An autopsy case of extensive aortic thrombosis with acute kidney injury as the sole clinical manifestation.

Aortic thrombosis is a rare but life-threatening condition. It typically presents with abdominal or lower-limb ischemia. Although acute kidney injury (AKI) can accompany aortic thrombosis, AKI as the sole clinical manifestation has not been previously reported. A 69-year-old man with extensive atherosclerotic disease and chronic kidney disease presented with severe oliguria. Initial evaluation, including non-contrast computed tomography (CT), did not reveal any aortic abnormalities. Renal Doppler ultrasonography findings and markedly elevated D-dimer levels prompted contrast-enhanced CT, which demonstrated extensive thrombus formation extending from the descending thoracic aorta to the bilateral iliac arteries, with complete occlusion of both renal arteries and major abdominal branches. Despite widespread occlusion, the patient exhibited no abdominal or limb ischemic symptoms, likely owing to well-developed collateral circulation. Subsequently, the patient developed persistent anuria requiring hemodialysis and died on day 17. Autopsy confirmed extensive subacute aortic thrombosis, occlusion of the renal artery, and preserved intestinal mucosa consistent with collateral perfusion. We describe an exceptionally rare autopsy-confirmed case of aortic thrombosis in a case that presented solely with AKI and lacked any abdominal or limb ischemic symptoms. This case highlights the importance of considering aortic thrombosis in unexplained AKI cases. Our findings support the judicious use of contrast-enhanced CT in patients with suspected life-threatening vascular disease, including those with impaired kidney function.