Renal angiomyolipoma with acute haemorrhage
Three-day history of worsening right iliac fossa and flank pain with associated frank haematuria. Anaemic with an acute kidney injury. Background of tuberous sclerosis with known renal angiomyolipomas.
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Large bilateral renal angiomyolipomas with minimal visible residual renal tissue. Haemorrhage within right renal angiomyolipoma with central hyperdense acute component and surrounding large sub-acute component extending inferiorly. Nil intraperitoneal haemorrhage/free fluid.
Distended gallbladder. Multiple hypodense liver lesions unchanged from previous imaging. Lung bases clear. No pleural effusion. Multiple sclerotic foci throughout the visible skeleton unchanged from previous imaging. VP shunt in situ.
Renal angiomyolipomas are present within 55-75% of patients with tuberous sclerosis.The risk of spontaneous haemorrhage increases when tumour size increases beyond 3 cm in diameter.
Case courtesy of Dr Annah Lane.
- Crino PB, Nathanson KL, Henske EP (2006). "The tuberous sclerosis complex". N. Engl. J. Med. 355 (13): 1345–56.