Arteriovenous (AV) shunting in malignant tumors is an unusual occurrence encountered most frequently in both primary and metastatic renal cell carcinomas (hypernephromas). This phenomenon has been little emphasized, compared to the many well-known metabolic alterations produced by these tumors. If sufficient shunting of blood occurs, high-output heart failure may result.1 Intrarenal shunting may induce ischemia and subsequent hypertension.2 Many of the hemodynamic changes produced by an AV communication in a metastatic renal cell carcinoma are exemplified by the patient discussed here.
A 62-year-old man (11-59-07) was admitted to the University of Florida Teaching Hospital because of weakness and wasting of the right thigh of ten months' duration. Seven years previously, a left nephrectomy had been performed for a renal cell carcinoma. No local extension or distant metastases were detected. The patient received local irradiation therapy postoperatively. Mild hypertension had been present for 15 years, and diabetes