In vitro, i.v. contrast-enhanced MDCT is more sensitive than first-order aortic branch-selective DSA in detecting active hemorrhage unless the catheter position is highly superselective and is close to the bleeding artery. These results suggest that MDCT can be used as the initial imaging technique in the diagnosis of active hemorrhage if the clinical condition of the patient allows.
Percutaneous embolization is the currently preferred treatment of symptomatic or ruptured renal angiomyolipomas (AMLs). Alcohol, microparticles, and coils are usually used. We present what is to our knowledge the first case of successful embolization of a solitary sporadic AML with the use of a new nonadhesive liquid embolic agent (ethylene vinyl alcohol copolymer; Onyx). Onyx injection was slow and controllable and achieved complete tumor devascularization, producing a characteristic appearance like a vascular cast. Short-term follow-up magnetic resonance imaging showed complete tumor necrosis without any recurrent pathologic vessels. The specific features, potential advantages in AML treatment, and technical limitations of this new liquid embolic agent are discussed.
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