Interventional management of acute bleeding giant renal angiomyolipoma: Report of three cases and review of the literature

To report our experiences of catheter embolization of three acute bleeding giant renal angiomyolipoma and to discuss the diagnostic and interventional management of this tumor entity in an emergency and elective setting in review of the literature.Materials and methodsThree female patients (43 ± 5.9 years) with giant renal angiomyolipomas (AML), two associated with tuberous sclerosis, presented with spontaneous acute perirenal hemorrhage and large retroperitoneal hematomas. Due to their age and intact parenchyma with normal renal retention parameters, they were treated with superselective transarterial embolization (TAE), applying a combination of particulate and liquid embolic material: 0.5–2 ml (300–500 μm/700–900 μm) Embospheres™ (Biosphere, France) were injected to block the tumor periphery followed by 0.2–1 ml mixture of Lipiodol™ (Byk Gulden, Germany) and Ethibloc™ (Ethicon, Germany) to occlude the feeder of the ruptured angiomyolipoma.All embolizations were successful and patients were discharged after 3–5 days. Follow-up MRI on discharge showed no bleeding and distinct atrophy of the embolized areas without impairment of normal renal parenchymal perfusion.Renal function remained normal during clinical and MRI follow-up (mean 28.3 ± 30.4 months).ConclusionsIn most patients with acute bleeding giant angiomyolipomas, it would be impossible to preserve the kidney by surgical attempts alone, so they should be, if technically possible, initially treated by selective arterial embolization. Catheter embolization should be considered as an elective therapy option in patients with symptomatic and/or large (>4 cm) AMLs. All AMLs associated with tuberous sclerosis should be monitored by annually MRI for lifetime to assess tumor growth and to predict complications.