Selective embolization in renal angiomyolipoma with pseudoaneurysm

Öz

Angiomyolipomas are usually diagnosed incidentally and are usually asymptomatic. Dysmorphic blood vessels in angiomyolipomas usually do not contain an internal elastic lamina, so bleeding risks are high. Particularly, lesions larger than 4 cm have a tendency to become symptomatic and can present with life-threatening retroperitoneal or urinary bleeding. Although intrarenal or perinephric bleeding is the usual complication of angiomyolipomas, a pseudoaneurysm appears unusual. In this case, we aimed to present a patient with pseudoaneurysm, an unusual complication of angiomyolipoma. In this article, a patient who presented with complaints of left flank pain and hematuria and who underwent selective arterial embolization due to pseudoaneurysmatic angiomyolipoma in the left kidney is presented. The patient's angiography showed a large hypervascular mass filling the upper and middle segments of the left kidney. A pseudoaneurysmal filling originating from a subsegmental branch was observed in the mass. The patient underwent selective embolization. After 5 years of follow-up, the mass was observed to shrink. Angiomyolipomas are benign tumors, but especially symptomatic masses larger than 4 cm and especially masses with aneurysms larger than 5 mm can cause life-threatening retroperitoneal hemorrhages. Coexistence of angiomyolipomas with pseudoaneurysm is rare, especially. Safe, effective and minimally invasive selective arterial embolization can be safely performed to prevent massive bleeding and rupture.

Anahtar Kelimeler

• Angiomyolipoma
• pseudoaneurysm
• retroperitoneal hemorrhage
• selective angiography

Psödoanevrizmalı renal anjiyomiyolipomda selektif embolizasyon

Öz

Anjiyomiyolipomalar genellikle tesadüfen teşhis edilir ve genellikle semptomsuzdur. Özellikle, 4 cm'den büyük lezyonlar semptomatik olma eğilimindedir ve yaşamı tehdit eden retroperitoneal veya üriner kanama ile ortaya çıkabilir. Anjiyomiyolipomaların tipik komplikasyonu intrarenal veya perinefratik kanamadır, ancak bir psödoanevrizma görünüşü olağandışıdır. Bu çalışmada anjiyomiyolipomanın olağan dışı komplikasyonu olan psödoanevrizmalı hastayı sunmayı amaçladık. Bu makalede, sol yan ağrısı ve hematüri şikayetleri ile başvuran ve böbrekteki psödoanevrizmatik anjiyomiyolipoma nedeniyle seçici arteriyel embolizasyon geçiren bir hasta sunulmaktadır. Hastanın anjiyografisi, sol böbreğin üst ve orta segmentlerini dolduran büyük bir hipervasküler kitleyi göstermiştir. Kütlede bir subsegmental dal kökenli psödoanevrizmal dolgu gözlemlenmiştir. Seçici anjioembolizasyon sonrasında, kitlede 5 yıllık takipte küçülme olduğu gözlemlenmiştir. Anjiyomiyolipomaların psödoanevrizma ile bir araya gelmesi nadirdir. Büyük kanama ve yırtılma önlemek için güvenli, etkili ve minimal invaziv seçici arteriyel embolizasyon güvenle uygulanabilir.

Anahtar Kelimeler

• Anjiyomiyolipoma
• psödoanevrizma
• retroperitoneal kanama
• selektif anjiyografi

Kaynakça

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