Gross hematuria caused by a congenital intrarenal arteriovenous malformation: a case report

Abstract

Introduction: We report the case of a woman who presented with gross hematuria and was treated with a percutaneous embolization.

Case presentation: A 48-year-old Caucasian woman presented with gross hematuria, left flank pain, and clot retention. The patient had no history of renal trauma, hypertension, urolithiasis, or recent medical intervention with percutaneous instrumentation. The patient did not report any bleeding disorder and was not taking any medication. Her systolic and diastolic blood pressure values were normal at presentation. The patient had anemia (8 mg/dL) and tachycardia (110 bpm). She underwent color and spectral Doppler sonography, multi-slice computed tomography, and angiography of the kidneys, which showed a renal arteriovenous malformation pole on top of the left kidney.

Conclusions: The feeding artery of the arteriovenous malformation was selectively embolized with a microcatheter introduced using a right transfemoral approach. By using this technique, we stopped the bleeding, preserved renal parenchymal function, and relieved the patient's symptoms. The hemodynamic effects associated with the abnormality were also corrected.

Figure 1

Spectral Doppler sonogram showing the arteriovenous malformation (AVM). The image aliasing area highlights the AVM.

Figure 2

Computed tomography with iodinated contrast enhancement shows the presence of tortuous blood arterial vessel with thin arterial ramifications of spiral form. The arrowhead indicates the renal vein, the arrows indicate the renal artery, and the asterisk indicates the renal AVM.

Figure 3

Selective digital subtraction arteriography of the left kidney showing dynamic images of the AVM. The black arrow indicates the renal artery, the white arrow indicates the AVM, and the arrows indicate the renal vein.

Figure 4

Digital subtraction arteriography performed after selective embolization of the lesion with the use of microcoils. Complete excision of the lesion is shown. The renal pelvis is opacified by contrast medium used for arteriography.