PMC3738343_01
Axial CT of the lower abdomen demonstrates a well-defined tumor mass of 8.5 x 14 cm containing adipose and soft tissue elements consistent with a renal angiomyolipoma (small white arrows)
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ARSR-11-0029F1
Conventional CT with i.v. contrast injection (Figs. 1 and 2) demonstrated a left renal mass containing fat with an extended retroperitoneal hematoma.
Sagittal CT image demonstrates the longitudinal extend (17 cm) of the giant angiomyolipoma. The upper part of the left kidney shows regular renal parenchyma without tumor infiltration (black arrows). There is a significant retroperitoneal hematoma (small white arrows)
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ARSR-11-0029F2
Conventional CT with i.v. contrast injection (Figs. 1 and 2) demonstrated a left renal mass containing fat with an extended retroperitoneal hematoma.
Selective angiogram of the left upper renal artery supplying approximately two-thirds of the regular renal parenchyma. There are no significant feeders to the angiomyolipoma
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ARSR-11-0029F3
A selective catheterization of the upper and lower pole left renal artery revealed that the upper renal artery was exclusively supplying the renal parenchyma not affected by the AML with no significant feeding of the tumor (Fig. 3) whereas the lower renal artery solely supplied the giant AML (Fig. 4).
Implantation of an Amplatzer Vascular Plug Type II in the left lower renal artery. There is an abrupt and complete occlusion of the AML supplying vessel
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ARSR-11-0029F5
AVP was deployed through a long 6-F envoy-guiding catheter (Codman & Shurtleff, Raynham, MA, USA) with 0.070" ID (1.8 mm). An instant and complete occlusion of the lower left renal artery was achieved (Fig. 5).
Coronal view of the CT demonstrates an extended necrosis (large white arrows) of the angiomyolipoma tumor mass 10 days after the selective arterial embolization. The air bubbles are indicative for an abscess formation (small white arrows)
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ARSR-11-0029F6
AML with signs of abscess formation (Fig. 6) 14 days post embolization. A nephron-sparing surgical resection of the residual AML was performed, preserving the healthy upper pole of the left kidney, which was supplied by the separate upper renal artery.