64 Angiomyolipoma Embolization

CASE 64


Clinical Presentation


An 18-year-old male presented with left-sided flank pain and gross hematuria.



image

Figure 64-1 CT of the abdomen. (A) Precontrast-enhanced and (B) postcontrast-enhanced CT images of the abdomen show masses (arrows) in both kidneys. Note the irregular enhancement. Low-density components of these masses represent fat elements.


Radiologic Studies


Cross-Sectional Imaging


Contrast-enhanced CT scans show bilateral renal masses (Figs. 64-1A, B). The masses were heterogenous in appearance and contained fat. Brain imaging of this patient obtained previously shows the presence of an enhancing mass lesion in the region of the enlarged right lateral ventricle (Figs. 64-2A, B). Coarse calcifications are present in the brain on CT (Fig. 64-2C).


Diagnosis


Bleeding angiomyolipoma in a patient with tuberous sclerosis (TS).


Treatment


Equipment



  • 5F sheath
  • 5F pigtail angiographic catheter (Boston Scientific, Natick, Massachusetts)
  • 5F RC-1 catheter for selective renal angiography (Boston Scientific, Natick, Massachusetts)
  • Microcatheters for superselective catheterization and embolization
  • 0.035” and 0.014” guidewires
  • 300- to 500-micron PVA particles (Boston Scientific, Natick, Massachusetts)


image

Figure 64-2 Cross-sectional imaging of the brain. (A) T1-weighted axial MR image of the brain shows an enlarged right lateral ventricle with a mass lesion (arrow) in the region of the foramen of Monro. (B) Sagittal T1-weighted gadolinium-enhanced image of the brain shows intense enhancement of this mass (arrow). (C) Noncontrast-enhanced CT shows coarse calcifications (arrows) in the brain.



  • Balloon-occlusion catheters (Boston Scientific, Natick, Massachusetts)
  • Alcohol
  • Contrast material

Selective Embolization


The right common femoral artery was catheterized using the Seldinger technique, and a 5-French (F) sheath was inserted. An aortogram was obtained using a 5F pigtail catheter (Boston Scientific, Natick, Massachusetts), which revealed bilateral vascular lesions in the kidneys (Figs. 64-3A, B). The right renal artery was selectively catheterized with a 5F RC-1 catheter (Boston Scientific, Natick, Massachusetts), and renal arteriography was performed (Fig. 64-3C

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Jan 8, 2016 | Posted by in INTERVENTIONAL RADIOLOGY | Comments Off on 64 Angiomyolipoma Embolization
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