We reported a rare case of a spontaneous rupture of an intratumoral pseudoaneurysm in a giant renal angiomyolipoma of a 52-year-old lady. The initial presentation was a sudden onset of right hypochondriac pain, nausea, and vomiting. CT scan revealed large heterogenous exophytic enhancing mass with mixed solid and fat density within, arising from the right kidney likely represent a giant right renal angiomyolipoma. There is associated right perinephric hematoma and active bleeding within the mass. No features suggestive of tuberous sclerosis. Subsequent right renal angiogram revealed a pseudoaneurysm of an inferior segmental right renal artery and emergency embolization was done with successful obliteration of the aneurysmal sac and devascularization of the mass.
Bronchial artery embolization was first performed in 1973 by Remy et al with widespread acceptance since then. Multi-detector computed tomography (MDCT) CT angiography (CTA) is currently the gold standard imaging modality used to identify the site and cause of bleeding in patient presented with haemoptysis. Bronchial artery anatomies and precise location can be obtained by scrutinizing CTA prior to interventional procedures. CTA has the advantage of not only can preclude the need of digital subtraction angiography (DSA) in inappropriate cases, but also can shorten the intervention procedure timing. We present a case of false negative bronchial artery caliber seen on MDCT which was abnormal in DSA.
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