Renal angiomyolipoma

Case contributed by Dr Andrew Lawson

Presentation

Female patient presenting with acute pain in the right flank.

Patient Data

Age: 38
Gender: Female
Modality: CT

Heterogeneous fat containing rounded exophytic mass extending off the upper pole of the right kidney measuring 11.7 x 10.7 x 15.4 cm. The angiomyolipoma demonstrates internal density consistent with haematoma and haematoma also seen in the right pararenal space extending particularly posterior and inferior to the kidney, the largest portion measuring approximately 8.7 x 3.2 x 6.6 cm. The right kidney is displaced anteriorly and inferiorly as have the gallbladder and pancreatic head. The IVC is partially compressed. Small amount of free fluid seen around the liver. No renal calculus. No calculi seen in the path of the ureters. The liver, spleen, left adrenal gland and bowel are unremarkable. The right adrenal gland is not well discerned.

Modality: DSA (angiography)

Initial angiographic runs showed a significantly ptosed right kidney, with supply to the large upper pole angiomyolipoma via tortuous artery arising from the superior division of the right renal artery.

Selective catheterisation of the branch supplying the angiomyolipoma was achieved via a microcatheter, and contrast runs through this vessel showed tumour filling, but no supply to renal parenchyma. Embolisation was performed using a 50:50 dilution of absolute alcohol in lipiodol. A total of 12 mL was injected under careful angiographic observation to ensure no reflux to vessels supplying renal cortex.

Conclusion: Angiographically successful alcohol embolisation of the right renal angiomyolipoma.

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Case Information:

rID: 25628
Diagnostic certainty: Almost Certain
System: Urogenital
Tag: kidney
Inclusion in quiz mode: Included

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