The kidneys have been almost completely replaced by angiomyelolipomas, and appear grossly enlarged and echogenic with loss of corticomedullary differentiation. There are also several renal cysts.
Within the liver, there are several cysts as well as small echogenic lesions. The differential for the echogenic lesions in this patient includes haemangioma and angiomyolipoma. Whilst angiomyolipomas of the liver are generally rare (and haemangiomas very common), there is a reported association of multiple hepatic angiomyolipomas with tuberous sclerosis, particularly in patients with diffuse renal angiomyolipomas1.