Arteriovenous Malformation

The patient was found to have a left lower pole arteriovenous malformation (AVM). The blush region seen on the angiogram is diagnostic of this known complication of percutaneous nephrostomy tube placement (Figure 1). Review of the procedure revealed that the tube could not be passed over a wire and a new percutaneous puncture was made through an upper pole calyx. It is believed that removal of the long standing lower pole tube withdrew tamponade from an existing AVM, causing the hematuria and anemia.

The patient was transfused with four units of packed red blood cells. She then underwent emergent super selective angiography with placement of a coil for embolization of the AVM (Figure 2). Her hematuria resolved, and she was discharged without further incident.

Angiogram

Figure 1

Figure 2