Answer for BIR CoW 20 Aug 2023
Renal AV malformation
Findings
CECT: Multiple shunts noted between renal arterioles and venules forming a complex vascular network noted involving right kidney. There is early filling of right renal vein and inferior vena cava noted in arterial phase. There is delayed nephrogram involving right kidney. Impression: Type III nontraumatic right renal AV shunt (arteriovenous malformation)
Discussion
Traumatic renal:
AV shunts Direct fistulous formation between a single artery and a single draining vein; coexistence of pseudoaneurysms (often)
Nontraumatic renal AV shunts:
Type I: A single or a few arteries shunting to a dilated single draining vein
Type II: Multiple arterioles shunting to a single dilated draining vein
Type III: Multiple shunts between the arterioles and venules, forming a complex vascular network. Postcontrast CT images typically show an early enhancement of the ipsilateral renal vein and inferior vena cava. In type III shunts that are fed by multiple segmental or interlobar arterial branches, CT angiography shows multiple tortuous and dilated vessels with thin, spiral arterial ramifications located in the renal sinus and surrounding the pelvicaliceal system.
Reference:
Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture. Miyuki Maruno, MD Hiro Kiyosue, MD, PhD Shuichi Tanoue, MD, PhD Norio Hongo, MD, PhD Shunro Matsumoto, MD, PhD Hiromu Mori, MD, PhD Yoshiko Sagara, MD Junji Kashiwagi, MD, PhD
Findings
CECT: Multiple shunts noted between renal arterioles and venules forming a complex vascular network noted involving right kidney. There is early filling of right renal vein and inferior vena cava noted in arterial phase. There is delayed nephrogram involving right kidney. Impression: Type III nontraumatic right renal AV shunt (arteriovenous malformation)
Discussion
Traumatic renal:
AV shunts Direct fistulous formation between a single artery and a single draining vein; coexistence of pseudoaneurysms (often)
Nontraumatic renal AV shunts:
Type I: A single or a few arteries shunting to a dilated single draining vein
Type II: Multiple arterioles shunting to a single dilated draining vein
Type III: Multiple shunts between the arterioles and venules, forming a complex vascular network. Postcontrast CT images typically show an early enhancement of the ipsilateral renal vein and inferior vena cava. In type III shunts that are fed by multiple segmental or interlobar arterial branches, CT angiography shows multiple tortuous and dilated vessels with thin, spiral arterial ramifications located in the renal sinus and surrounding the pelvicaliceal system.
Reference:
Renal Arteriovenous Shunts: Clinical Features, Imaging Appearance, and Transcatheter Embolization Based on Angioarchitecture. Miyuki Maruno, MD Hiro Kiyosue, MD, PhD Shuichi Tanoue, MD, PhD Norio Hongo, MD, PhD Shunro Matsumoto, MD, PhD Hiromu Mori, MD, PhD Yoshiko Sagara, MD Junji Kashiwagi, MD, PhD
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!