Isom Nicholas, Masoomi Reza, Alli Adam, Gupta Kamal
Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA.
Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, KS, USA.
Am J Case Rep. 2019 Mar 10;20:314-317. doi: 10.12659/AJCR.912727.
BACKGROUND Congenital renal vascular anomalies have been classified into 3 categories: cirsoid, angiomatous, and aneurysmal. These classifications are based on the size, location, and number of vessels involved. Aneurysmal malformations, such as the one reported here, have a single (and dilated) feeding and draining vessel. The prevalence of renal AVMs is estimated at less than 0.04%, making them rare causes of secondary hypertension. CASE REPORT A 29-year-old white woman was seen in the hypertension clinic as a referral from high-risk obstetric clinic for management of hypertension (HTN). A secondary hypertension workup with Doppler waveforms of the renal arteries revealed prominent diastolic flow in the left compared to the right. For confirmation, an MRA was done, which showed a large left renal upper-pole arteriovenous malformation (AVM) with associated vascular shunting and early opacification of the left renal vein. This congenital AVM was identified as the cause of her hypertension. Angiography and coil embolization were performed. The patient's BP normalized within a few days and she was taken off her antihypertensive medications. CONCLUSIONS This case illustrates that a careful review of duplex waveforms beyond just peak velocity and ratios is important to identify uncommon pathologies. This is important, as renal AVMs respond well to embolization, with resolution of hypertension in 59% of patients treated.
背景 先天性肾血管异常已被分为3类：蔓状、血管瘤样和动脉瘤样。这些分类基于受累血管的大小、位置和数量。动脉瘤样畸形，如此处报道的病例，有单一（且扩张的）供血和引流血管。肾动静脉畸形（AVM）的患病率估计低于0.04%，使其成为继发性高血压的罕见病因。病例报告 一名29岁白人女性因高血压（HTN）被高危产科诊所转诊至高血压诊所。对肾动脉进行的多普勒波形继发性高血压检查显示，与右侧相比，左侧舒张期血流明显。为明确诊断，进行了磁共振血管造影（MRA），结果显示左肾上极有一个大的动静脉畸形（AVM），伴有相关的血管分流和左肾静脉早期显影。该先天性AVM被确定为其高血压的病因。进行了血管造影和弹簧圈栓塞术。患者的血压在几天内恢复正常，她停用了降压药。结论 本病例表明，仔细分析双功波形，而不仅仅是峰值速度和比值，对于识别罕见病变很重要。这很重要，因为肾AVM对栓塞治疗反应良好，59%接受治疗的患者高血压得到缓解。
