Selective angioembolization in symptomatic renal angiomyolipoma: A series of four cases along with review of literature

Abstract

Abstract The management of renal angiomyolipoma (R-AML) should be characterized on the basis of symptoms and/or the presence of associated risk factors of hemorrhage. In total, four cases of large symptomatic R-AML were visited in our urology out-patient department within the 9-month period. They underwent selective angioembolization (SAE) and were followed up for at least 3 months. Case 1—A 40-year-old female with bilateral R-AML, largest 4 cm × 8 cm × 9 cm lesion on right kidney. Postangioembolization, she underwent a right partial nephrectomy and is in further follow-up with contrast-enhanced computed tomography of the kidney ureter bladder (KUB) region (CECT KUB). Case 2—A 36-year-old female had bilateral large R-AML associated with active bleeding and perinephric hematoma on her right side and underwent urgent SAE. Follow-up CECT KUB revealed bilateral large AML with no evidence of perinephric hematoma. Now, we are planning for a bilateral partial nephrectomy. Case 3—A 52-year-old female with symptomatic 54 × 53 mm left mid-pole R-AML. She developed postembolization syndrome and managed it conservatively. Follow-up CECT KUB revealed a marked reduction of the left R-AML lesion (1 cm × 1 cm). Case 4—A 41-year-old female with 44 mm × 40 mm exophytic upper pole right R-AML with active bleed underwent urgent SAE. Follow-up CECT KUB revealed right kidney AML lesion size reduction (27 mm × 28 mm) with no perinephric hematoma. SAE is better suited for AML with acute hemorrhage or patients with multiple comorbidities or multiple AML lesions. For large AMLs, SAE can also be used before surgery to decrease the size of tumors and the possibilities of procedural difficulty for nephron-sparing surgery.