Arteriovenous malformation of the ureter — a rare cause of haematuria

Abstract

Arteriovenous malformation (AVM) of the urinary tract A 19-year-old woman was admitted with gross haematuria and fever; she reported a history of repeated wholeis uncommon; since the first case documented by Varela in 1928 [1], only 200 cases have been reported, mostly stream haematuria from the age of 9 years, and intermittent right loin discomfort associated with the attacks of of renal AVM, the cause being congenital or acquired. Kaplan et al.[2] reported the first case of ureteric AVM, haematuria. A general physical examination revealed marked pallor; her blood pressure was stable at the final diagnosis being made after excisional biopsy and fulguration of the ureteric nodule, later confirmed 130/80 mmHg. There was no organomegaly of the abdomen, no loin tenderness could be elicited and by histology. The present case is the second ureteric AVM in the English literature. Patients with this conabdominal bruit was not detected. Investigations confirmed microcytic and hypochromic anaemia (haemodition usually present with recurrent gross whole-stream globin 4.5 g/L); liver and renal function and the coagulation profile were all normal. Urine analysis confirmed haematuria, with a red blood cell count of>30 cells per high-power field, but urine cultures for infection and acid-fast bacilli were negative. A blood culture grew Enterococcus fecalis. Her condition improved with antibiotics and blood transfusion.Ultrasonography showed a right hydroureter and hydronephrosis that was confirmed with IVU, which also detected delayed excretion of contrast over the right side, but the level and cause of obstruction were not clear. Cystoscopy and right retrograde pyelography showed a tubular filling defect at the distal end of the right ureter. There were also multiple filling defects in the renal pelvis and the proximal right ureter which were compatible with blood clots (Fig.

Benign lateralizing haematuria: the impact of upper tract endoscopy

“…However, there are a few patients with unilateral supravesical bleeding in whom these initial investigations are normal. While common conditions, including RCC, TCC of the renal pelvis or ureter, and renal or ureteric calculus may still be the cause of bleeding, less common conditions must be considered (Table 1) [1–27]. Second‐line urine, serum and radiological investigations (selective upper tract urine culture, urine microscopy for dysmorphic red cells, haemoglobin electrophoresis, clotting studies, percutaneous renal biopsy, renal angiography and venography, CT or MRI) are therefore often undertaken.…”

Arteriovenous malformation of the ureter diagnosed by CT urogram

“…Ureteral AVM is a known cause of hematuria that has been described in only a small number of prior case reports. 2 , 3 , 4 , 5 The diagnosis of AVM can be confirmed by catheter angiography or histology; however, as our case demonstrates, CTU can also diagnose ureteral AVM when characteristic imaging features are seen. In this case, the presence of a feeding artery and draining veins, and the presence of characteristic contrast enhancement and washout were sufficient to diagnose AVM.…”

“…The few existing case reports of ureteral AVM have been diagnosed by ureteroscopy and biopsies. 3 , 4 , 5 While ureteroscopy has the advantage of being both diagnostic and therapeutic, invasive studies may not be necessary or desirable in cases of asymptomatic AVM associated hematuria.…”

Polypoid arteriovenous malformation of the ureter mimicking a fibroepithelial polyp, a case report

“…Ureteroscopy revealed an inflamed, ulcerated, ‘cobblestone’-like mucosa and histology confirmed chronic inflammation without evidence of malignancy. Eventually, right renal artery cannulation showed tortuous vessels around the right ureter consistent with AVM, and selective embolization was carried out [6]. The third case was a 29 year old non-Caucasian woman with intermittent gross haematuria and right lower quadrant pain.…”