High-output Heart Failure Caused by a Tumor-related Arteriovenous Fistula: A Case Report and Literature Review

Abstract

High-output heart failure caused by a tumor-related arteriovenous fistula in adults is a rare clinical condition. We herein report a case of high-output heart failure caused by an arteriovenous fistula associated with renal cell carcinoma and a literature review of 29 published cases to date. Renal cell carcinoma seems to be the most common underlying tumor. For the diagnosis, right heart catheterization and enhanced computed tomography (CT) are considered useful. The removal of the underlying tumor and arteriovenous fistula is the best treatment for heart failure.

Keywords: arteriovenous fistula; high-output heart failure; renal cell carcinoma; tumor.

Figure 1.

Transition of chest X-ray findings. CTR: cardiothoracic ratio, BW: body weight, NT-proBNP: N-terminal pro-brain natriuretic peptide, BNP: brain natriuretic peptide

Figure 2.

Enhanced CT findings in the arterial phase. A: Axial plane. Arrowheads indicate a hypervascular mass in the right kidney. B: Coronal plane. The proximal part of the IVC is enlarged and enhanced. C: Axial plane. Multiple veins drain into the IVC. C’: An enlarged view of dotted area of the picture C. An arrow indicates the renal cancer extending to the IVC. IVC: inferior vena cava, pIVC: proximal part of IVC, dIVC: distal part of IVC, Ao: aorta, #: renal artery, *: veins draining into IVC