Renal angiomyolipoma - hemorrhagic

Case contributed by Tyler Tsang
Diagnosis certain

Presentation

History of dyslipidemia presented with sudden syncopal event after dinner and right lower quadrant flank pain. Admits nausea and vomiting. Patient became unresponsive in CT.

Patient Data

Age: 65 years
Gender: Female

IV contrast-enhanced CT image through the abdomen shows an 8.7 x 6.5 x 6.9 cm predominantly fat attenuated exophytic mass arising from the lower pole right kidney. There is severe perinephric and retroperitoneal hyperdense fluid adjacent to this finding.

1 day later

dsa

Digital subtraction angiography cine clip taken in a coronal plane of right kidney demonstrates a hypervascular mass off the inferior pole of the right kidney with dilated blood vessels and small focal outpouchings consistent with small aneurysms.

8 month follow-up

ct

IV contrast-enhanced CT image through the abdomen shows a 6.6 x 6.4 x 6.0 cm exophytic mass arising from the lower pole which is mostly fat density. There is also internal calcification and soft tissue density. Hemorrhage seen on prior CT has resolved.

Case Discussion

Initial CT demonstrated an exophytic right renal mass with attenuation <-10 Hounsfield units consistent with angiomyolipoma. The mass had internal calcifications present which are rarely seen in angiomyolipoma 1. There was a significant amount of surrounding hemorrhage suggestive of an actively bleeding angiomyolipoma (Wunderlich syndrome) 1. Subsequent angiography demonstrated a hypervascular mass. The patient was successfully treated with embolization of the vessels supplying the tumor with ethanol/lipiodol.

Co-authors: Rebecca Kish, MD, Christopher Stark, MD, Christine Cooley, MD

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