Introduction: Renal cell carcinoma (RCC) is the most common type of kidney cancer, typically presenting symptoms related to the urinary tract or metastatic spread(1). However, RCC can occasionally manifest with atypical signs and symptoms, leading to diagnostic challenges. Portal vein thrombosis (PVT) is a rare complication of RCC(2), and its presence as the initial presentation is even rarer. In this case report, we discuss a unique case in which PVT served as the presenting sign of RCC, highlighting the importance of considering RCC in the differential diagnosis of patients with PVT.

Introduction:Avascular necrosis arises as a consequence of vascular disruption, primarily affecting the blood supply to the femoral head and potentially leading to degenerative alterations within the hip joint. This condition can be attributed to a wide array of causes and risk factors, including systemic lupus erythematosus (SLE), post-transplant complications, certain medications like glucocorticoids and bisphosphonates, as well as genetic hemoglobinopathies such as sickle cell disease(1,2). Hemophilia, characterized by hemarthrosis, where joint bleeding may occur spontaneously or following minor trauma, is known to give rise to subsequent degenerative changes. Patients with hemophilia face an elevated risk of developing hemophilic arthropathy and are susceptible to avascular necrosis(3).This case report highlights the occurrence of avascular necrosis in the left hip joint of a patient who already manifests hemophilic arthropathy in multiple other joints. Importantly, due to the presence of recurrent small-scale hemarthrosis in the hip joint, even in the absence of trauma, the likelihood of silent avascular necrosis increases, placing them at significant risk.