This case is a nice illustration of TSC with lung and renal disease. It also highlights the association between TS and multiple bilateral large renal angiomyolipomas and potential complications. The propensity to bleed increases with the size of AMLs which tend to be bigger in patients with TS 1. The multiplicity of lesions also increases risk of bleeding for obvious reasons. As we can see this patient has undergone multiple embolization procedures previously. On this study there was no active hemorrhage.