PMC7804838_01
Contrast-enhanced computed tomography images in the arterial phase showed right renal injury classified as grade IV according to the American Association for Surgery of Trauma. There was a deep laceration at under pole reaching up to the hilum (arrowheads in A, B). There was a disruption of pararenal fascia and a large hematoma adjacent (arrows in A, B, and C).
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Besides, there was the presence of hematoma around the polar under the kidney spreading down pelvic lumbar muscles (Figure 1).
Computed tomography images unenhanced phase (A) and contrast-enhanced phases with the arterial (B), venous (C), and delayed (D). Arteriovenous fistula mimicking tumor in the right pelvis renal. Manifesting as a mass, enhancement in arterial phase, and washout in the venous and delayed phase. They seemed to match the blood pool in every single phase of contrast enhancement (arrows). Note that there were several stones in the lower renal calyx (arrowheads).
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The areas of enhancement in this AVF matched the attenuation of the appropriate vessels (blood pool) at all phases (Figure 2).
Interventional therapy for right renal arteriovenous fistula (AVF) with digital subtraction angiography. (A) The catheter tip image in the right main renal artery (arrow). (B) After the injection of contrast, the AVF bulge was detected (arrowhead). (C) Push the tip of the catheter into the middle renal artery branch adjacent to AVF (arrow). (D) Inject more contrast material to identify the lesion. (E) Injecting embolization material to cause AVF obstruction. (F) The lesion was gone, and the renal blood vessels were circulated normally.
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The fistula artery came from the middle branch (Figure 3).