Renal Arteriovenous Fistula: Occurrence in Renal-Cell Carcinoma

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RENAL arteriovenous fistula is a disorder of exceptional clinical interest because it is rare and produces unusual physical and roentgenographic findings. Of the 15 cases of arteriovenous fistula of the kidney reviewed by Scheifley, Daugherty, Greene, and Priestley,1 in only three cases was there associated renal-cell carcinoma. We are reporting a (fourth) case in which an intra-renal fistula occurred in a renal-cell carcinoma, with the typical clinical features of the renal-vascular syndrome.

Clinical Features

Scheifley2 states that there are four outstanding clinical features that comprise the renal-vascular syndrome typical of this unusual disease. These are: (1) continuous bruit heard diffusely over the upper abdomen or flank; (2) hypertension; (3) cardiomegaly, which was present in 12 of the 15 patients; and (4) heart failure, which occurred in 10 patients. He points out that because of these clinical features a renal arteriovenous fistula is distinguishable from a peripheral arteriovenous fistula.

Report of a Case

A 62-year-old woman was referred to us by Dr. Adib H. Karam of Canton, Ohio, because of his diagnosis of arteriovenous fistula of the right kidney. In January, I960, the patient experienced the sensation of a mass in the upper abdomen, but physical examination revealed only an increased resistance in this region on palpation. Ten months later she was re-examined by Doctor Karam because of a similar complaint, and at that time a mass was palpable in the right upper quadrant and flank. Further examination revealed a blood pressure of 206/110 mm. of Hg, cardiomegaly, with an . . .



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