Emergency room visits related to cocaine use have been increasing over the past 10 years, with the cost of cocaine-related hospitalization now more than 80 million dollars per year. Well-recognized and common complications associated with cocaine use include hypertension, cardiac ischemia, cerebrovascular accidents and rhabdomyolysis. Renal infarction is uncommon, while aortic involvement is even less documented in literature. We present the first report of a case of renal infarction and aortic thrombus in a patient who used nasal cocaine. This case suggests that aortic pathology should be considered in patients presenting with renal infarction related to cocaine use.