Presentation
Left flank pain, hematuria and recurrent urinary tract infections.
Patient Data
There is a focal defect within the left kidney, mid pole, with an echogenic, lobulated, intra and extra-renal mass lesion. There is no hydronephrosis or hydroureter. There is intralesional vascularity with features suggestive of left renal upper pole branch supply.
An ill-defined, irregular, mixed density, left renal and pararenal fat-containing mass is present. The origin appears left anterior renal upper/ mid-pole, with a wedge defect and volume loss. There is punctate calcification present. There is well-demonstrated left renal arterial branch supply and left renal venous drainage. There is a heterogeneous enhancement of the lesion suggestive of a left renal angiomyolipoma. The left adrenal gland is normal.
Additional findings:
intrahepatic hemangioma in liver segment 2
bulky uterus with a fundal submucosal uterine fibroid
nabothian cysts
Case Discussion
The patient has a known history of left renal exophytic angiomyolipoma with a history of prior embolization. The renal cortical defect with a claw sign, the identified arterial supply and venous drainage, heterogeneous architecture and enhancement are consistent with a renal angiomyolipoma.
The differential diagnosis includes a renal cell carcinoma in view of the large and atypical nature and a liposarcoma, both of which were considered less likely with the ongoing remission over a lengthy period of follow-up in an external department. A renal oncocytoma was considered unlikely due to the ill-defined, heterogeneous and exophytic appearance.
Case courtesy: Dr I.A.Nagdee.