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Post biopsy renal arteriovenous fistula and pseudoaneurysm

Case contributed by Maria Ana Serrado
Diagnosis almost certain

Presentation

Renal transplant performed 1 month earlier. Hematuria following the third percutaneous renal biopsy for increased creatinine levels.

Patient Data

Age: 50 year
Gender: Male

B mode & Doppler US 2 days...

ultrasound

B mode & Doppler US 2 days after the biopsy

B mode image of the transplanted kidney shows a hyperechoic linear image in the middle third of the kidney, corresponding to the site of the biopsy. Spectral Doppler tracing reveals a low resistance waveform with increased systolic and diastolic flow.

B mode & Doppler US 7 days...

ultrasound

B mode & Doppler US 7 days after the biopsy

B mode image of the transplanted kidney shows an anechoic round structure image in the middle third of the kidney, corresponding to the site of the biopsy. Color Doppler images show focal color aliasing indicating high velocity at the arterio-venous fistula and surrounding blue and red speckles that indicate a “soft tissue bruit” caused by tissue vibrating. With increased color scale, the yin-yang sign, color flow pattern typical of pseudoaneurysm is present. The “soft tissue bruit” is no longer present.

B mode & Doppler US 1 mth...

ultrasound

B mode & Doppler US 1 mth after the biopsy

B mode and color Doppler images shows an anechoic round structure without flow within it, corresponding to the thrombosed pseudoaneurysm.

Case Discussion

This case demonstrates two uncommon post-image guided percutaneous renal biopsy complications, a renal arteriovenous fistula and a renal pseudoaneurysm. Both resolved spontaneously in short time.

 

Images courtesy of Dr Regina Martins, Dr Margarida Albergaria and Dr Lucinda Bogalho.

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