VOLUMINOUS ANGIOMYOLIPOMA TREATED WITH PERCUTANEOUS EMBOLIZATION: CASE REPORT AND LITERATURE REVIEW
Objective
Percutaneous embolization represents one of the feasible treatments of voluminous angiomyolipomas, because of the haemorragic risks related to this type of renal lesion.
We described the story of a woman with an angiomyolipoma with a maximum diameter of 8 cm, treated with percutaneous embolization. Additionally, we reviewed the literature about this field.
Materials and Methods
We described our case report. We searched in Medline and Embase using the following key words: ” kidney angiomyolipoma” and “percutaneous embolization”.
Results
RESULTS-DISCUSSION
61 year-old woman described nonspecific abdominal pain. The US reported a “Solid hyperechoic lesion with a maximum diameter of 8 cm, located in the cortical part of the inferior third of right kidney, with uncertain significance”.
The abdominal CT scan with contrast medium evidenced an esophitic lesion with in the inferior part of the left kidney, in its anterior side, with maximum axial and logitudinal diameter of 75 mm and 86 mm, respectively. The content was mainly fatty, with several vascular branches inside the lesion itself, with arterial ones directly derived from the renal artery. The lesion was surrounded by a thin capsule. There were no solid components with contrast enhancement. The appereance suggested an angiomyolipoma (fig.2).
The patient executed percutaneous embolization of the lesion using endo-coils The duration of treatment was about 35 minutes (fig.3-6). The were no technical complications. She had fever until 38°C, responsive to antibiotic therapy with ceftriaxone during the first day after the procedure. Additionally, she described mild lumbar pain during the 2 days after the procedure, treated with paracetamol. The patient was discharged in 5th day after the embolization.
The CT two months after the procedure demostrated a stable lesion (fig. 7); the patient was asymptomatic.
We found several reports about the procedure, with different materials used for embolization.
Discussions
RESULTS-DISCUSSION
61 year-old woman described nonspecific abdominal pain. The US reported a “Solid hyperechoic lesion with a maximum diameter of 8 cm, located in the cortical part of the inferior third of right kidney, with uncertain significance”.
The abdominal CT scan with contrast medium evidenced an esophitic lesion with in the inferior part of the left kidney, in its anterior side, with maximum axial and logitudinal diameter of 75 mm and 86 mm, respectively. The content was mainly fatty, with several vascular branches inside the lesion itself, with arterial ones directly derived from the renal artery. The lesion was surrounded by a thin capsule. There were no solid components with contrast enhancement. The appereance suggested an angiomyolipoma (fig.2).
The patient executed percutaneous embolization of the lesion using endo-coils The duration of treatment was about 35 minutes (fig.3-6). The were no technical complications. She had fever until 38°C, responsive to antibiotic therapy with ceftriaxone during the first day after the procedure. Additionally, she described mild lumbar pain during the 2 days after the procedure, treated with paracetamol. The patient was discharged in 5th day after the embolization.
The CT two months after the procedure demostrated a stable lesion (fig. 7); the patient was asymptomatic.
We found several reports about the procedure, with different materials used for embolization.
Conclusion
Our case report is similar to those described in literature. The percutaeous embolization represents a valid method for the treatment of amgiomyolipomas with big dimensions, especially considering the risk-benefit ratio for the patient.
Reference
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2. Guziński M, Kurcz J, Tupikowski K, Antosz E, Słowik P, Garcarek J. The Role of Transarterial Embolization in the Treatment of Renal Tumors.. Adv Clin Exp Med 2015; 24 (5):837-43.
3. Flum AS, Hamoui N, Said MA, Yang XJ, Casalino DD, McGuire BB, Perry KT, Nadler RB. Update on the Diagnosis and Management of Renal Angiomyolipoma. J Urol 2016;195 (4P1): 834-46.