Intra-renal arterio-venous fistula with associated carcinoma of the kidney.

Case report The patient, Mrs J.S., aged 54, was first admitted to Stobhill General Hospital on 17 August 1965. Five years previously she had been investigated elsewhere because of haematuria and hypertension. A diagnosis of chronic pyelonephritis affecting the left kidney was made on the evidence of the intravenous pyelogram. She had been taking methyldopa, 500 mg t.i.d. since that time. Six weeks prior to her admission to Stobhill she had suddenly developed a bitemporal headache associated with a transient loss of vision. The headache had persisted since then, and had occasionally been associated with vomiting. On examination the only abnormality was a gross lumbar kyphoscoliosis. The pulse was regular, 185/100 mmHg. The apex beat was 5 in. from the midline in the fifth left interspace and was heaving in character. The fundi showed grade 2 hypertensive changes. These findings were associated with the presence of a harsh continuous murmur over the left renal angle. No neurological abnormalities could be detected. The possibility of a mild subarachnoid haemorrhage was considered, but skull X-ray, CSF analysis, electro-encephalography and bilateral