Diagnosis of Renal Arteriovenous Malformation using 64-row Multiple Detector Computed Tomography and Computed Tomography Angiography

Reprint requests to: Dr. Chen-Pin Chou Department of Radiology, Kaohsiung Veterans General Hospital. No. 386, Ta Chung 1st Road, Kaohsiung 813, Taiwan, R.O.C. A 47-year-old woman presented to our hospital with chief complaints of hematuria and left flank pain. The patient denied any recent history of trauma, renal surgery or urinary tract disease. Arterial-phase CT and three-dimensional CT angiography were performed by 64-row multiple detector computed tomography (64-MDCT) and manufacturer-provided workstation. Tortuous f istulas close to the collecting system between the branches of left renal artery and vein were found on arterial phase 64-MDCT and CT angiography. The diagnosis of cirsoid renal arteriovenous malformation (AVM) was made according to CT imaging findings. The patient underwent conventional angiography and transcatheter arterial embolization for renal AVM. She remained symptom free at three-month clinical follow-up. Hematur ia is a clinical commonly encountered symptom of diverse urinary tract disorders, including renal or ureteral calculus, uroepithelial neoplasms, trauma, infection and renal vascular diseases [1]. Among the differential diagnoses of hematuria, renal vascular diseases are extremely rare and difficult diagnoses. Clinicians sometimes fail to diagnose and delay treatment of renal vascular diseases. Non-invasive imaging modalities, including int ravenous urography (IVU), ult rasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), are commonly used to diagnose urinary tract diseases [1]. Most of imaging modalities have their limitation in the evaluation of a renal vascular lesion. With the recent development of 64-row multiple detector computed tomography (64-MDCT) and reformatted CT angiography (CTA) images, various vascular diseases can be easily demonstrated [2]. We presented a rare case of renal arteriovenous malformation (AVM) and its imaging findings at 64-MDCT and CTA.