Rodgers M V, Moss A J, Hoffman M, Lipchik E O
Circulation. 1975 Aug;52(2):345-50. doi: 10.1161/01.cir.52.2.345.
A 63-year-old woman presented with progressive congestive heart failure and unexplained cardiomegaly. Diagnostic workup revealed large arteriovenous fistulae in the lower pole of the left kidney. A total left nephrectomy was performed and microscopic exam revealed renal cell carcinoma. Following surgery, the congestive heart failure cleared and the patient has been asymptomatic for one year. The pertinent findings of the 22 patients who have been reported previously in the literature with arteriovenous fistulae complicating renal cell carcinoma are reviewed. Thirty percent of the patients presented with cardiovascular complaints, and 60% had significant cardiovascular findings during the course of evaluation. An abdominal bruit was the most discriminating finding on physical exam, and it occurred in 72% of the reported cases. The diagnosis was unexpectedly established by surgery in 13%, and by angiography in 87% -- usually in the course of a workup for hypertension, abdominal pain, hematuria, or during search for an occult malignancy. An extensive evaluation is required for early diagnosis of this correctible cause of hypertension and heart failure.
一名63岁女性因进行性充血性心力衰竭和不明原因的心脏肿大就诊。诊断检查发现左肾下极有大型动静脉瘘。行左肾全切术，显微镜检查显示为肾细胞癌。术后，充血性心力衰竭症状消除，患者已无症状达一年。本文回顾了先前文献报道的22例肾细胞癌合并动静脉瘘患者的相关发现。30%的患者有心血管方面的主诉，60%的患者在评估过程中有明显的心血管表现。腹部杂音是体格检查中最具鉴别意义的发现，在72%的报道病例中出现。13%的病例意外地通过手术确诊，87%通过血管造影确诊——通常是在对高血压、腹痛、血尿进行检查的过程中，或在寻找隐匿性恶性肿瘤时。对于这种可纠正的高血压和心力衰竭病因，早期诊断需要进行全面评估。
