Minoca Revealed by Renal Infarction Associated With Left Ventricular Thrombus in a Young Patient: A Case Report and Literature Review

Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) is a heterogeneous clinical entity characterized by evidence of myocardial infarction in the absence of significant obstructive coronary artery disease. Its diagnosis remains challenging, particularly in young patients presenting with atypical extracardiac manifestations. We report the case of a 33-year-old man with chronic tobacco use and occasional cannabis consumption who was initially admitted for right flank pain in a pseudo-infectious setting. Abdominal computed tomography revealed a hypodense lesion of the lower pole of the right kidney suggestive of either pyelonephritis or renal infarction. Subsequent cardiac investigations demonstrated severe dilated cardiomyopathy with major left ventricular systolic dysfunction. Cardiac magnetic resonance imaging showed extensive transmural late gadolinium enhancement in the left anterior descending artery territory associated with a 5-mm left ventricular thrombus. Coronary angiography revealed normal coronary arteries, leading to the diagnosis of MINOCA complicated by probable systemic renal embolization. This case highlights the major diagnostic value of cardiac magnetic resonance imaging in MINOCA and underlines the possibility of extracardiac manifestations revealing silent myocardial infarction.