doi:10.5348/Z08-2015-5-CR-5

Address correspondence to:
Moez Kdous
Department of Obstetric and Gynecology
Aziza Othmana Hospital
Kasba, Tunis Postal Code: 1008
Tunisia
Phone: 00216 21 852 683
Fax: 00216 71 260 327

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How to cite this article:
Kdous M, Brahem M, Khlifi O, Khrouf M, Ferchiou M, Zhioua F. Antenatal bilateral renal vein and vena cava thrombosis in dichorionic twin pregnancy. J Case Rep Images Gynecol Obstet 2015;1:15–19.


Abstract
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 supra-renal 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 and prognostic probabilities still show large discrepancies.

Keywords: Antenatal thrombosis, Inferior vena cava thrombosis, Thrombosis of renal veins, Twin pregnancy


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Author Contributions
Moez Kdous – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Marwene Brahem – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Oussema Khlifi – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Mohamed Khrouf – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Monia Ferchiou – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Fethi Zhioua – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2015 Moez Kdous et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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