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Metastatic Renal Cell Carcinoma Producing Arteriovenous Shunt

Stephen A. Howlett, MD; George J. Caranasos, MD
Arch Intern Med. 1970;125(3):493-495. doi:10.1001/archinte.1970.00310030103012.
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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.

Patient Summary  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


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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