Angioembolisation for Bilateral Angiomyolipoma in TSC patient

Abstract

Introduction: Bilateral Angiomyolipoma is a rare entity, usually associated with tuberous sclerosis. The condition is seen more in females and the tumours show progressive increase in size over a period of time bringing with it considerable risk of complications like haemorrhage and morbidity in the form of pain, haematuria, palpable mass, shock and hypotension.  

Objective: To report a case of multiple large bilateral angiomyolipoma in a case of Tuberous sclerosis treated successfully with transarterial embolization and to review the literature concerning treatment of AML.  

Case report: A 23 year old female patient, on treatment for epilepsy and a known case of tuberous sclerosis with family history too presented with abdominal pain and shock in a peripheral hospital. She was resuscitated and evaluated. CT Scan Abdomen revealed bilateral multifocal AMLs largest over 4 cm and with evidence of pseudo aneurysm with intralesional bleeding. After a preliminary angiogram confirming the intralesional bleed transarterial embolization was done with good results. A mild post embolization syndrome was managed conservatively. Imaging was repeated after 3 months.  

Conclusion: Transarterial embolization is a safe option in the management of selected cases of bilateral multifocal AMLs seen in hereditary syndromes like tuberous sclerosis.