以軟式輸尿管鏡診斷腎臟動靜脈畸形之病例報告

謝棨圳 1, 黃琮懿 1

1 高雄醫學大學附設中和紀念醫院泌尿部

Diagnosis of Renal Arteriovenous Malformation by Flexible Ureterorenoscopy: A Case Report

Chi-Chun Hsieh¹, Tsung-Yi Huang¹

¹Department of Urology, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan

Abstract Background

Renal arteriovenous malformation (AVM) is an unusual vascular abnormality with incidence less than about 0.1%. Diagnosis is often challenging due to variety of presentation. Some people complained hematuria with flank soreness. Treatment may be started non-invasively and intervention may be needed in uncontrolled symptoms and cases with unstable vital signs. We present a case of 82-year-old female diagnosed as renal AVM by flexible ureterorenoscopy.

Case Presentation

An 82-year-old female with underlying disease of hepatitis C and bilateral renal cysts. She complained gross hematuria for weeks with flank pain. Computed

tomography showed left hydronephrosis and suspicious tumor or blood clots were noted in left renal pelvis. During the retrograde intrarenal surgery for lesion biopsy, a pine-hole like defect was noted at left upper calyx. At the same time, active bleeding was noted intermittently from the lesion and AVM was suspected beneath it. During hospitalization, progressive anemia and hematuria were noted. The patient received angiography thereafter and AVM was confirmed at left upper calyx. Embolization was then carried out. Gross hematuria subsided right after the intervention, accompanied with stabilized hemoglobin level. The patient was then discharged smoothly.

Conclusion

Gross hematuria may conceal many differential diagnoses need to be figure out. Flexible ureterorenoscopy may provide thorough examination of collecting system, even AVM can be detected occasionally.

Keywords: Arteriovenous malformation, Flexible ureterorenoscopy, Renal