Paul H. Blom, M.D., William Parker, M.D., &
Ziv Haskal, M.D.
New York Presbyterian Hospital
|
|
Paul H. Blom, M.D., William Parker, M.D., & |
 Fig. 1. Abnormal tangle of arteries originating from the inferior segmental artery of the posterior division of the right renal artery. |
 Fig. 2. The arterio-venous malformation demonstrates an early draining vein. |
|
A 28-year-old female patient presented to the emergency room with a sudden onset of hematuria. The patient was hemodynamically stable. The patient denied any history of trauma, fever or flank pain. There was no significant past medical or surgical history and the patient was not taking any medications. The genitourinary service was consulted and a urinalysis and complete blood count were performed. There were too many red blood cells to count and 3 - 5 white blood cells. The hematocrit was 27.9. A retrograde cystoscopy was performed and a pulsatile mass was visualized in the right renal pelvis. A double J pigtail catheter was placed and the patient was sent to angiography. Selective angiography of the right renal artery was performed revealing a nest of vessels originating from the inferior segmental artery of the posterior division (Fig. 1). A rapidly draining vein was visualized draining into the main renal vein (Fig. 2). The diagnosis of an arterio-venous malformation was confirmed and treatment with Histoacryl (B/Braun Medical INC.; Bethlehem, PA) was begun. Using a micro-catheter, 1.0cc (2 vials) mixed with ethiodol and tantalum powder, was injected into one of two supplying arteries. After the first micro-catheter was removed, a second micro-catheter was positioned in the second feeding artery and 0.5cc (1 vial) mixed with ethiodol and tantalum powder was injected into the malformation (Fig. 3). Complete cure of the malformation was achieved and was demonstrated by filling of the draining vein with Histoacryl (B/Braun Medical INC.; Bethlehem, PA) (Fig. 4). |
 Fig. 3. Selective injection of the posterior division of the right renal artery post embolization demonstrates absence of filling of the arterio-venous malformation.
Fig. 4. Digital imaging over the right kidney demonstrates Histoacryl (B/Braun Medical INC.; Bethlehem, PA) in the arterio-venous malformation (Arrow B) and Histoacryl (B/Braun Medical INC.; Bethlehem, PA) extending into the renal vein (Arrow A). |
| The patient was followed for 2 days and was discharged home after an uncomplicated post-operative course with no repeat episodes of hematuria.
Questions: 1) Would anyone have used anything other than glue in this patient? 2) Would anyone have screened for an ASD prior to treatment in a patient with or without a heart murmur? Related cases: Case 0498_11 -- Management of massive pelvic AVM Case 0998_09 -- Pulmonary Arteriovenous Malformation (PAVM) |
|
 |
 |
 |
