Spontaneous retroperitoneal bleeding from rupture of a massive renal angiomyolipoma managed with transcatheter arterial embolization

Ruptured renal angiomyolipoma (AML) is a rare but potentially life-threatening condition requiring prompt diagnosis and intervention. We report the case of a young female who presented with acute left-sided abdominal pain and gross hematuria. She had a known diagnosis of a large left renal AML. Init...

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Main Authors: Majd Oweidat, MD, Mohammed Alra'e, MD, Ammar W․ M․ Hassouneh, MD, Besan Sarahna, MD, Ibrahim Kattoush, MD
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:Radiology Case Reports
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Online Access:http://www.sciencedirect.com/science/article/pii/S1930043325004261
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author Majd Oweidat, MD
Mohammed Alra'e, MD
Ammar W․ M․ Hassouneh, MD
Besan Sarahna, MD
Ibrahim Kattoush, MD
author_facet Majd Oweidat, MD
Mohammed Alra'e, MD
Ammar W․ M․ Hassouneh, MD
Besan Sarahna, MD
Ibrahim Kattoush, MD
author_sort Majd Oweidat, MD
collection DOAJ
description Ruptured renal angiomyolipoma (AML) is a rare but potentially life-threatening condition requiring prompt diagnosis and intervention. We report the case of a young female who presented with acute left-sided abdominal pain and gross hematuria. She had a known diagnosis of a large left renal AML. Initial evaluation revealed stable vital signs and mild anemia. Contrast-enhanced computed tomography (CT) confirmed a ruptured AML with an associated hematoma but no active extravasation. The patient was admitted for conservative management and subsequently underwent transcatheter arterial embolization (TAE) 2 weeks later. Under ultrasound guidance, vascular access was obtained via the right common femoral artery, and superselective catheterization of the feeding arteries to the tumor was performed. Embolization was achieved using a Lipiodol–N-butyl cyanoacrylate (NBCA) glue mixture in a 1:5 ratio. Final angiography showed complete devascularization of the lesion. Follow-up contrast-enhanced CT showed hematoma resolution, reduced tumor size, and no evidence of residual bleeding or nontarget embolization. The patient experienced marked clinical improvement and remained stable on follow-up without recurrence of symptoms. This case highlights the importance of considering renal AML in the differential diagnosis of spontaneous retroperitoneal hemorrhage. It also demonstrates the value of imaging in diagnosis and follow-up, as well as the role of TAE as an effective intervention in selected cases while preserving renal function.
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spelling doaj-art-8eb25dfdbbc943dab3277beda656906c2025-08-20T02:36:49ZengElsevierRadiology Case Reports1930-04332025-09-012094555456010.1016/j.radcr.2025.04.127Spontaneous retroperitoneal bleeding from rupture of a massive renal angiomyolipoma managed with transcatheter arterial embolizationMajd Oweidat, MD0Mohammed Alra'e, MD1Ammar W․ M․ Hassouneh, MD2Besan Sarahna, MD3Ibrahim Kattoush, MD4College of Medicine, Hebron University, Hebron, West Bank, Palestine; Department of Radiology, Princess Alia Hebron Governmental Hospital, Hebron, West Bank, Palestine; Corresponding author.College of Medicine, Hebron University, Hebron, West Bank, PalestineCollege of Medicine, Hebron University, Hebron, West Bank, Palestine; Department of Radiology, Princess Alia Hebron Governmental Hospital, Hebron, West Bank, Palestine; Department of Radiology, Al-Mezan Specialty Hospital, Hebron, West Bank, PalestineCollege of Medicine, Hebron University, Hebron, West Bank, PalestineCollege of Medicine, Hebron University, Hebron, West Bank, PalestineRuptured renal angiomyolipoma (AML) is a rare but potentially life-threatening condition requiring prompt diagnosis and intervention. We report the case of a young female who presented with acute left-sided abdominal pain and gross hematuria. She had a known diagnosis of a large left renal AML. Initial evaluation revealed stable vital signs and mild anemia. Contrast-enhanced computed tomography (CT) confirmed a ruptured AML with an associated hematoma but no active extravasation. The patient was admitted for conservative management and subsequently underwent transcatheter arterial embolization (TAE) 2 weeks later. Under ultrasound guidance, vascular access was obtained via the right common femoral artery, and superselective catheterization of the feeding arteries to the tumor was performed. Embolization was achieved using a Lipiodol–N-butyl cyanoacrylate (NBCA) glue mixture in a 1:5 ratio. Final angiography showed complete devascularization of the lesion. Follow-up contrast-enhanced CT showed hematoma resolution, reduced tumor size, and no evidence of residual bleeding or nontarget embolization. The patient experienced marked clinical improvement and remained stable on follow-up without recurrence of symptoms. This case highlights the importance of considering renal AML in the differential diagnosis of spontaneous retroperitoneal hemorrhage. It also demonstrates the value of imaging in diagnosis and follow-up, as well as the role of TAE as an effective intervention in selected cases while preserving renal function.http://www.sciencedirect.com/science/article/pii/S1930043325004261Acute abdominal painAngioembolizationHematuriaRuptured renal angiomyolipomaTranscatheter arterial embolization
spellingShingle Majd Oweidat, MD
Mohammed Alra'e, MD
Ammar W․ M․ Hassouneh, MD
Besan Sarahna, MD
Ibrahim Kattoush, MD
Spontaneous retroperitoneal bleeding from rupture of a massive renal angiomyolipoma managed with transcatheter arterial embolization
Radiology Case Reports
Acute abdominal pain
Angioembolization
Hematuria
Ruptured renal angiomyolipoma
Transcatheter arterial embolization
title Spontaneous retroperitoneal bleeding from rupture of a massive renal angiomyolipoma managed with transcatheter arterial embolization
title_full Spontaneous retroperitoneal bleeding from rupture of a massive renal angiomyolipoma managed with transcatheter arterial embolization
title_fullStr Spontaneous retroperitoneal bleeding from rupture of a massive renal angiomyolipoma managed with transcatheter arterial embolization
title_full_unstemmed Spontaneous retroperitoneal bleeding from rupture of a massive renal angiomyolipoma managed with transcatheter arterial embolization
title_short Spontaneous retroperitoneal bleeding from rupture of a massive renal angiomyolipoma managed with transcatheter arterial embolization
title_sort spontaneous retroperitoneal bleeding from rupture of a massive renal angiomyolipoma managed with transcatheter arterial embolization
topic Acute abdominal pain
Angioembolization
Hematuria
Ruptured renal angiomyolipoma
Transcatheter arterial embolization
url http://www.sciencedirect.com/science/article/pii/S1930043325004261
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