PMC9595573_01
Preoperative contrast-enhanced computed tomography of the abdomen: (A) axial plane (red arrow: right renal angiomyolipoma); and (B) sagittal plane.
fsurg-09-955932-g001.jpg
PMC9595573_01_fsurg-09-955932-g001.jpg
F1
A contrast-enhanced CT scan showed a left renal tumor of 28 cm x 17 cm x 27 cm (Figure 1), suggestive of a giant angiomyolipoma, occupying the entire abdominal cavity and shifting abdominal organs. A 10 cm x 6.7 cm x 7.9 cm angiomyolipoma was also present in the right kidney (Figure 1A).
(A) Intraoperative left renal artery angiography (red arrow: main renal artery). (B) Endovascular clamping of the left renal artery (endovascular balloon occluding the main renal artery).
fsurg-09-955932-g002.jpg
PMC9595573_01_fsurg-09-955932-g002.jpg
F2
Surgery began with a preliminary angiography through a left femoral artery percutaneous access to evaluate the left renal artery (Figure 2A). The renal artery was end-clamped using a 12 mm x 40 mm angioplasty balloon (Cordis Powerflex Pro, Cordis, Miami Lakes, FL, USA) (Figure 2B).
(A) Left thoraco-phreno-laparotomy. (B) Surgical specimen.
fsurg-09-955932-g003.jpg
PMC9595573_01_fsurg-09-955932-g003.jpg
F3
By a left thoracic-phreno-laparotomy at the level of the ninth intercostal space, a retroperitoneal kidney dissection was performed (Figure 3A). Pathological examination revealed a tumor measuring 40 cm x 30 cm x 9 cm and 10 kg of weight and confirmed the presence of AML (Figure 3B).
Postoperative contrast-enhanced computed tomography of the abdomen: (A) axial plane; (B) sagittal plane.
fsurg-09-955932-g004.jpg
PMC9595573_01_fsurg-09-955932-g004.jpg
F4
A postoperative CT scan showed a complete resection (Figure 4).