Crisis Averted: Clinical T1b Renal Mass with Concurrent Arteriovenous Malformation and Renal Vein Thrombus.

Case Reports in Urology Pub Date : 2022-11-17 eCollection Date: 2022-01-01 DOI:10.1155/2022/9176199
David Zekan, Kareem Wasef, Zachary Werner, Robert Grammer, Cara Lombard, Adam Luchey, Ali Hajiran
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引用次数: 0

Abstract

Arteriovenous malformations (AVMs) secondary to renal-cell carcinoma (RCC) are well-described in the literature. Independently, renal vein and inferior vena cava tumor thrombi can be detected in locally-advanced RCC. A 67-year-old gentleman presented with a cT1b renal mass detected on workup for elevated creatinine. Multiphase CT imaging obtained for partial nephrectomy surgical-planning revealed an initially-missed renal cortical AVM. This drastically changed the plan for intervention, including use of an open approach with AVM embolization by interventional radiology prior and avoidance of a nephron-sparing approach. Final pathology confirmed the AVM and a subclinical renal vein thrombus masked by arterial flow on CT imaging, making this the first concurrent case described in the literature. Herein, we describe avoidance of catastrophic intraoperative hemorrhage by careful review of preoperative imaging and provide a literature review of imaging modalities for both renal surgical-planning and detection of tumor thrombi in RCC.

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避免危机:临床T1b肾肿块并发动静脉畸形和肾静脉血栓。
肾细胞癌(RCC)继发的动静脉畸形(AVMs)在文献中有很好的描述。局部晚期肾癌可单独检测到肾静脉和下腔静脉肿瘤血栓。一位67岁的男士在肌酐升高的检查中发现cT1b肾肿块。在部分肾切除术手术计划中获得的多期CT成像显示最初未发现的肾皮质AVM。这彻底改变了干预计划,包括通过介入放射学预先使用开放的AVM栓塞入路和避免保留肾单元的入路。最终病理证实AVM和亚临床肾静脉血栓在CT上被动脉血流掩盖,这是文献中第一例同时出现的病例。在此,我们描述了通过仔细检查术前影像学来避免灾难性术中出血,并提供了肾细胞癌中肾脏手术计划和肿瘤血栓检测的影像学方法的文献综述。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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审稿时长
13 weeks
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