Presentation
Left loin pain and painless hematuria.
Patient Data
Large left renal AVM noted involving most of the left kidney:
- having nidus at the upper zone measures 6 cm showing markedly dilated vascular channels, compressing the upper calyx
- smaller nidus at the lower zone measures 2.5 cm in diameter
- having arterial feeders from the dilated main renal artery and smaller accessory renal artery
- venous drainage through the large left renal vein and smaller retro-aortic accessory renal vein
The right kidney is normal in size, shape and position. No vascular malformations identified. Accessory right renal vein.
Case Discussion
Renal arteriovenous malformations are rare abnormal communications between the renal artery and vein with a vascular nidus that bypass the capillary bed. They are divided into two categories, traumatic and non-traumatic, and can present with hematuria, retroperitoneal hemorrhage, flank pain, hypertension and high-output heart failure. Early enhancement and dilatation of the draining renal vein are of its features. Management is usually by transcatheter arterial embolization.