title: Intrarenal arteriovenous fistula causing a "pseudonutcracker effect".
abstract: We report a case in which an intrarenal arteriovenous fistula caused the nutcracker effect. Color Doppler sonography of the left renal artery showed a peak systolic velocity of 150 cm/second and renoaortic ratio of 2.1. The left renal vein was significantly dilated, and the adjacent renal artery was kinked. A stenosis in the left renal vein at the aorto-mesenteric bifurcation was demonstrated, with a maximum velocity of 201 cm/second. Renal Doppler evaluation showed an area of high-velocity, low-resistance arterial flow consistent with an arteriovenous fistula in the inferior half of the left kidney. Angiography confirmed the fistula. The fistula was successfully occluded by coil embolization. Follow-up sonography showed almost complete obliteration of the fistula, regression of the renal vein dilatation, and a reduction in renal venous and arterial flow velocities. Given the reversibility of the fistula's effects, we suggest the term "pseudonutcracker effect" to describe this case.
authors.affiliation: Department of Radiology, University of Ankara School of Medicine, Ibn-i Sina Hospital, 06100 Samanpazari, Ankara, Turkey.
authors.forename: Banu
authors.initials: B
authors.lastname: Yagmurlu
authors.forename: Hasan
authors.initials: H
authors.lastname: Ozcan
authors.forename: Suat Kemal
authors.initials: SK
authors.lastname: Aytaç
authors.forename: Sadik
authors.initials: S
authors.lastname: Bilgiç
authors.forename: Umman
authors.initials: U
authors.lastname: Sanlidilek
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging* / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D012077:Renal Artery / Q000000981:diagnostic imaging*; D012082:Renal Veins / Q000000981:diagnostic imaging*; D014463:Ultrasonography