Left renal vein thrombosis: a rare cause of acute scrotal pain.

To cite: Nana GR, Basra M, Maudgil DD, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013202237 DESCRIPTION A 70-year-old man with a history of chronic liver disease presented with increasing scrotal pain and swelling. There was an associated dull left loin pain. His general practitioner had started antibiotics after an ultrasound scan revealed hypervascularity of the testes, suggestive of left epididymo-orchitis. An ultrasound scan also revealed a left varicocoele. Blood tests were unremarkable while urinalysis was positive for blood. A CT urogram revealed an oedematous, congested left kidney secondary to an acute left renal vein thrombus with retrograde flow into the left testicular vein, resulting in a left-sided varicocoele (figures 1–3). Following haematology advice, the patient was conservatively managed with anticoagulation, as no definite cause of renal vein thrombosis was detected. The patient remains well with no flank or scrotal pain, with no bleeding diathesis after 6 weeks of low-molecular-weight heparin injections. Causes of acute varicocoele include renal cell carcinoma and renal vein thrombosis. The commonest cause of renal vein thrombosis in adults is the nephrotic syndrome. Other causes include hypercoagulable states, antiphospholipid syndrome, trauma, etc. No association with chronic liver disease has been