Renal angiomyolipomas (AML) are benign lesions
usually left alone. However, lesions larger than 4 cm carry the risk of
spontaneous haemorrhage and need urgent treatment. Angiography and embolization
are the current standard of care particularly in patients with high operative
risks. Angio-embolization is a safe, minimally invasive procedure preserving
maximum renal parenchyma, with the added advantage of preventing
peri-procedural morbidity. Transarterial embolization of angiomyolipoma
demonstrates low rates of mortality and serious complications. However is
transarterial embolization a definite curative option in cases of large lesions
or has it only a role in management of bleeding tumours to arrest hemorrhage.
Here we present a case of young 25 year old female with sporadic non
tuberous sclerosis related left lower pole renal angiomyolipoma. The patient
was diagnosed with the same following spontaneous unprovoked retroperitoneal
hemorrhage and underwent emergency angioembolization using gelform and pushable
microcoils. Subsequent follow up after 4 months with contrast enhanced CT scan
showed reduction the vascularity with no significant reduction in size of the
tumour. Later following a multidisciplinary team discussion it was decided to
repeat angioembolization as the patient refused to undergo surgery. Repeat Angiography
showed new vessels recrutited from the inferior braches of the left lower pole
renal artery. The patient underwent a second session of embolization with
embospheres 100-300 microns until complete stasis was obtained with absent
tumour blush. Follow up after 6 months
showed more than 30% reduction in size of the tumour.
