Images in Nephrology (Section Editor: G. H. Neild) Successful management of angiomyolipoma of the left kidney

a normal urine analysis, was investigated with technetium-99m renogram and multidetector computer-ized tomography (MDCT) as a renal donor for her daugh-ter. The glomerular filtration rate (GFR) was 100 mL/min with the left kidney 42 mL/min and right kidney 58 mL/ min. MDCT revealed a large lipomatous tumour on the renal cortex of the left lower pole with exophytic exten-sion into the perirenal space measuring 7.3 3 5.2 cm (Figure 1). The arterial phase revealed dual arterial supply to the left kidney with the tumour being supplied by a branch from the lower renal artery (Figure 2a). The pres-ence of fat [67 Hounsfield unit (HU)] with interposed soft tissue (42 HU), ectatic vessels and an aneurysm that measured 9 mm 3 8.9 mm with no direct arteriovenous shunting favoured the diagnosis of angiomyolipoma. Superselective catheterization of the feeding artery was performed and the neovascular vessels were embolized. Post-embolization MDCT revealed complete obliteration of the abnormal feeding artery and the aneurysmal lumen (Figure 2b). A week later, the GFR was 107 mL/min, left kidney 43 mL/min and right kidney 64 mL/min. Angiomyolipoma is a benign renal neoplasm with vari-able amounts of fat, vascular and smooth muscle elements. Attenuation of less than 20 HU on computerized tomog-raphy is widely accepted to confirm the presence of fat and this finding confirms the diagnosis of angiomyolipoma [1]. A tumour>4 cm with an aneurysm measuring>5 mm has a high risk of rupture [2]. Conflict of interest statement. None declared