From imaging to impact: A case of renal arteriovenous malformation

Renal arteriovenous malformations (rAVMs) are rare vascular anomalies, presenting with gross hematuria and requiring prompt diagnosis and management. We reported a case of a middle-aged male presenting with persistent and unexplained gross hematuria. Initial cystoscopy revealed a significant burden in the urinary bladder without any identifiable bleeding source. Contrast-enhanced computed tomography followed by CT angiography demonstrated a vascular nidus with early venous filling at the lower pole of the left kidney, consistent with rAVMs. The patient had a successful selective transcatheter embolization involving polyvinyl alcohol particles, coils, and a lipiodol-based embolic agent. Postembolization angiography confirmed a substantial reduction in arteriovenous shunting, with the preservation of renal parenchyma. The patient reported transient postprocedure flank pain and hematuria; however, hemoglobin levels and renal function remained stable. This situation highlights the significance of evaluating vascular causes in cases of unexplained hematuria and supports the endovascular embolization as a viable, kidney-preserving treatment option.