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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 15  |  Issue : 1  |  Page : 134-135

Bilateral sporadic renal angiomyolipoma - Ultrasonography and computed tomography imaging


Department of Radio-diagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India

Date of Submission10-Oct-2019
Date of Decision15-Nov-2019
Date of Acceptance28-Nov-2019
Date of Web Publication13-Oct-2020

Correspondence Address:
Dr. Suresh V Phatak
Department of Radio-diagnosis, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_199_19

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  Abstract 


Angiomyolipomas (AML) are basically benign hamartomas. When associated with other autoimmune diseases such as tuberous sclerosis, it can prove to be fatal due to increased hemorrhage or malignant transformation if left untreated. High fat containing AML can be diagnosed well on computed tomography as well as ultrasonography.

Keywords: Bilateral sporadic renal angiomyolipoma, computed tomography, renal, ultrasonography


How to cite this article:
Pattabiraman S, Phatak SV, Patwa PA, Marfani G. Bilateral sporadic renal angiomyolipoma - Ultrasonography and computed tomography imaging. J Datta Meghe Inst Med Sci Univ 2020;15:134-5

How to cite this URL:
Pattabiraman S, Phatak SV, Patwa PA, Marfani G. Bilateral sporadic renal angiomyolipoma - Ultrasonography and computed tomography imaging. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2020 Oct 23];15:134-5. Available from: http://www.journaldmims.com/text.asp?2020/15/1/134/297976




  Introduction Top


Angiomyolipomas (AML) contain three main components: smooth muscle cells, blood vessels, and mature fat cells. The prevalence of AML in the general population is approximately 0.3% and makes up at least 3% of solid renal masses.[1]


  Case Report Top


A 30-year-old male patient with no significant history presented with gross hematuria since 3 years and no other complaints. The patient gave no history of pain in flanks either, and was not a known case of renal or ureteric calculi. Local examination gave no signs to further aide diagnosis or indicates tuberous Sclerosis. Abdominal sonography revealed enlarged kidneys with multiple hyperechoic fatty lesion in each kidney showing peripheral vascularity on color Doppler [Figure 1] and [Figure 2]. Computed tomography (CT) was done to further evaluate the lesion, which revealed enlarged kidneys with a hypodense lesion within both kidneys of (-17 HU) on the right and (-25 HU) on the left [Figure 3].
Figure 1: Large hyperechoic nodule in the right kidney showing posterior acoustic shadowing suggestive of a fat containing lesion

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Figure 2: Fatty lesion showing peripheral vascularity on Doppler

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Figure 3: Bilateral kidneys showing multiple hypodense lesions with – 17 HU on the right and –25 HU on the left indicative of presence of fat

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  Discussion Top


It is one of the few renal masses that can be definitively diagnosed by imaging modalities alone. AML have a strong female predisposition with it vastly occurring in the middle-age group of patients. Usually, 80% of the AMLs are solitary and small in presentation and are somewhat asymptomatic. If at all symptoms occur, they are the result of tiny aneurysms in the vasculature supplying the AML or are also caused by pressure changes. While the remaining 20% present with the stigmata of tuberous sclerosis and are more expansile lesions and get diagnosed before the patient attains their fourth-decade of life.[2]

Sporadic renal AML have a prevalence of 0.44% with about 57% found in the right kidneys and 43% in the left with incidence of bilateral multiple renal AML being very rare.[3]

The appearance of AML is variable on ultrasonography depending on the percentage of the respective components and if hemorrhage is present or not. Typically, AMLs appear well-circumscribed and have high reflectivity which makes it more echogenic than the fat present in the sino-echogenic complex of the kidneys. This makes it easier to incidentally detect even smaller lesions. AMLs with a higher percentage of muscle or those undergoing hemorrhage or necrosis show decreased reflectivity/echogenicity. Meanwhile posterior acoustic shadowing is seen in approximately 30% of AMLs.[4]

Sporadic AMLs on CT could be described as a well-circumscribed lesion with the presence of intratumoral fat almost clinching the diagnosis, although it can also be present in Wilms' tumor, renal oncocytoma, and renal cell carcinoma (RCC) which are indistinguishable from AMLs on CT. Rare cases may show retroperitoneal lymph node involvement and extrarenal extension. In some cases, there is extension of AMLs into the renal vein and then maybe inferior vena cava as well.[5],[6],[7],[8],[9]


  Conclusion Top


Sporadic bilateral renal AMLs are a rare entity. Ultrasound and CT are highly specific for its diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kaur G, Thajudeen B. Asymptomatic bilateral giant angiomyolipoma. Saudi J Kidney Dis Transpl 2017;28:675-7.  Back to cited text no. 1
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2.
Zagoria RJ, Brady CM, Dyer RB. Renal masses. Genitourinary Imaging: The Requisites. 3rd ed., Ch. 3. Philadelphia: Elsevier; 2016. p. 90-2.  Back to cited text no. 2
    
3.
Fittschen A, Wendlik I, Oeztuerk S, Kratzer W, Akinli AS, Haenle MM, et al. Prevalence of sporadic renal angiomyolipoma: A retrospective analysis of 61,389 in- and out-patients. Abdom Imaging 2014;39:1009-13.  Back to cited text no. 3
    
4.
Maher M, Dixon AK. Renal masses: Imaging and biopsy. In: Grainger and Allison's Diagnostic Radiology: Abdominal Imaging. 5th ed., Ch. 36. Philadelphia: Churchill Livingston Elsevier; 2015. p. 886-7.  Back to cited text no. 4
    
5.
Haaga JR, Boll D. Kidney. In: Computed Tomography and Magnetic Resonance Imaging of the Whole Body E-Book. 6th ed., Ch. 54. Philadelphia: Elsevier; 2017. p. 1823-7.  Back to cited text no. 5
    
6.
Balwani MR, Pasari A, Tolani P. Widening Spectrum of Renal Involvement in Psoriasis:First Reported Case of C3 Glomerulonephritis in a Psoriatic Patient. Saudi Journal of Kidney Diseases and Transplantation: An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia 2019;30:258-60.  Back to cited text no. 6
    
7.
Singhania S, Singhania A, Khan S, Kumar V, Singhania P. Prenatal Diagnosis of Cross-Fused Renal Ectopia: Still a Dilemma. Donald Sch J Ultrasound Obstet Gynecol 2017;11:225-6. Available from: https://doi.org/10.5005/jp-journals-10009_1526. [Last accessed on 2019 Sep 19].  Back to cited text no. 7
    
8.
Balwani MR, Bawankule C, Khetan P, Ramteke V, Tolani P, Kute V. An Uncommon Cause of Rapidly Progressive Renal Failure in a Lupus Patient: Pauci-Immune Crescentic Glomerulonephritis. Saudi Journal of Kidney Diseases and Transplantation: An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia 2018;29:989-92. Available from: https://doi.org/10.4103/1319-2442.239632. [Last accessed on 2019 Sep 19].  Back to cited text no. 8
    
9.
Balwani MR, Pasari A, Meshram A, Jawahirani A, Tolani P, Laharwani H, et al. An Initial Evaluation of Hypokalemia Turned out Distal Renal Tubular Acidosis Secondary to Parathyroid Adenoma. Saudi Journal of Kidney Diseases and Transplantation: An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia 2018;29:1216-19. Available from: https://doi.org/10.4103/1319-2442.243965. [Last accessed on 2019 Sep 19].  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Introduction
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