PMC5216143_01
The cardiomegaly and pulmonary congestion of the chest X-ray improved before (A) and after the procedure (B). (C) Echocardiography showed right heart dilatation, pericardial effusion, and severe tricuspid regurgitation before the procedure. (D) After the procedure, the tricuspid regurgitation improved.
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Chest radiograph showed severe cardiomegaly with dilated pulmonary vessels (Fig. 1A). The left ventricular ejection fraction was 61.5%, and she had severe tricuspid regurgitation associated with a trans-tricuspid pressure gradient of 46.9 mmHg (Fig. 1C). The patient's symptoms subsided immediately after the treatment, and a chest radiograph taken after 10 days showed normal findings (Fig. 1B). Her tricuspid regurgitation had also diminished (Fig. 1D).
(A) Contrast-enhanced computed tomography showed significant dilatation of the feeding artery and the draining vein at the right renal hilum. The dilated inferior vena cava (IVC) is indicated by arrows. One feeding artery (B) and two drainage veins (C) were visualized by transcatheter angiography. The venous sacs were filled with NBCA and Lipiodol  (D). Post-embolization angiography showed stoppage of the dilated renal lower artery at the mid-portion (E).
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Contrast-enhanced computed tomography revealed a renal AVF, with the conglomerated dilated vessels visualized at the center of the right kidney draining to the inferior vena cava (Fig. 2A). The lower polar artery was the main feeder artery, measuring about 8 to 10 mm in diameter (Fig. 2B). Two dilated and tortuous draining veins were continuously visualized (Fig. 2C). Following injection of a sufficient amount of 10% glucose solution, a 50% mixed solution of NBCA with Lipiodol was slowly injected until the dilated venous sacs were completely filled (total: 6 mL) (Fig. 2D). The parenchymal impairment corresponded to the area fed by the lower polar renal artery (Fig. 2E).
(A) Computed tomography revealed hydronephrosis of the right kidney (arrowhead). The white arrow indicates the stenotic lesion behind the coil. (B) After inserting the ureteral stent, the hydronephrosis improved. The white arrow indicates the inserted ureteral stent.
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CT showed newly developed right-sided hydronephrosis (Fig. 3A), and Proteus vulgaris was cultured in both blood and urine. After ureteral stent placement (Fig. 3B), she recovered well and was discharged from the hospital 4 days after the second admission.