Presentation
Hypotensive.
Patient Data
Heterogeneous fat containing rounded exophytic mass extending from the upper pole of the right kidney measuring 11.7 x 10.7 x 15.4 cm. This is most in keeping with an angiomyolipoma which was seen on previous abdominal ultrasound. The angiomyolipoma demonstrates internal density consistent with hematoma and hematoma 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.
A small amount of free fluid seen around the liver.
No renal calculus. No calculi are 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.
No free intra-abdominal air identified. Two 5 mm pulmonary nodule seen in the lateral left lower lobe. These could be followed up with outpatient CT chest.
Conclusion: 15 cm angiomyolipoma is seen extending from the upper pole of the right kidney with evidence of acute bleed with internal hematoma and retroperitoneal hematoma.
Case Discussion
CT features are those of a bleeding AML. DSA with embolization was performed.
There were no features of tuberous sclerosis in this patient.
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