A case of renal arteriovenous fistula diagnosed by pharmacoangiography

A 17-year-old man, who had previously been followed for Nutcracker phenomenon, presented with back pain and gross hematuria. As he developed tamponade of the urinary bladder repeatedly, and the hemoglobin level decreased, we thus performed emergency angiography. A selecive left renal venogram revealed the left renal vein to be compressed between the superior mesenteric artery and the abdominal aorta, while the development of an extensive peri- and para-renal collateral circulation was also observed. We next performed epinephrine pharmacoangiography in order to better visualize any abnormal vessels. A left renal arteriovenous fistula was thus diagnosed by this method, and treated successfully by transcatheter embolization using a platinum coil.