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CASE REPORT |
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| Year : 2004 | Volume
: 20
| Issue : 2 | Page : 69-70 |
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Renal and ureteral arteriovenous malformation
Kamal Jeet Singh, M Raghvendran, Amit Suri, Anil Mandhani
Dept of Urology, SGPGIMS, Rae Barelli Road, Lucknow, India
Correspondence Address:
Anil Mandhani
Dept of Urology, SGPGIMS, Rae Barelli Road, Lucknow
India
 Source of Support: None, Conflict of Interest: None  | Check |
Keywords: Contrast enhanced CT, IVU, US, RGP, AVM, Radical nephrectomy.
How to cite this article:
Singh KJ, Raghvendran M, Suri A, Mandhani A. Renal and ureteral arteriovenous malformation. Indian J Urol 2004;20:69-70 |
 Case Report | |  |
A 50 year old male presented with gross total hematuria. Abdominal examination was insignificant. His renal function tests and plain X-ray KUB were normal. Ultrasound revealed clots in renal pelvis with thickened walls. Intravenous urography showed normally excreting right kidney with filling defects [Figure 1]. Contrast enhanced CT scan revealed normally functioning right kidney with thickened walls and multiple collaterals at hilar level [Figure 2]a & b. Cystoscopy revealed hemorrhagic efflux from right side. Diagnostic ureterorenoscopy showed thickened upper ureteral and renal pelvic wall. Subsequently patient was subjected to radical nephrectomy. Histopathology revealed renal and ureteral arteriovenous malformations (AVM) with increased fibrosis in the ureteral wall [Figure 3].
| Comments | | |
Two uncommon vascular lesions presenting as intrarenal masses are aneurysms and AVM. AVM's are usually congenital and rare. Hematuria is an uncommon mode of presentation. Though various diagnostic modalities like ultrasound and color Doppler have been described, there is no single specific finding reported. The diagnostic study of choice is arteriography, which is also used for therapeutic means. CT angiography cannot identify these lesions due to small nature of these masses [1] . MR angiography though reported to have a sensitivity of 78%, has drawback of inability to identity small lesions [2] . Often we encounter large collaterals during radical nephrectomies being performed for malignant disease. Hence we feel that the presence of small, multiple (>6), hilarcollaterals as seen in our case is an indicator for presence of AVM. Such patients should undergo diagnostic angiography with embolization in orderto preserve the nephron mass.
| References | | |
| 1. | Rottenbeg G, Rankin S: Renal masses in Grainger CRG, Allison DJ, and Adem A et al (Ed): Grainger and Allison's Diagnostic radiology. London, Churchill Livingstone,2001, volume 2, 4th edition, pp 1564-65.  |
| 2. | Takebayashi S, Ohno T and Tanka K: MR angiography of renal vascular malformations. Journal of Computer assisted Tomographyl 994,18: 596-600. |
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