心不全症状を呈した腎動静脈瘻を伴う腎細胞癌の1例

Abstract

The patient was a 62-year-old male who had visited a physician with the chief complaint of fever. After IVP and CT scanning, left real carcinoma was suspected and he was transferred to our hospital on March 2, 1982. The chest X-ray showed cardiac enlargement, distention of the pulmonary veins and symptoms of congestive heart, such as dyspnea. Selective renal angiography revealed marked arteriovenous fistulae present in the neovascularity, while cardiac echo and VCG did not suggest any disease of the endocardium or the valves. Thus, the case was diagnosed as cardiac insufficiency caused by renal cell carcinoma accompanied by arteriovenous fistulae. On March 31, 1982, left transabdominal nephrectomy was performed. The specimen measured 6 x 6.5 x 13.5 cm and weighed 395 g. Histological examination of the specimen showed clear cell carcinoma, and fragmentation of the lamina elastica was observed in the arteries. Improvements in the chest X-ray findings as well as the subjective symptoms were observed post-operatively, and the patient was discharged on April 21, 1982. Since cases of renal cell carcinoma accompanied by renal arteriovenous fistulae in which congestive heart failure develops are rare in Japan, we have reported this case.