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AKI following mechanical [http://en.wikipedia.org/wiki/Tryptophan_synthase Tryptophan synthase] thrombolysis occurs rarely. The AngioJet device  destroys thrombi by trapping and hydraulic recirculation. This process results in the lysis of red blood cells.15 16 Haemolysis following AngioJet has been reported to cause a transient increase in serum creatine levels.17 Haemoglobin by-products such as haeme have pro-inflammatory effects, while high amounts of haeme proteins (haemoglobin and myoglobin) can cause oxidative stress leading to nephrotoxicity.18 The exact mechanism of nephrotoxicity by haemoglobinuria may be unknown but it is thought that haeme proteins precipitate cast formation leading to obstruction of renal tubules resulting in acute tubular necrosis.19  The subject of this case report experienced dramatic deterioration in his renal function immediately following thrombolysis and a further disimprovement following urgently performed CT studies of thorax, abdomen and pelvis with intravenous contrast. Learning points This case demonstrates a classical presentation of Paget-Schroetter Syndrome in an 18-year-old man. His management was complicated by dialysis dependent acute kidney injury from a combination of catheter-directed thrombolysis (CDT) and radiological contrast medium. CDT with first rib resection provides greater patency rate than anticoagulation therapy alone. Current treatment is based on small series and case reports. Randomised controlled trials are needed to provide an evidence base to inform the optimum management of this rare pathology. Footnotes Competing interests: None. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed.""A 40-year-old woman presented to our orthopaedic clinic with left-sided wrist pain after falling. On physical examination, there was no limitation in range of motion of the  wrist; however, flexion and extension were minimally painful. There was no swelling or tenderness in the wrist. Other findings were normal. Plain anteroposterior radiograph of left wrist showed a left-sided osseous fusion of the lunate and triquetrum with a distal notch according to Minaar's classification type II (figure 1). MRI also revealed the lunotriquetral coalition Minaar type II confirming the stable proximal fusion of the bones with a distal notch of the left wrist and no bone oedema (figure 2). Analgesics and bandage to the left wrist was given. The patient became asymptomatic and returned to her normal activities within 5?days. Figure?1 Anteroposterior radiograph of the left asymptomatic wrist showing a lunotriquetral coalition Minaar type I. Figure?2 MRI shows the lunotriquetral coalition Minaar type II confirming the stable proximal fusion of the bones with a distal notch of the left wrist. Carpal coalitions are rare, asymptomatic entities that most often present as incidental findings.