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Giant posterior abdominal wall arteriovenous malformation mimicking renal mass: rare images
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  1. Arvind Kumar,
  2. Manmeet Singh,
  3. Satyanarayan Sankhwar
  1. Department of Urology, King George Medical University, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Arvind Kumar, drarvindg4{at}gmail.com

https://doi.org/10.1136/bcr-2014-204311

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    Description

    Vascular malformations (VMs) are congenital abnormalities of aberrant angiogenesis with reported prevalence of 1.2–1.5%. VMs can be either high flow (eg, arteriovenous malformation (AVM) or arteriovenous fistula (AVF)) or low flow (eg, capillary, venous, lymphatic) type.1 Head, neck and extremities are the common sites for VMs.2 Although congenital and often asymptomatic they rarely manifest before adolescence. Pain, bleeding, compressible lump, congestive heart failure and cosmetic appearance are clinical presentations of VMs which may require intervention. Here we report a case of AVM of the posterior abdominal wall presented as flank mass mimicking renal mass.

    A 21-year-old unmarried woman presented with left flank fullness and dull aching pain for the past 4 years. She had no urinary symptoms and had normal menstrual cycles. Clinical examination showed an ill-defined, soft, compressible mass in the left flank with palpable thrill and audible bruit. Ultrasound showed dilated vascular channels in layers of posterior abdominal wall. CT angiogram revealed a heterogeneously enhancing soft tissue lesion measuring 7×7 × 10 cm with multiple dilated tortuous vascular channels involving layers of posterior abdominal wall, compressing and displacing the left kidney anteriorly and superiorly (figures 1and 2). It was fed by all four left lumber arteries and draining into the left common iliac vein suggestive of AVM (figure 3). She underwent transarterial coil embolisation followed by surgical resection of AVM. The patient is doing well at 2-month follow-up without any recurrence.

    Figure 1
    Figure 1

    CT angiogram showing heterogeneously enhancing soft tissue lesion with multiple dilated tortuous vascular channels involving layers of posterior abdominal wall, compressing and displacing the left kidney anteriorly and superiorly.

    Figure 2
    Figure 2

    CT angiogram showing heterogeneously enhancing soft tissue lesion with multiple dilated tortuous vascular channels involving layers of posterior abdominal wall, compressing and displacing the left kidney anteriorly and superiorly.

    Figure 3
    Figure 3

    Showing feeding of arteriovenous malformation from all four left lumber arteries and draining into the left common iliac vein.

    Learning points

    • Vascular malformations are rare congenital malformations of the vascular system that are challenging to diagnose and treat.

    • CT and MRI are the most useful modalities to diagnose and classify this entity.

    • Therapeutic embolisation followed by surgical excision is the best treatment of resectable arteriovenous malformations.

    References

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      . Haemangioma, vascular malformations, and lymphovenous malformations: classification and methods of treatment. Plast Reconstr Surg 1993;91:1216–30.
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      . Soft-tissue venous malformations in adult patients: imaging and therapeutic issues. Radiographics 2001;21:1519–31.
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    Footnotes

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.