Cinematic Rendering of Giant Renal Arteriovenous Fistula

HomeRadiologyVol. 309, No. 3 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyCinematic Rendering of Giant Renal Arteriovenous FistulaJing Luo, Peng Liu Jing Luo, Peng Liu Author AffiliationsFrom the Department of Radiology, Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), No. 61 Jiefang W Rd, Changsha, Hunan, China.Address correspondence to P.L. (email: [email protected]).Jing LuoPeng Liu Published Online:Dec 5 2023https://doi.org/10.1148/radiol.231045MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Supplemental material is available for this article.A 47-year-old man presented with episodic right flank pain for 3 months. CT angiography revealed a giant right renal arteriovenous fistula (AVF) and a 5.2 × 6.6-cm venous aneurysmal sac (Figure, Movie), which is consistent with aneurysmal-type renal AVF. Given the size of the fistula and its mass effect, right total nephrectomy was performed.Images in a 47-year-old man with a right renal arteriovenous fistula (AVF). (A) Axial CT angiogram in corticomedullary phase shows the large right renal AVF with aneurysmal dilatation (*) of the venous end. DV = draining vein, FA = feeding artery. (B) Axial CT angiogram in renal parenchymal phase shows low perfusion of posterior renal parenchyma (arrows) caused by the high-flow renal AVF. (C) Cinematic rendering of CT angiogram in corticomedullary phase shows the right renal AVF with a dilated and elongated renal artery (open arrow), three feeding arteries (solid arrows), and a single draining vein (arrowhead). Note the low perfusion of the upper pole of the right kidney (curved arrow). The cube represents the orientation of the image: A = anterior, H = head, R = right.Download as PowerPoint Movie: Cinematic rendering from CT angiography in a 47-year-old man diagnosed with aneurysmal-type renal arteriovenous fistula.Download Original Video (15.5 MB)Renal AVFs are anomalous direct communications between arteries and veins in the kidney (1). There are three types of renal AVFs: congenital, acquired, and idiopathic. The latter two types typically involve large arteriovenous communications (2). The overall prevalence of all types of renal AVF is less than 0.04% (3). AVF, when in association with aneurysm, is believed to evolve from progressive erosion of the aneurysm wall into an adjacent vein (4). This patient's AVF is characterized as type I (ie, fewer than four separate arteries shunting to a single draining vein), according to the classification by Cho et al (5). The majority of renal AVFs are asymptomatic, but associated signs and symptoms can include flank pain, gross hematuria, acute urinary retention, hemodynamic changes, and loss of renal function.Disclosures of conflicts of interest: J.L. No relevant relationships. P.L. No relevant relationships.References1. Sanoudos GM, Berenbaum E, Clauss RH. Ruptured renal arteriovenous fistula. JAMA 1972;219(12):1581–1583. Crossref, Medline, Google Scholar2. Crotty KL, Orihuela E, Warren MM. Recent advances in the diagnosis and treatment of renal arteriovenous malformations and fistulas. J Urol 1993;150(5 Pt 1):1355–1359. Crossref, Medline, Google Scholar3. Cho KJ, Stanley JC. Non-neoplastic congenital and acquired renal arteriovenous malformations and fistulas. Radiology 1978;129(2):333–343. Link, Google Scholar4. Okamoto Y, Sugimoto T, Yamamoto K, Yoshii S. Heart failure caused by renal arteriovenous fistula with giant renal artery aneurysms. Vasc Endovascular Surg 2014;48(5-6):434–437. Crossref, Medline, Google Scholar5. Cho SK, Do YS, Shin SW, et al. Arteriovenous malformations of the body and extremities: analysis of therapeutic outcomes and approaches according to a modified angiographic classification. J Endovasc Ther 2006;13(4):527–538. Crossref, Medline, Google ScholarArticle HistoryReceived: Apr 22 2023Revision requested: July 17 2023Revision received: July 27 2023Accepted: Sept 8 2023Published online: Dec 05 2023 FiguresReferencesRelatedDetailsRecommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 309, No. 3 Metrics Altmetric Score PDF download