Aorto-left renal vein fistula

Case contributed by Dr Vincent Tatco

Presentation

Prior exploratory laparotomy for penetrating abdominal trauma (stabbing). Presented with abdominal pain and haematuria. Abdominal bruit was demonstrated on auscultation.

Patient Data

Age: 40 years old
Gender: Male
Modality: CT

There is a communication (fistula) between the right lateral portion of the abdominal aorta and left renal vein with pseudoaneurym formation.

The right renal artery arises from the pseudoaneurysm. The right kidney is atrophic likely due to "steal phenomenon" caused by the fistula. 

The inferior vena cava and renal veins are dilated. Linear defect is seen within the left renal vein which is likely part of post-traumatic or post-surgical changes. 

A large retroperitoneal haematoma is demonstrated surrounding the enlarged left kidney. 

Rectus abdominis diastasis is also observed.

Case Discussion

This is a case of post-traumatic aorto-left renal vein fistula. Fistulas between the aorta and the left renal vein are extremely rare. It most cases, this pathological communication results as a complication of abdominal aortic aneurysms, mostly when a retroaortic left renal vein is present. It is less commonly seen as a post-traumatic or post-surgical complication since simultaneous injury to both vessels (aorta and left renal vein) is necessary for it to form. 

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Case Information

rID: 45534
Case created: 28th May 2016
Last edited: 28th May 2016
System: Vascular
Inclusion in quiz mode: Included

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