Post biopsy renal arteriovenous fistula and pseudoaneurysm

Case contributed by Dr Maria Ana Serrado

Presentation

Renal transplant performed 1 month earlier. Haematuria following the third percutaneous renal biopsy for increased creatinine levels.

Patient Data

Age: 50 year
Gender: Male

B mode and Doppler ultrasound (2 days after the biopsy)

Modality: Ultrasound

B mode image of the transplanted kidney shows a hyperechoic linear image in the middle third of the kidney, corresponding to the site of the biopsy. Spectral Doppler tracing reveals a low resistance waveform with increased systolic and diastolic flow.

B mode and Doppler ultrasound (7 days after the biopsy)

Modality: Ultrasound

B mode image of the transplanted kidney shows an anechoic round structure image in the middle third of the kidney, corresponding to the site of the biopsy. Color Doppler images show focal color aliasing indicating high velocity at the arterio-venous fistula and surrounding blue and red speckles that indicate a “soft tissue bruit” caused by tissue vibrating. With increased color scale, the yin-yang sign, color flow pattern typical of pseudoaneurysm is present. The “soft tissue bruit” is no longer present.

B mode and Doppler ultrasound (1 month after the biopsy)

Modality: Ultrasound

B mode and color Doppler images shows an anechoic round structure without flow within it, corresponding to the thrombosed pseudoaneurysm.

Case Discussion

This case demonstrates two uncommon post-image guided percutaneous renal biopsy complications, a renal arteriovenous fistula and a renal pseudoaneurysm. Both resolved spontaneously in short time.

 

Images courtesy of Dr Regina Martins, Dr Margarida Albergaria and Dr Lucinda Bogalho.

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Case Information

rID: 48602
Case created: 16th Oct 2016
Last edited: 20th Oct 2016
Inclusion in quiz mode: Included

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