Giant posterior abdominal wall arteriovenous malformation mimicking renal mass: rare images.

To cite: Kumar A, Singh M, Sankhwar S. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014204311 DESCRIPTION Vascular malformations (VMs) are congenital abnormalities of aberrant angiogenesis with reported prevalence of 1.2–1.5%. VMs can be either high flow (eg, arteriovenous malformation (AVM) or arteriovenous fistula (AVF)) or low flow (eg, capillary, venous, lymphatic) type. Head, neck and extremities are the common sites for VMs. Although congenital and often asymptomatic they rarely manifest before adolescence. Pain, bleeding, compressible lump, congestive heart failure and cosmetic appearance are clinical presentations of VMs which may require intervention. Here we report a case of AVM of the posterior abdominal wall presented as flank mass mimicking renal mass. A 21-year-old unmarried woman presented with left flank fullness and dull aching pain for the past 4 years. She had no urinary symptoms and had normal menstrual cycles. Clinical examination showed an ill-defined, soft, compressible mass in the left flank with palpable thrill and audible bruit. Ultrasound showed dilated vascular channels in layers of posterior abdominal wall. CT angiogram revealed a heterogeneously enhancing soft tissue lesion measuring 7×7× 10 cm with multiple dilated tortuous vascular channels involving layers of posterior abdominal wall, compressing and displacing the left kidney anteriorly and superiorly (figures 1and 2). It was fed by all four left lumber arteries and draining into the left common iliac vein suggestive of AVM (figure 3). She underwent transarterial coil embolisation followed by surgical resection of AVM. The patient is doing well at 2-month follow-up without any recurrence.