title: Ruptured renal arteriovenous malformation successfully treated by catheter embolization: a case report.
abstract: BACKGROUND
  Renal arteriovenous fistula (RAVF) is a comparatively rare malformation. Here, we report a case of ruptured RAVF that was successfully treated by catheter embolization.
  
  
  METHODS
  An 89-year-old female was transferred to our institution with massive gross hematuria in March 2011. Plain abdominal computed tomography (CT) revealed dilated left renal pelvis with high-density contents. Hematoma was suspected. Subsequent plain abdominal magnetic resonance imaging revealed left hydronephrosis and blood retention in the dilated left renal pelvis. No renal or ureteral cancer was evident. Hematuria was conservatively treated using hemostatic agents but hematuria persisted. Repeated urinary cytology revealed no malignant cells. On day 9, the patient went into septic and/or hemorrhagic shock. Fluid and catecholamine infusion, blood transfusion, and antibacterial drugs were rapidly initiated, and the patient's general condition gradually improved. Contrast-enhanced abdominal CT revealed marked expansion of the hematoma in the renal pelvis and microaneurysms in the segmental arteries of the left kidney. Inflammation improved, and a left double-J stent was inserted. Selective renal angiography revealed RAVF with microaneurysms in the left segmental arteries; therefore, catheter embolization using metallic coils was performed, which resolved hematuria.
  
  
  CONCLUSIONS
  We report a case of ruptured renal arteriovenous malformation, which was successfully treated by catheter embolization.
authors.affiliation: Department of Internal Medicine, Kawasaki Hospital, Kobe, Japan. takeuchi_nobuhiro@kawasaki-hospital-kobe.or.jp.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takeuchi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nomura
mesh_terms: D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D001165:Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy*; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006417:Hematuria / Q000209:etiology; D006490:Hemostatics / Q000627:therapeutic use; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D007668:Kidney / Q000098:blood supply*; D008279:Magnetic Resonance Imaging; D012422:Rupture, Spontaneous; D012771:Shock, Hemorrhagic / Q000188:drug therapy / Q000209:etiology; D015607:Stents; D014057:Tomography, X-Ray Computed
chemical_list: D006490:Hemostatics