An unusual varicocele due to spontaneous arteriovenous fistula

Case report of a successful multidisciplinary approach to a giant scrotal malformation

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Giant arterio-venous malformations in the pelvic region are rare.

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Selective angiography is mandatory for diagnosis and treatment to define the extent and limits of the malformation.

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Skin necrosis can by managed jointly by vascular and plastic surgeons.

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Azoospermia is frequent in the postoperative period.

Introduction

Congenital pelvic malformations are rare and represent a difficult therapeutic challenge. Scrotal arteriovenous malformations are quite unusual, with only a few such cases reported in the literature. Only one case of scrotal malformation? due to an arteriovenous fistula resulting in azoospermia has been described.

Presentation of case

The two-phase strategy adopted in that case permitted complete treatment of a large-sized malformation that was served by 4 main blood confluences.

Discussion

Angio-CT performed using reconstructions with MIP and SSD algorithms provided more detailed data about the extension of the afferents and efferents of the arteriovenous malformation, thus enabling us to plan the endovascular treatment of the lesion.

Conclusion

A multidisciplinary approach is mandatory to achieve good results in these cases.

Varicocele Due to Post-traumatic Arteriovenous Fistula

Varicocele consists of abnormally dilated and tortuous veins within the pampiniform plexus, usually in the left scrotum. We reported a rare case of right varicocele due to post-traumatic arteriovenous fistula successfully treated by percutaneous embolization.

Varicocele complicating spontaneous arteriovenous fistula

We describe herein a rare case of a varicocele complicating spontaneous arteriovenous fistula. A 40-year-old man was referred to our hospital in November 2006, complaining of a non-tender mass in the left scrotum at the age of 15 and thereafter. On examination, his left scrotum revealed a large varicocele, but no manifest superficial thrill was noted. Scrotal ultrasonograpy revealed approximately 7 cm large varicocele. Computed tomography angiography revealed the existence of an arteriovenous fistula between the left testicular artery and the veins of the left pampiniform plexus. We laparoscopically carried out internal spermatic vessels ligation under the diagnosis of a varicocele complicating a spontaneous arteriovenous fistula. The postoperative course was uneventful. At 18 months postoperatively, the varicocele and fistula had not recurred.

Delayed presentation of arteriovenous fistula 20 years after blunt renal trauma

Delayed hematuria following blunt trauma is rare but can be significant. We describe an unusual delayed presentation of renal arteriovenous fistula following blunt trauma.A gentleman presented with hematuria and clot colic. Following initial investigations, renal arteriography showed an arteriovenous fistula in the mid-pole of the right kidney. The fistula was successfully occluded by super-selective coil embolization. Although this case is an unusual presentation, AV fistulae must be ruled out in management of patients of hematuria.