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Clinical Images

A Flank Bruit

Yoshinosuke Shimamura MD, Yasuo Sakurai MD, Hideki Takizawa MD
November 7, 2014

A 65-year-old Japanese male with hypertension presented with one-week history of anorexia and decreased urine output. Past medical history was significant with proteinuria found in his early 20’s, for which he underwent an open kidney biopsy at that time (results unknown). Physical exam was notable for an audible flank bruit above the right kidney. On admission, his blood urea nitrogen of 109.1 mg/dl, creatinine of 9.98 mg/dl and estimated glomerular filtration rate of 5 ml/min per 1.73 m2 according to the Modification of Diet in Renal Disease equation.  Plain computed tomography of the abdomen revealed right renal cysts with increased kidney size.  Enhanced computed tomography revealed enhanced renal vascular malformation, seen as a vascular-attenuation mass on arterial phase.  Selective renal angiography was performed, which demonstrated an arteriovenous fistula (AVF) and pesudoaneurysm in the right kidney (Fig 1). The feeding artery was embolized, and the postembolization angiogram showed complete obliteration of the fistula (Fig 2). The flank bruit disappeared after the procedure.

Figure 1

Figure 2

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1) Cura M, Elemerhi F, Suri R, et al. Vascular malformations and arteriovenous fistulas of the kidney. Acta Raidol. 2010; 51: 144-149.
2) Chimpiri AR, Natarajan B. Renal vascular lesions: diagnosis and endovascular management. Semin Intervent Radiol. 2009; 26(3): 253-61.

Brief Biography
Yoshinosuke Shimamura MD
Faculty, Department of Nephrology, Teine Keijinkai Medical Center, Sapporo, Hokkaido, Japan