Renal arteriovenous malformations are abnormal communications between the intrarenal arterial and venous systems. They are a rare cause of hematuria. Color Doppler ultrasonography, multislice CT angiography, and DSA are important tools for making the diagnosis. We describe the case of a 62-year-old man with renal arteriovenous malformation who presented with gross hematuria.

A 34-year-old healthy asymptomatic man was referred to our institute with nonspecific vague complains like heaviness in flanks and occasional low grade flank pains. He was diagnosed as having bilateral polycystic kidneys in other center and was referred to our center for further management. On evaluation at our center, he had no significant medical or family history. There was no positive history of infection or trauma. Clinical and physical examination were within normal limits. Blood pressure was 120/86 mmHg. Urinalysis was normal. Serum creatinine was within normal limits. Ultrasound revealed normal sized kidneys with increased echo texture and preserved cortico-medullary differentiation. Bilateral kidneys showed multi septated anechoic collections in perinephric regions of maximum width of 33mm [Table/ Fig-1]. No evidence of calculus or hydronephrosis was seen on either side. Rest of the abdominal ultrasound was unremarkable. Based on imaging findings, provisional diagnosis of bilateral Renal Lymphangiectasia (RLM) was thought of and CT-scan was performed on Siemens Somatom 64 Slice CT scanner with non-iodinated contrast. CT scan revealed multi-septated collections with typical fluid density (0 to 10 HU) in perinephric regions of both kidneys [Table/ Fig-2]. No evidence of soft tissue or fat density mass lesion was seen. Both kidneys showed normal parenchymal enhancement and contrast excretion with no evidence of contrast leakage within the perinephric collections. Both ureters were normal in course and caliber. Further, the perinephric fluid collection was aspirated and laboratory investigation showed total leucocyte count of 55/cmm, out of which 85% were lymphocytes; protein level of 550mg/dl, Renal Lymphangiectasia (RLM) is very rare benign lymphatic malformation. It can be misdiagnosed for other cystic renal masses, most commonly polycystic kidneys. Though incidentally found in most cases, it may be the cause for hypertension and renal failure in undiagnosed patients. Here, we report a case of an adult asymptomatic male with bilateral RLM which was detected as an incidental finding on ultrasound. Confirmation by CT-scan and laboratory diagnosis of aspirated fluid was done, and patient was managed conservatively.

Background:Evaluation of renal vascular variations is important in renal donors to avoid vascular complications during surgery. Venous variations, mainly resulting from the errors of the embryological development, are frequently observed.Aim:This retrospective cross-sectional study aimed to investigate the renal vascular variants with multidetector computed tomography (MDCT) angiography to provide valuable information for surgery and its correlations with surgical findings.Materials and Methods:A total of 200 patients underwent MDCT angiography as a routine work up for live renal donors. The number, course, and drainage patterns of the renal veins were retrospectively observed from the scans. Anomalies of renal veins and inferior vena cava (IVC) were recorded and classified. Multiplanar reformations (MPRs), maximum intensity projections, and volume rendering were used for analysis. The results obtained were correlated surgically.Results:In the present study, out of 200 healthy donors, the standard pattern of drainage of renal veins was observed in only 67% of donors on the right side and 92% of donors on the left side. Supernumerary renal veins in the form of dual and triple renal veins were seen on the right side in about 32.5% of donors (dual right renal veins in 30.5% cases and triple right renal veins in 2.5% cases). Variations on the left side were classified into four groups: supernumerary, retro-aortic, circumaortic, and plexiform left renal veins in 1%, 2.5%, 4%, 0.5%, cases respectively.Conclusions:Developmental variations in renal veins can be easily detected on computed tomography scan, which can go unnoticed and can pose a fatal threat during major surgeries such as donor nephrectomies in otherwise healthy donors if undiagnosed.

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