Pelvic Arteriovenous Malformation (AVM) in Male Patient Presented as Perineal Pain: A Case Report and Review of Literature

Abstract

Pelvic arteriovenous malformations (AVM) of the pelvis are rare diseases and difficult to treat due to complex pelvic anatomy and extensive feeding vessel. Diagnosis of pelvic AVM relies on transrectal ultrasound (TRUS) and digital rectal examination as initial survey and computed tomography (CT) as secondary evaluation. Treatment options include surgical resection and embolization. We reported as 41-year-old male patient with congenital pelvic AVM that presented as perineal pain. TRUS revealed hypoechoic lesion with turbulent blood flow. CT demonstrated engorged vessel and angiography suggested high flow AVM with feeding artery from the right internal pudendal artery. Congenital pelvic AVM was diagnosed, but the patient refused treatment and requested clinical follow-up.

Congenital periprostatic pelvic arteriovenous malformation presenting as isolated pelvic pain and requiring endovascular embolization

“…Diagnosis of periprostatic AVMs requires high clinical acuity. They often present with vague, non‐localizing symptoms but can also be the cause of dramatic post‐operative bleeding events 1,4,5,8 . Abdominal auscultation may reveal a lower abdominal bruit; whereas further inspection may demonstrate haemorrhoids and/or perineal varicosities or a pulsatile mass on digital rectal examination 1,3 .…”

“…Thus, supplementation with contrast‐enhanced CT may be necessary. CT angiography is useful in determining the vascular anatomy and defining the extent of lesions during assessment and can also characterize progression and recurrence during follow‐up 1–7 …”

“…They are usually located in the brain, lungs and kidney. [1][2][3][4][5] AVMs confined to the pelvis are rare, and twice as uncommon in males. [1][2][3][4] Pelvic AVMs can be incidental findings, 4,6 but are usually diagnosed during symptomatic workup.…”

“…1,3 These manoeuvres are not routinely performed and clinical signs may not be elicited in the majority of patients. 5 Laboratory analyses are often non-specific. Owari et al 4 reported a case discovered during the work up of a patient with an elevated prostate specific antigen (PSA), whereas PSA was normal in a separate report by Suzuki et al 1 Transrectal Doppler ultrasonography is an appropriate first line imaging modality for detecting periprostatic AVMs.…”

“…[1][2][3]7 It is generally well tolerated and avoids the use of intravenous contrast at low cost. 5 Ultrasonography is readily available in rural and regional healthcare facilities; however, it is operator-dependent, with a narrow field of view and limited three-dimensional views. 2 Thus, supplementation with contrast-enhanced CT may be necessary.…”