A 63 year old female patient with history of renal transplan | Figure 1

SIRRFS

Case Summary

A 63 year old female patient with history of renal transplant and small indeterminate vascular malformation at the transplant renal hilum was referred for progressive weight loss, abdominal pain, and recurrent urinary tract infections. Multimodality evaluation revealed an enlarging and tortuous renal vein at the graft hilum demonstrating rapid filling on arterial phase followed by early inferior vena cava opacification. Findings were consistent with an enlarging arteriovenous fistula.

Imaging Findings

Figure 1

MR Angiogram (2011) shows abnormal tangle of vessels at the graft hilum. Note main renal artery off the external iliac artery, and the main renal vein draining into the external iliac vein. There is rapid early filling the veins bypassing renal parenchymal opacification. AV fistula is favored as the location is at the hilum with direct communication and absent nidus. AV malformation considered unlikely given its location and pattern of enhancement.

Figure 2

Ultrasound shows a markedly enlarging and tortuous renal vein with patent flow and no thrombus.

Figure 3

CT Angiogram shows a fistulous connection between the main renal artery and aneurysmal vein just beyond the main renal artery anastomosis.

Question

What is the most common cause of renal arteriovenous fistula?

1. Percutaneous biopsy
2. Congenital
3. Post infection
4. Neoplasm

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