PMC3819914_01
Coronal CT image showing a vascular tangle (arrow) in the left kidney.
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A CT scan of the abdomen and pelvis with contrast revealed a small left renal stone and a 4.6 x 4.5 cm highly vascular mass in the anteromedial portion of the left kidney and profound urothelial thickening (Figure 1).
Axial MR VIBE fat saturation postcontrast depicting left-sided renal AVM (arrow). At time of imaging, the RCC could not be identified.
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A postoperative MRI demonstrated a 6 cm AVM of the left kidney (Figure 2).
Angiography demonstrating the renal AVM with characteristic early draining vein (arrow).
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Interventional radiology (IR) was consulted and completed a two-stage catheter-directed embolization of the AVM with Onyx (ev3, Plymouth, MN) that resulted in 80-90% decreased flow to the AVM (Figures 3 and 4).
Angiography post-Onyx (ev3, Plymouth, MN) embolization of left renal AVM demonstrating decreased flow.
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Interventional radiology (IR) was consulted and completed a two-stage catheter-directed embolization of the AVM with Onyx (ev3, Plymouth, MN) that resulted in 80-90% decreased flow to the AVM (Figures 3 and 4).
Axial dynamic MR postgadolinium LAVA sequence demonstrating RCC (arrow) in left kidney.
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In the process of evaluating this anemia, a repeat MRI revealed an enhancing, heterogenous 6 cm mass that was highly concerning for a renal neoplasm arising from the left kidney (Figure 5).
Angiography after preoperative coil embolization of left renal vein demonstrating decreased flow to left kidney.
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Shortly after the MRI, he developed recurrent flank pain and gross hematuria and an urgent left renal angiogram with embolization of the renal artery was performed (Figure 6) (GFR 69, Cr 1.08, Hb 8.3).
Gross image of the left kidney with RCC (arrow) and adjacent AVM (arrowhead).
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T3aNxMx Fuhrman 2/4 7.5 cm RCC, clear cell type. The pathologist noted that prominent vessels, consistent with an AVM, were present next to the tumor (Figure 7). 