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Comune R, Grassi F, Picchi SG, De Simone F, Sarti G, Giardina C, Galluzzo M, Scaglione M, Tamburrini S. Gross hematuria: Renal cell carcinoma mimicking a renal arteriovenous malformation. Radiol Case Rep 2024; 19:2130-2134. [PMID: 38645536 PMCID: PMC11026910 DOI: 10.1016/j.radcr.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 04/23/2024] Open
Abstract
The differential diagnosis between renal arteriovenous malformations (AVM) and cancer may be a challenge, due to the similar clinical and imaging findings. Herein, we report the case of an 80-year-old male patient presenting gross hematuria, initially diagnosed and treated with embolization for a renal AVM. Due to the recurrence of hematuria and rapid progression and changes of the vascular lesion with detection also of an intralesional solid nodule, a radical nephrectomy was performed revealing the presence of a renal cell carcinoma (RCC). Renal cell carcinoma and renal AVM can be difficult to differentiate from one another, for this reason a short-term follow-up should be carried out in patients diagnosed and treated for renal AVM to confirm the resolution of AVM or to assess any changes, such as atypical neovascularization or intralesional renal masses, which may increase the suspect of a hidden renal tumor.
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Affiliation(s)
- Rosita Comune
- Division of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | - Francesca Grassi
- Division of Radiology, "Università degli Studi della Campania Luigi Vanvitelli", Naples, Italy
| | | | - Fiore De Simone
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Naples, Italy
| | - Giuseppe Sarti
- Department of Radiology, Ospedale del Mare-ASL NA1 Centro, Naples, Italy
| | - Claudio Giardina
- Department of Radiology, ASP of Messina-Hospital of Taormina, (ME), Italy
| | - Michele Galluzzo
- Department of Emergency Radiology, San Camillo Forlanini Hospital, Rome, Italy
| | - Mariano Scaglione
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK
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2
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Kolber MK, Cui Z, Chen CK, Habibollahi P, Kalva SP. Nutcracker syndrome: diagnosis and therapy. Cardiovasc Diagn Ther 2021; 11:1140-1149. [PMID: 34815965 DOI: 10.21037/cdt-20-160] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
Nutcracker syndrome (NCS) is an extrinsic compression of the left renal vein (LRV) by the superior mesenteric artery (SMA) anteriorly and aorta posteriorly resulting in renal vascular congestion manifesting as hematuria, proteinuria, orthostatic hypotension, pain, or even renal dysfunction. Long-standing venous compression can encourage collateral drainage pathways through gonadal and pelvic veins, which may explain reported symptom and syndrome overlap with pelvic congestion syndrome. Diagnosis can be challenging and variable, frequently involving a combination of ultrasound Doppler, cross-sectional, and invasive imaging. Often, intravascular pressure measurements are required to prove a renocaval pressure gradient to aid in a definitive diagnosis. Conservative management is appropriate, especially in children, who tend to outgrow the disorder. In the interim, medical management with angiotensin converting enzyme inhibitors (ACEIs) is a useful therapy to manage orthostatic hypotension in the pediatric population. In adults, invasive therapies are more frequently pursued. These are aimed at relieving the extrinsic compression on the LRV. The standard of care is renal vein transposition, with renal autotransplantation reserved for recalcitrant cases. Endovascular stenting is a less invasive option. Laparoscopic placement of an exovascular stent is a newer therapy intended to minimize trauma to the LRV. In this review, we will discuss the clinical manifestations, diagnostic criterion, imaging features, and conservative and surgical therapies for this condition.
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Affiliation(s)
- Marcin K Kolber
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zhonghao Cui
- University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Christine K Chen
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peiman Habibollahi
- Division of Interventional Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Sanjeeva P Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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3
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Abstract
Hematuria is common; whether gross or microscopic, it is incumbent on emergency providers to consider life-threatening and benign processes when evaluating these patients. Most workup is driven by a focused history and physical, including laboratory studies and diagnostic imaging. The cause originates in the genitourinary tract and, as long as the patient remains stable, they can be discharged with close outpatient follow-up. The importance of this cannot be stressed enough because hematuria, especially in the elderly, frequently signals the presence of urologic malignancy. In addition, the workup occasionally yields a nongenitourinary tract cause, and these patients often require emergent management.
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Affiliation(s)
- George C Willis
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA.
| | - Semhar Z Tewelde
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, Sixth Floor, Suite 200, Baltimore, MD 21201, USA. https://twitter.com/HeartEMed
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Ihedioha JI, Ukachukwu CV, Ugochukwu ICI, Anyogu DC. Evaluation of kidney function and urinary analytes in Nigerian trade cattle. Trop Anim Health Prod 2019; 51:1867-1875. [PMID: 30968275 DOI: 10.1007/s11250-019-01879-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/22/2019] [Indexed: 01/17/2023]
Abstract
This cross-sectional study evaluated kidney function and urinary analytes in cattle presented for slaughter at Nsukka abattoir, Enugu State, Nigeria. A total of 133 cattle were evaluated; they were physically examined at the lairage before slaughter and after slaughter, blood for hematology and serum biochemistry were collected from the jugular vein, and urine samples for urinalysis was also collected from the urinary bladder. Standard procedures were followed in all the laboratory determinations. Results showed that, out of 133 sample population of cattle evaluated, 74 (55.6%) were apparently healthy, while 59 (44.4%) were unhealthy with observable clinical signs of diseases or disorders. Serum creatinine evaluation of the 133 cattle showed that 7.5% (10 cattle out of 133) had renal impairment (serum creatinine above 2 mg/dl). There was no significant association (p > 0.05) between renal impairment and age or sex. Out of the sampled cattle, 11 (8.3%) had positive urine bilirubin levels, while none (0%) had urobilinogen in urine, and 5 (3.8%) were positive for ketonuria. Only 6 (4.5%) were positive for urine glucose, but 113 (92.5%) were positive for urine proteins. The cattle sampled had urine pH ranging from 6 to 9, and specific gravity ranging from 1.000 to 1.030 and of all the sampled cattle, 6 (4.5%) were positive for nitrite. Based on the results, it is suggestive that based on the serum creatinine level which is a known marker of kidney function, 7.5% of cattle sampled had renal impairment.
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Affiliation(s)
- John Ikechukwu Ihedioha
- Department of Veterinary Pathology and Microbiology, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Chimere Victor Ukachukwu
- Department of Veterinary Pathology and Microbiology, University of Nigeria Nsukka, Nsukka, Nigeria
| | | | - Davinson Chuka Anyogu
- Department of Veterinary Pathology and Microbiology, University of Nigeria Nsukka, Nsukka, Nigeria
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5
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Gagne SM, Newbury A, Nowitzki KM, Chen BY, Lo HS. Name That Nephrogram: Asymmetric Renal Enhancement in the Acute Care Setting. Curr Probl Diagn Radiol 2018; 48:616-625. [PMID: 30415790 DOI: 10.1067/j.cpradiol.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/06/2018] [Accepted: 10/16/2018] [Indexed: 12/23/2022]
Abstract
Disorders of the kidney and urinary collecting system are common encountered in the acute care setting. Computed tomography has progressively replaced intravenous pyelography for the evaluation of most urinary tract pathology including acute flank pain, suspected malignancy, congenital abnormalities, anatomical variants, and inflammatory/vascular conditions through evaluation of the "nephrogram" produced by intravenous contrast material filtering through the kidneys. In this review, we describe the most common types of abnormal nephrograms seen on renal computed tomography, and highlight the salient features and conditions associated with them, in addition to a pictorial review with specific and interesting related cases. The types of abnormal nephrograms reviewed are absent, unilateral delayed, striated, spotted, and persistent.
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Affiliation(s)
- Staci M Gagne
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA
| | - Alex Newbury
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA
| | - Kristina M Nowitzki
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA
| | - Byron Y Chen
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA
| | - Hao S Lo
- University of Massachusetts Medical School, Department of Radiology, Worcester, MA..
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Suzuki T, Imai N, Hisamichi M, Ichikawa D, Koike J, Shibagaki Y. Can nutcracker phenomenon cause glomerular hematuria? Nephrology (Carlton) 2018; 23:495. [DOI: 10.1111/nep.13096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Tomo Suzuki
- Division of Nephrology and Hypertension, Department of Internal Medicine; St. Marianna University School of Medicine; Kanagawa Japan
| | - Naohiko Imai
- Division of Nephrology and Hypertension, Department of Internal Medicine; St. Marianna University School of Medicine; Kanagawa Japan
| | - Mikako Hisamichi
- Division of Nephrology and Hypertension, Department of Internal Medicine; St. Marianna University School of Medicine; Kanagawa Japan
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine; St. Marianna University School of Medicine; Kanagawa Japan
| | - Junki Koike
- Department of Diagnostic Pathology; St. Marianna University School of Medicine; Kanagawa Japan
| | - Yugo Shibagaki
- Division of Nephrology and Hypertension, Department of Internal Medicine; St. Marianna University School of Medicine; Kanagawa Japan
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Phan YC, Eli N, Pillai P, O'Dair J. A rare presentation of haematuria: hip prosthesis in the bladder. BMJ Case Rep 2018; 2018:bcr-2017-222831. [PMID: 29572365 DOI: 10.1136/bcr-2017-222831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An 80-year-old woman presented to our department with visible haematuria and stage II acute kidney injury (AKI). She had stage IIB cervical cancer, for which she received chemotherapy and external beam radiotherapy in 2003. Four years later, she had a left dynamic hip screw for an extracapsular neck of femur fracture following a fall. In 2010, she underwent a right total hip replacement owing to osteoarthritis, and it was subsequently revised in 2012 owing to a right acetabular component failure. In this admission, her AKI improved with intravenous fluid administration and her haematuria settled following catheterisation with a three-way catheter and bladder irrigation with saline. She underwent a flexible cystoscopy which revealed that a part of her right hip prosthesis was in the bladder, having eroded through the right bony pelvis. However, she declined any surgical interventions.
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8
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Mohamed MA, Hamid KA. How an Elevated Creatinine Level Can Deter the Diagnosis of Acute Aortic Dissection. Cureus 2018; 10:e2057. [PMID: 29545980 PMCID: PMC5849348 DOI: 10.7759/cureus.2057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute aortic dissection (AAD) classically manifests with sudden, severe chest pain radiating to the back or abdomen, often described as ripping or tearing sensation. Considering its abrupt onset, the diagnosis requires a high index of suspicion prompting immediate imaging using computed tomography (CT) with contrast. However, the use of contrast is a relative contraindication in the patients with renal compromise and acute care physicians are often deterred from contrast use in these patients. Herein, we present an unusual case of hematuria as the presenting symptom of a developing the Stanford type-A AAD. A 65-year-old female presented with sudden, severe chest pain radiating to her lower back. She reported that her urine color was 'pink' on the previous day and was becoming more 'red-colored' as the day progressed. The next morning, she began feeling a 10/10 crushing-type chest pain that was relieved when she lay on her left side and was associated with nausea, vomiting, and diaphoresis. The urine analysis revealed gross hematuria. The laboratory findings revealed a creatinine of 1.3. Due to her elevated creatine levels and possible acute kidney injury, a computed tomography (CT) without contrast was performed initially, which did not reveal an AAD. However, the index of suspicion was still high for the AAD, after prompt discussions about the risk of using contrast and contrast nephropathy versus the risks of potential complications, if AAD was missed. Further evaluation with CT of the chest and abdomen, with contrast, was obtained with the patients' consent, which revealed a Stanford type-A AAD starting proximally from the aortic arch and extending to the common iliac. In conclusion, the clinical presentations of AAD are more heterogeneous. Hematuria in the presence of high index of suspicion and symptoms of AAD could indicate the extension of the involvement of the renal arteries. Prompt CT with contrast may be indicated despite relative contraindications from the laboratory findings.
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Affiliation(s)
| | - Kewan A Hamid
- Department of Combined Internal Medicine-Pediatrics, Hurley Medical Center, Michigan State University College of Human Medicine
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9
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What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1746570. [PMID: 29376066 PMCID: PMC5742442 DOI: 10.1155/2017/1746570] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 10/12/2017] [Indexed: 12/21/2022]
Abstract
Nutcracker syndrome (NCS) is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. The development of NCS is associated with the formation of the left renal vein (LRV) from the aortic collar during the sixth to eighth week of gestation and abnormal angulation of the superior mesenteric artery from the aorta. Collateralization of venous circulation is the most significant effect of NCS. It includes mainly the left gonadal vein and the communicating lumbar vein. Undiagnosed NCS may affect retroperitoneal surgery and other radiological and vascular procedures. The clinical symptoms of NCS may generally be described as renal presentation when symptoms like haematuria, left flank pain, and proteinuria occur, but urologic presentation is also possible. Radiological methods of confirming NCS include Doppler ultrasonography as a primary test, retrograde venography, which can measure the renocaval pressure gradient, computed tomography angiography, which is faster and less traumatic, intravascular ultrasound, and magnetic resonance angiography. Treatment can be conservative or surgical, depending on the severity of symptoms and degree of LRV occlusion. Nutcracker syndrome is worth considering especially in differential diagnosis of haematuria of unknown origin.
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10
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Sherif MF. Role of multidetector computed tomography in diagnostic evaluation of different renal sinus lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2017. [DOI: 10.1016/j.ejrnm.2017.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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11
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Juan YH, Lin YC, Sheng TW, Cheung YC, Ng SH, Yu CW, Wong HF. Application of Onyx for Renal Arteriovenous Malformation With First Case Report of a Renal Hyperdense Striation Sign: A CARE-Compliant Article. Medicine (Baltimore) 2015; 94:e1658. [PMID: 26426661 PMCID: PMC4616815 DOI: 10.1097/md.0000000000001658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Onyx is an emerging treatment modality for visceral vascular malformations, especially in cases in which delicate nidal penetration of the arteriovenous malformation (AVM) is desired. A computed tomography (CT) image presentation of hyperdense striations along the renal medulla secondary to the tantalum powder has not been previously reported. A 65-year-old woman presented to our institution with intermittent gross hematuria and left flank pain for 10 days. Both CT and conventional angiographies confirmed cirsoid-type renal AVM, which was successfully treated with Onyx. Follow-up CT after treatment revealed presence of hyperdense striations along the renal medulla, which resolved during later image follow-up. Despite its frequent usage in neural intervention, the application of Onyx in visceral AVM is gradually gaining interest, especially in cases in which delicate nidal penetration of the AVM is desired. Renal hyperdense striation sign should be recognized to avoid confusion with embolizer migration, and further studies in patients with renal function impairment may be helpful in understanding its influence of renal function.
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Affiliation(s)
- Yu-Hsiang Juan
- From the Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University, Taoyuan, Taiwan (YHJ, TWS, YCC, SHN, HFW); Healthy Aging Research Center, Chang Gung University, Taiwan (YHJ); Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Keelung and Chang Gung University, Taoyuan, Taiwan (YCL); and Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung and Chang Gung University, Taoyuan, Taiwan (CWY)
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12
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Affiliation(s)
- T Keefe Davis
- Washington University School of Medicine, St Louis, MO 63110, USA
| | - Paul Hmiel
- Washington University School of Medicine, St Louis, MO 63110, USA
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13
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Inal M, Karadeniz Bilgili MY, Sahin S. Nutcracker Syndrome Accompanying Pelvic Congestion Syndrome; Color Doppler Sonography and Multislice CT Findings: A Case Report. IRANIAN JOURNAL OF RADIOLOGY : A QUARTERLY JOURNAL PUBLISHED BY THE IRANIAN RADIOLOGICAL SOCIETY 2014; 11:e11075. [PMID: 25035694 PMCID: PMC4090635 DOI: 10.5812/iranjradiol.11075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 04/04/2013] [Accepted: 05/08/2013] [Indexed: 11/16/2022]
Abstract
Nutcracker syndrome (NCS) is a rare pathology, caused by compression of the left renal vein (LRV) between the abdominal aorta (AA) and the superior mesenteric artery (SMA), due to reduction of the angle between AA and SMA. This leads to LRV varices, left gonadal vein varices and therefore, the pelvic congestion syndrome. For this reason, coexistence of NCS and pelvic congestion syndrome has been described. It manifests by hematuria, proteinuria, and nonspecific pelvic pain secondary to pelvic congestion, dyspareunia and persistent genital arousal. We report a 27-year-old woman who experienced hematuria and left flank pain. The diagnosis of NCS accompanied by pelvic congestion syndrome was missed initially, but later on the diagnosis was made by color Doppler ultrasound, abdominal computed tomography (CT) and CT angiography that were later performed. She refused interventional and surgical treatments, and was lost to follow up.
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Affiliation(s)
- Mikail Inal
- Department of Radiology, Kirikkale University, Yahsihan, Kirikkale, Turkey
| | | | - Safa Sahin
- Department of Radiology, Kirikkale University, Yahsihan, Kirikkale, Turkey
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Pseudoaneurisma intrarrenal secundario a nefrolitotomía percutánea: revisión de la literatura y reporte de un caso. UROLOGÍA COLOMBIANA 2014. [DOI: 10.1016/s0120-789x(14)50008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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15
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16
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Affiliation(s)
- Haq Wajid
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian R Herts
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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17
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Renal cell carcinoma initially presenting as an arteriovenous malformation: a case presentation and a review of the literature. Case Rep Urol 2013; 2013:356819. [PMID: 24251063 PMCID: PMC3819914 DOI: 10.1155/2013/356819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 09/08/2013] [Indexed: 01/10/2023] Open
Abstract
We describe a case of a patient who presented with hematuria and was diagnosed with a renal arteriovenous malformation (AVM). Transcatheter arterial embolization subsequently was performed on this lesion multiple times. Follow-up imaging demonstrated that the AVM was masking an underlying, rapidly growing renal cell carcinoma (RCC). We describe the pathological and radiographic characteristics of AVMs and RCC. We describe the strengths and weaknesses of computed tomography (CT) and magnetic resonance imaging (MRI) to detect and characterize RCC and AVM. We recommend initial and follow-up MR imaging in patients with an AVM to establish a baseline, monitor treatment response, and survey lesions for underlying and obscured malignancy.
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Abstract
Wunderlich syndrome (WS) is a rare condition characterized by acute onset of spontaneous, nontraumatic renal hemorrhage into the subcapsular and perirenal spaces. Wunderlich syndrome is classically characterized by the Lenk's triad: acute flank pain, flank mass, and hypovolemic shock. However, the clinical manifestations can be varied and nonspecific. A wide spectrum of neoplastic and nonneoplastic renal pathologies may result in WS. Renal neoplasms are the most common cause for WS, with angiomyolipoma being the most common benign neoplasm, whereas renal cell carcinoma is the most common malignant neoplasm. Other causative conditions of WS include vascular causes (vasculitis [polyarteritis nodosa being the most common cause], renal artery aneurysms, arteriovenous malformations and fistulas, and venous thrombosis), cystic renal diseases, renal infections, calculus disease, nephritis, and coagulation disorders. Cross-sectional imaging findings help in the detection of the subcapsular and/or perinephric hemorrhage and may identify underlying etiology. Renal angiography not only helps in diagnosis of the underlying cause in select cases but also allows control of active bleeding, which can avoid unnecessary emergent radical surgery.
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An HS, Kang TG, Yun HJ, Kim MJ, Jung JA, Yoo JH, Lee YS. Hypertension caused by renal arteriovenous fistula. Korean Circ J 2010; 39:548-50. [PMID: 20049142 PMCID: PMC2801464 DOI: 10.4070/kcj.2009.39.12.548] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 07/20/2009] [Indexed: 11/11/2022] Open
Abstract
We describe a case of secondary hypertension caused by renal arteriovenous fistula. An 8-year old girl was hospitalized with a severe headache, vomiting, and seizure. Renal angiography demonstrated multiple renal arteriovenous fistula and increased blood renin concentration in the left renal vein. Thus, left renal arteriovenous fistula and renin induced secondary hypertension were diagnosed. Her blood pressure was well controlled by medication with angiotensin converting enzyme inhibitor.
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Affiliation(s)
- Hye-Sung An
- Department of Pediatric Cardiology, College of Medicine, Dong-A University, Busan, Korea
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