Fig. 4

A 72-year-old woman was admitted to the emergency department because of right flank pain and macroscopic haematuria. Laboratory investigation revealed haemoglobin of 9.3 mg/dl. Abdominal US showed only multiple clots within the urinary bladder. a-b Contrast-enhanced CT scan revealed a conglomerate of vessels in the upper pole of the right kidney, visible in arterial phase with early filling of the IVC (arrow). The diagnosis of RAVM was made and the patient was submitted to a selective right renal angiogram using a hydrophilic 4-F Simmons 1 catheter. c Angiogram showed a tortuous nidus in the RAVM at the level of the upper renal pole with supply from two different superior branches without contrast blush, which would have suggested active bleeding. d Subsequent embolisation with injection of liquid embolic material (Onyx, eV3 Europe SAS, Paris, France); interval angiogram shows exclusion of the upper lesion. Angiogram of the lower lesion followed