Giant idiopathic renal arteriovenous fistula managed by coils and amplatzer device: Case report and literature review

Figure 1 Axial contrast enhanced computed tomography image. A: Axial contrast enhanced CT image at the level of the heart shows markedly dilated RA and the RV. Note small right pleural effusion due to right ventricular failure; B: Axial contrast enhanced CTA image at the level of right kidney reveals dilated right renal artery (red curved arrow) and a peripherally calcified aneurysm (yellow arrowheads) with early enhancing dilated renal vein (straight arrows) and IVC suggestive of arteriovenous fistula. Note mild ascites due to right ventricular failure (white arrowheads); C: 3D volume rendered image from the CTA data provides an excellent demonstration of marked aneurysmal right renal artery and vein with secondary severe dilatation of the IVC and gonadal varices due to increased blood flow volume. RA: Right atrium; RV: Right ventricle; CTA: Computed tomography angiogram; IVC: Inferior vena cava.