Case Report # 1

Submitted by: Keith Pettibon

Faculty reviewer: Sandra Oldham, MD

Date accepted: 24 August 2010

Radiological Category: Principal Modality (1):

Principal Modality (2): Fluoroscopy

CTVascular Radiology

Case History

Ms. W is a 63 year old white female who presented to her outside physician with

symptoms of pneumonia and fluid around her lungs. As part of her evaluation,

she had a CT scan of the abdomen and pelvis.

Radiological Presentations

Radiological Presentations

Radiological Presentations

Case History

Ms. W denied any symptoms related to the mass. She denied any pain, hematuria,

or dysuria.

• Percutaneous Biopsy

• MRI

• Sonogram

• Lab work

Which one of the following is your choice for the appropriate diagnosis?

Test Your Diagnosis

• Angiomyolipoma

• Renal Cell Carcinoma

• Liposarcoma

• Wilms Tumor

• Lipoma

Findings:

Differential:

Findings and Differentials

• Angiomyolipoma

• Renal Cell Carcinoma – usually does not contain fat

• Liposarcoma

• Wilms Tumor

• Lipoma

Findings:

Differential:

Findings and Differentials

• Angiomyolipoma

• Renal Cell Carcinoma – usually does not contain fat

• Liposarcoma – no defect in renal parenchyma

• Wilms Tumor

• Lipoma

Findings:

Differential:

Findings and Differentials

• Angiomyolipoma

• Renal Cell Carcinoma – usually does not contain fat

• Liposarcoma – no defect in renal parenchyma

• Wilms Tumor – very uncommon in adults

• Lipoma

Findings:

Differential:

Findings and Differentials

Percutaneous biopsy performed was consistent with angiomyolipoma.

• Angiomyolipoma

• Renal Cell Carcinoma

• Liposarcoma

• Wilms Tumor

• Lipoma

Findings:

Differential:

Findings and Differentials

The CT shows a 7 cm. heterogenous, fat containing mass. The presence of fat in a

renal mass is usually considered diagnostic for angiomyolipoma (although renal

lipoma, liposarcoma, and renal cell carcinoma engulfing perinephric fat are other

rare possibilities).

Discussion

The CT shows a 7 cm. heterogenous, fat containing mass. The presence of fat in a

renal mass is usually considered diagnostic for angiomyolipoma (although renal

lipoma, liposarcoma, and renal cell carcinoma engulfing perinephric fat are other

rare possibilities).

95% of angiomyolipomas contain enough fat to be detected by CT scan.

Discussion

The CT shows a 7 cm. heterogenous, fat containing mass. The presence of fat in a

renal mass is usually considered diagnostic for angiomyolipoma (although renal

lipoma, liposarcoma, and renal cell carcinoma engulfing perinephric fat are other

rare possibilities).

95% of angiomyolipomas contain enough fat to be detected by CT scan.

Angiomyolipomas are benign hamartomas composed of vascular components,

smooth muscle components and fat.

Discussion

The CT shows a 7 cm. heterogenous, fat containing mass. The presence of fat in a

renal mass is usually considered diagnostic for angiomyolipoma (although renal

lipoma, liposarcoma, and renal cell carcinoma engulfing perinephric fat are other

rare possibilities).

95% of angiomyolipomas contain enough fat to be detected by CT scan.

Angiomyolipomas are benign hamartomas composed of vascular components,

smooth muscle components and fat.

Smaller angiomyolipomas are often asymptomatic and are usually very slow growing.

Discussion

Angiomyolipomas become at risk for spontaneous hemorrhage at 4 cm.

Discussion

Angiomyolipomas become at risk for spontaneous hemorrhage at 4 cm.

80% develop spontaneously, however 20% are associated with tuberous sclerosis.

Discussion

When associated with tuberous sclerosis, patient often has multiple

angiomyolipomas along with renal cystic disease.

80% of people with tuberous sclerosis develop angiomyolipomas. They are grow

more rapidly than the sporadic form.

Discussion

When associated with tuberous sclerosis, patient often has multiple

angiomyolipomas along with renal cystic disease.

80% of people with tuberous sclerosis develop angiomyolipomas. They are grow

more rapidly than the sporadic form.

Other findings in tuberous sclerosis include: seizures, mental retardation, ash leaf spots on skin, cortical and retinal hamartomas, cardiac rhabdomyomas.

Discussion

Treatment Options include nephrectomy, active surveillance and selective

embolization.

Discussion

Treatment Options include nephrectomy, active surveillance and selective

embolization.

Ms. W was referred to the interventional radiology department for selective

embolization.

Discussion

Radiological Presentations

Radiological Presentations

From study published in Journal of Vascular and Interventional Radiology, 2005

19 patients underwent selective embolization for 30 AMLs. 10 of these patients had TS. The other 9 were sporadic.

Recurrence (defined as increase of tumor size by 2 cm or repeated symptoms over the following 6 months-11 years) occurred in 6 of the patients with TS but there was no recurrence in the sporadic patients.

Conclusion: Embolization is an effective treatment option for angiomyolipomas however lifelong surveillance is important, especially in patients with TS.

Discussion

Zagoria, Ronald J., Ronald J. Zagoria, Julia R. Fielding, and Wiliams W. Mayo-Smith.Genitourinary Imaging: Case Review. Philadelphia: Mosby, 2007. Print.

Kothary, Nishita. “Renal Angiomyolipoma: Long-tern Results after Arterial Embolization.” Journal of Vascular and Interventional Radiology 16.1 (2005): 45-50.

Israel, Gary. “CT Differentiation of Large Exophytic Renal Angiomyolipomas and Perirenal Liposarcomas.” American Journal of Radiology 179 (2002): 769-73.

References