PMC5450460_01
A 41-year-old pregnant woman in the 7th month of pregnancy referred for right-sided abdominal pain and the sonographic diagnosis of polyhydramnios and diagnosed with renal epithelioid angiomyolipoma associated with pulmonary lymphangioleiomyomatosis. (a) Transverse T2-weighted image depicts right renal heterogeneous mass lesion with slightly hyperintense parts (arrowhead), corresponding to areas of fat and solid components (asterisk), of low-signal intensity when compared to normal renal parenchyma. (b) Transverse T1-weighted image shows lesion heterogeneity, with areas of fat detected hyperintense (arrowhead) and solid parts (asterisk), isointense to normal renal medulla. (c) Transverse fat-suppressed T1-weighted image demonstrates saturation of the hyperintense T1 components (arrowhead) of the lesion, findings compatible with the presence of fat. (d) Transverse apparent diffusion coefficient map derived from source image with b value of 700 s/mm2 shows areas of restricted diffusion (asterisk) within the lesion. The apparent diffusion coefficient values were 0.92 x 10-3 mm2 s-1, lower than that of the normal contralateral kidney (2.30 x 10-3 mm2 s-1).
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F1
An ill-defined upper pole right renal mass was detected on MRI [Figure 1], with effacement of the ipsilateral adrenal gland. The lesion was heterogeneous, mainly solid, with signal intensity similar and lower than that of normal renal parenchyma on T1-weighted (T1WI) and T2-WI, respectively, and restricted diffusion [Figure 1a, b, and d]. Small amounts of fat were revealed within the mass [Figure 1b and c].
A 41-year-old pregnant woman diagnosed with renal epithelioid angiomyolipoma associated with pulmonary lymphangioleiomyomatosis. (a) Sagittal sonographic image of the right hypochondrium depicts the presence of a heterogeneous, ill-defined mass (cursors) in the interpolar region of the right kidney. The lesion is mainly hypoechoic, extending into the renal sinus. (b) The presence of vascularity is detected within the mass lesion on Doppler examination.
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F2
Subsequent ultrasound examination showed hypoechoic, vascular right renal mass lesion, with lobulated contour, extending into the renal sinus [Figure 2].
A 41-year-old woman diagnosed with renal epithelioid angiomyolipoma associated with pulmonary lymphangioleiomyomatosis. (a) Transverse unenhanced computed tomography image depicts lesion heterogeneity, with small areas of fat (arrowheads) and solid parts (arrow), slightly hyperdense (mean computed tomography density: 45 HU) relative to the normal renal parenchyma. Contrast-enhanced computed tomography scan, (b) transverse, and (c) coronal reformations during the portal phase depict moderate, heterogeneous lesion enhancement (mean computed tomography density: 95 HU, arrow). Note areas of fat (arrowhead). (d) Contrast-enhanced computed tomography scan, coronal reformation, delayed phase. The mass (arrow) is seen in proximity to the pelvicaliceal system (long arrow), without obvious signs of invasion. No significant wash-out is detected (mean computed tomography density: 65 HU).
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F3
The presence of a heterogeneous right renal mass was confirmed, with small areas of macroscopic fat [Figure 3]. The solid parts of the tumor were hyperdense on unenhanced images, relative to normal renal parenchyma [Figure 3a]. After intravenous contrast medium administration, the mass enhanced moderately and heterogeneously, with slow wash-out [Figure 3b-d].
A 41-year-old woman diagnosed with renal epithelioid angiomyolipoma associated with pulmonary lymphangioleiomyomatosis. Transverse chest computed tomography reveals multiple diffuse pulmonary thin-walled cysts (arrowheads).
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F4
CT of the thorax showed multiple thin-walled cysts, of variable size, measuring from 5 to 15 mm [Figure 4].