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Renal angiomyolipoma presenting with massive retroperitoneal haemorrhage due to deranged clotting factors: a case report.

Wright T, Sooriakumaran P - Cases J (2008)

Bottom Line: They may be associated with tuberous sclerosis and occasionally present with flank pain, a palpable mass, and gross haematuria.A case of massive retroperitoneal haemorrhage in a patient on warfarin is presented.For this to occur, it is imperative to consider the diagnosis early in warfarinized patients (and others at risk of bleeding) who present with abdominal pain.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Kingston Hospital, Galsworthy Road, Kingston, Surrey, KT2 7QB, UK. sooriakumaran@gmail.com.

ABSTRACT

Background: Angiomyolipomata of the kidney are unusual lesions composed of abnormal vasculature, smooth muscle, and adipose elements. They may be associated with tuberous sclerosis and occasionally present with flank pain, a palpable mass, and gross haematuria. As angiomyolipomata grow their risk of bleeding increases, with a greater than 50% chance of significant bleeding in lesions > 4 cm; anticoagulant therapy accentuates this risk.

Case presentation: A case of massive retroperitoneal haemorrhage in a patient on warfarin is presented. The underlying diagnosis of renal angiomyolipoma was diagnosed based on CT findings. Emergency resuscitation and selective interpolar arterial embolization was performed which saved the patient's life as well as his kidney.

Conclusion: This case illustrates the clinical scenario of massive retroperitoneal haemorrhage in an anticoagulated patient with renal angiomyolipomata. In the emergent situation, adequate resuscitation along ABC principles, as well as control of haemorrhage with either nephrectomy (partial or radical), non-selective renal arterial embolization, or selective embolization of the feeding vessel(s), is necessary. For this to occur, it is imperative to consider the diagnosis early in warfarinized patients (and others at risk of bleeding) who present with abdominal pain. The authors hope this case report highlights to readers the clinical scenario of massive retroperitoneal haemorrhage in anticoagulated patients with renal angiomyolipomata so that they can deal appropriately with such presentations.

No MeSH data available.


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CT scans to illustrate angiomyolipomata with a massive retroperitoneal haemorrhage.
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Figure 1: CT scans to illustrate angiomyolipomata with a massive retroperitoneal haemorrhage.

Mentions: The CT showed a massive retroperitoneal bleed behind the left kidney and thus was difficult to interpret; the radiologist initially reported the bleed as arising from the psoas. Despite the use of FFP and Vitamin K his Hb continued to drop over 24 hrs from 16.1 to 5.9. Repeat examination of the CT revealed multiple angiomyolipomata found in the left kidney with the bleed originating from a sub-capsular angiomyolipoma (see Figure 1). The patient was transfused and underwent selective interpolar arterial embolisation of the left kidney. At embolization it was found that there was a large psuedoaneurysm arising from the interpolar artery as well as the abnormal vessels consistent with the vessels supplying the angiomyolipoma. Post-treatment contrast injection into the left renal artery confirmed adequate embolization and the patient was stable enough to be discharged one week later with no further evidence of bleeding.


Renal angiomyolipoma presenting with massive retroperitoneal haemorrhage due to deranged clotting factors: a case report.

Wright T, Sooriakumaran P - Cases J (2008)

CT scans to illustrate angiomyolipomata with a massive retroperitoneal haemorrhage.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2567302&req=5

Figure 1: CT scans to illustrate angiomyolipomata with a massive retroperitoneal haemorrhage.
Mentions: The CT showed a massive retroperitoneal bleed behind the left kidney and thus was difficult to interpret; the radiologist initially reported the bleed as arising from the psoas. Despite the use of FFP and Vitamin K his Hb continued to drop over 24 hrs from 16.1 to 5.9. Repeat examination of the CT revealed multiple angiomyolipomata found in the left kidney with the bleed originating from a sub-capsular angiomyolipoma (see Figure 1). The patient was transfused and underwent selective interpolar arterial embolisation of the left kidney. At embolization it was found that there was a large psuedoaneurysm arising from the interpolar artery as well as the abnormal vessels consistent with the vessels supplying the angiomyolipoma. Post-treatment contrast injection into the left renal artery confirmed adequate embolization and the patient was stable enough to be discharged one week later with no further evidence of bleeding.

Bottom Line: They may be associated with tuberous sclerosis and occasionally present with flank pain, a palpable mass, and gross haematuria.A case of massive retroperitoneal haemorrhage in a patient on warfarin is presented.For this to occur, it is imperative to consider the diagnosis early in warfarinized patients (and others at risk of bleeding) who present with abdominal pain.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Urology, Kingston Hospital, Galsworthy Road, Kingston, Surrey, KT2 7QB, UK. sooriakumaran@gmail.com.

ABSTRACT

Background: Angiomyolipomata of the kidney are unusual lesions composed of abnormal vasculature, smooth muscle, and adipose elements. They may be associated with tuberous sclerosis and occasionally present with flank pain, a palpable mass, and gross haematuria. As angiomyolipomata grow their risk of bleeding increases, with a greater than 50% chance of significant bleeding in lesions > 4 cm; anticoagulant therapy accentuates this risk.

Case presentation: A case of massive retroperitoneal haemorrhage in a patient on warfarin is presented. The underlying diagnosis of renal angiomyolipoma was diagnosed based on CT findings. Emergency resuscitation and selective interpolar arterial embolization was performed which saved the patient's life as well as his kidney.

Conclusion: This case illustrates the clinical scenario of massive retroperitoneal haemorrhage in an anticoagulated patient with renal angiomyolipomata. In the emergent situation, adequate resuscitation along ABC principles, as well as control of haemorrhage with either nephrectomy (partial or radical), non-selective renal arterial embolization, or selective embolization of the feeding vessel(s), is necessary. For this to occur, it is imperative to consider the diagnosis early in warfarinized patients (and others at risk of bleeding) who present with abdominal pain. The authors hope this case report highlights to readers the clinical scenario of massive retroperitoneal haemorrhage in anticoagulated patients with renal angiomyolipomata so that they can deal appropriately with such presentations.

No MeSH data available.


Related in: MedlinePlus