An unusual renal mass
A woman aged 52, otherwise fit and well, was admitted as an emergency with the history of a sudden onset constant back pain on the right hand side, for the past four hours.
On examination her vital signs were blood pressure: 130/78 mm Hg; pulse 80/minute.
Abdominal examination was unremarkable, except for mild tenderness in the right renal angle. All blood investigations including inflammatory markers and liver function tests were within normal limits, with a haemoglobin of 12×10 g/l. The haemoglobin suddenly dropped to 8×10 g/l a day after admission. The patient was stabilised with fluid resuscitation and blood transfusion. She had an ultrasound scan of the abdomen (fig 1) and subsequently a computed tomography scan (fig 2).
Angiomyolipoma associated with tuberous sclerosis accounts for 20% of the tumours; these lesions are typically larger than isolated angiomyolipomas, and they are often bilateral and multiple.1