64 year old male who presents with right testicular pain, mild right flank pain, and signs of early CHF.
Comment: This patient presented with scrotal pain, right flank pain, and early CHF. Upon review of the imaging, it became clear that all three of these symptoms were related. The renal angiogram demonstrated prompt opacification of the right renal vein and IVC. This appeared to be secondary to an AV fistula that resulted in increased venous pressure, which contributed to the development of a varicocele (through a branch of the right renal vein draining into the right testicular vein before passing into the IVC). In addition, the outflow from the fistula likely increased right heart pressure, leading to his cardiac symptoms.