Ruptured renal arteriovenous malformation successfully treated by catheter embolization: a case report

Abstract

Background: Renal arteriovenous fistula (RAVF) is a comparatively rare malformation. Here, we report a case of ruptured RAVF that was successfully treated by catheter embolization.

Case presentation: An 89-year-old female was transferred to our institution with massive gross hematuria in March 2011. Plain abdominal computed tomography (CT) revealed dilated left renal pelvis with high-density contents. Hematoma was suspected. Subsequent plain abdominal magnetic resonance imaging revealed left hydronephrosis and blood retention in the dilated left renal pelvis. No renal or ureteral cancer was evident. Hematuria was conservatively treated using hemostatic agents but hematuria persisted. Repeated urinary cytology revealed no malignant cells. On day 9, the patient went into septic and/or hemorrhagic shock. Fluid and catecholamine infusion, blood transfusion, and antibacterial drugs were rapidly initiated, and the patient's general condition gradually improved. Contrast-enhanced abdominal CT revealed marked expansion of the hematoma in the renal pelvis and microaneurysms in the segmental arteries of the left kidney. Inflammation improved, and a left double-J stent was inserted. Selective renal angiography revealed RAVF with microaneurysms in the left segmental arteries; therefore, catheter embolization using metallic coils was performed, which resolved hematuria.

Conclusion: We report a case of ruptured renal arteriovenous malformation, which was successfully treated by catheter embolization.

Figure 1

Plain abdominal computed tomography and magnetic resource imaging. Plain abdominal computed tomography revealed dilated left renal pelvis with retention of high-density contents (A: axial view, B: coronal view). T2-weighted abdominal magnetic resonance imaging revealed dilated left renal pelvis with retention of low-intensity fluid, which suggested the presence of blood (C).

Figure 2

Contrast-enhanced abdominal computed tomography. Contrast-enhanced abdominal computed tomography revealed expansion of hematoma in the pelvis and small aneurysms (arrow) in the segmental arteries of the left kidney (A: axial view, B: threedimensional construction).

Figure 3

Selective renal angiography. Selective renal angiography revealed renal arteriovenous fistula with microaneurysms (arrows) in the left segmental arteries (A). Catheter embolization using metallic coils was successfully performed (B).

Figure 4

Plain abdominal computed tomography revealed resolution of hematoma in the left renal pelvis and presence of metallic coils (A). Abdominal radiography revealed a well-positioned double-J stent (B).