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CASE REPORT
Year : 2006  |  Volume : 22  |  Issue : 1  |  Page : 75-76
 

Management of intratumoral pseudoaneurysm in a patient with bleeding renal angiomyolipoma


Department of Urology and Radiology, Shohada-e-Tajrish Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran

Correspondence Address:
Amir Haji Mohammad Mehdi Arbab
Shohada Hospital-Tehran-Iran, Tehran - 1989934148,
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-1591.24665

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   Abstract 

Angiomyolipoma (AML) is the most common benign renal tumor and intratumoral pseudoaneurysms are not uncommon in this condition .The risk of hemorrhage correlates with the size of tumor and persistence of pseudoaneurysms. We report a case of hemorrhagic angiomyolipoma associated with intratumoral pseudoaneurysm which was embolized successfully.


Keywords: Pseudoaneurysm, angiomyolipoma


How to cite this article:
Barghi M R, Rahmani M R, Haghighatkhah H R, Mehdi Arbab AH, Simaei N R, Khoob S. Management of intratumoral pseudoaneurysm in a patient with bleeding renal angiomyolipoma. Indian J Urol 2006;22:75-6

How to cite this URL:
Barghi M R, Rahmani M R, Haghighatkhah H R, Mehdi Arbab AH, Simaei N R, Khoob S. Management of intratumoral pseudoaneurysm in a patient with bleeding renal angiomyolipoma. Indian J Urol [serial online] 2006 [cited 2019 Jul 18];22:75-6. Available from: http://www.indianjurol.com/text.asp?2006/22/1/75/24665



   Introduction Top


Angiomyolipoma (AML) is the most common benign renal tumor that consists of varying amounts of mature adipose tissue, smooth muscle and thick-walled vessels .[1]

A renal angiomyolipoma is typically recognized as a fat-containing tumor on CT.[2] Although vascular complication is unusual, the risk of complication-especially when lesion is larger than 4 cm-is the main indication for treatment of angiomyolipoma.[2],[3] Intratumoral pseudoaneurysms are not uncommon within angiomyolipomas.

We report one case of hemorrhagic angiomyolipoma associated with intratumoral pseudoaneurysm.


   Case Report Top


A 54-year-old woman presented with sudden onset of right flank pain. Vital signs were normal. Laboratory studies disclosed a hemoglobin level of 11.5 g/dL.

CT was performed before and after administration of contrast material. A 4.5-cm heterogeneous tumor associated with a subcapsular hematoma was seen in the upper pole of the right kidney. A small amount of fat (confirmed by Hounsfield units -20) with in a lesion was seen on CTscan which was considred diagnostic of angiomyolipoma [Figure - 1]. Selective renal digital subtraction angiography was performed with a 5-F cobra catheter and confirmed the diagnosis of Intratumoral pseudoaneurysm [Figure - 2].

A hypervascular tumor in upper pole of renal was embolized with 300 mm PVA particles and because of leakage from pseudoaneurysm, which was embolized successfully using metal coil. [Figure - 3]


   Discussion Top


The risk of hemorrhage correlates with the size of the tumor. It is significantly greater in angiomyolipomas of more than 4 cm.[2],[3] In addition, multiple reports demonstrate association of pseudoaneurysm with angiomyolipoma which can increase risk of hemorrhage. Therefore Intrarenal or perinephric hemorrhage is the usual complication of

angiomyolipoma.[4],[5],[6]

In conclusion, large angiomyolipomas should be treated to avoid hemorrhage and the detection of pseudoaneurysms should prompt urgent treatment.

 
   References Top

1.Jinzaki M, Tanimoto A, Narimatsu Y, Ohkuma K, Kurata T, Shinmoto H, et al . Angiomyolipoma: Imaging findings in lesions with fat. Radiology 1997;205:497-502.  Back to cited text no. 1    
2.Oesterling JE, Fishman EK, Goldman S, Marshall FF. The management of renal angiomyolipoma. J Urol 1986;135:1121-4.  Back to cited text no. 2    
3.Steiner MS, Goldman SM, Fishman EK, Marshal FF. The natural history of renal angiomyolipoma. J Urol 1993;150:1782-6.  Back to cited text no. 3    
4.Lapeyre M, Correas JM, Ortonne N, Balleyguier C, Helenon O. Color-flow Doppler sonography of pseudoaneurysms in patients with bleeding renal angiomyolipoma. AJR 2002;179:145-7.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Yamakado K, Tanaka N, Nakagawa T, Kobayashi S, Yanagawa M, Takeda K. Renal angiomyolipoma: relationships between tumor size, aneurysm formation and rupture. Radiology 2002;225:78-82.   Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Koh KB, George J. Radiological parameters of bleeding renal angiomyolipoma. Scand J Urol Nephrol 1996;30:265-8.  Back to cited text no. 6  [PUBMED]  


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]



 

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