Hemorrhagic renal angiomyolipoma: An analysis of 6 cases with review of the literature

Abstract

Renal angiomyolipoma is the most common benign solid tumor of the kidney. It can occur sporadically or in association with tuberous sclerosis, which is an autosomal dominant inherited disease. Hemorrhagic rupture of renal angiomyolipoma with retroperitoneal hematoma is the most serious complication that can be life-threatening and requires urgent management. The aim of this study is to review, through 6 cases and by means of a review of the literature, the diagnostic criteria of renal angiomyolipoma and the particularities of management of hemorrhagic renal angiomyolipoma. We carried out a retrospective study which concerned 6 patients with hemorrhagic renal angiomyolipoma, unilateral or bilateral, during the period between January 2019 and August 2021, in the Urology Department of the Hassan II University Hospital in Fez. The average age of our patients was 53 years with an F/M sex ratio of 2. Bourneville's tuberous sclerosis was diagnosed in 3 patients. The circumstances of discovery of renal angiomyolipoma were: acute flank pain associated with anemic syndrome in 3 patients, incidental discovery in 1 patient, clot hematuria in 1 patient and abdominal mass in 1 patient. Clinical examination revealed hemodynamic instability in 1 patient, flank defense in 2 patients, lumbar mass in 1 patient and lumbar tenderness in 1 patient. The abdominal CT angiogram allowed us to retain the diagnosis of renal angiomyolipoma in all the patients, with a bilateral form in the 3 patients with tuberous sclerosis of Bourneville. Renal embolization was performed in 5 patients, while total nephrectomy was performed in 1 patient. Renal angiomyolipoma is a rare tumor in daily urological practice. Its hemorrhagic risk requires a good knowledge of diagnostic, therapeutic and monitoring methods.