Infatti gli studi sulla sorveglianza attiva degli angiomiolipomi renali sono pochi e riguardano limitate casistiche di pazienti. Lo studio, eseguito presso il Glickman Urological and Kidney Institute di Cleveland OH, USA , ha preso in analisi pazienti con diagnosi di angiomiolipoma renale, per i quali era stato deciso di non eseguire alcun trattamento a meno che non fossero insorti sintomi o complicanze. Al momento della diagnosi pazienti erano asintomatici, 15 avevano presentato dolore al fianco e 13 presenza di sangue nelle urine. In caso di comparsa di sintomi o complicanze si sarebbe proceduto a un trattamento attivo. Le principali cause che hanno reso necessario il trattamento sono state: dolore al fianco, crescita della lesione documentata alle tc di controllo, emorragia retroperitoneale, preferenza del paziente e macroematuria presenza di sangue nelle urine, visibile a occhio nudo.

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Imaging differential diagnosis Epidemiology Angiomyolipomas are the most common benign solid renal lesion and also the most common fat-containing lesion of the kidneys. They are more likely to be fat-poor which accounts for their earlier presentation 2,6,7. Clinical presentation Angiomyolipomas are often found incidentally when the kidneys are imaged for other reasons, or as part of screening in patients with tuberous sclerosis. Patients may present with numerous other symptoms and signs 2, e.

Pathology Angiomyolipomas are members of the perivascular epithelioid cells tumor group PEComas and are composed of variable amounts of three components; blood vessels -angio , plump spindle cells -myo and adipose tissue -lipo. This variant, unlike conventional AMLs, may mimic renal cell carcinoma Metastases have also been described 9.

Radiographic features The cornerstone of diagnosis on all modalities is the demonstration of macroscopic fat, however in the setting of hemorrhage, or when lesions happen to contain little fat, it may be difficult to distinguish an angiomyolipoma from a renal cell carcinoma. In tuberous sclerosis the lesions are larger than isolated AML and often multiple and bilateral.

Ultrasound tend to appear as hyperechoic lesions on ultrasound, located in the cortex and with posterior acoustic shadowing in the setting of tuberous sclerosis, they may be so numerous that the entire kidney is affected, appearing echogenic with the loss of normal corticomedullary differentiation 7 contrast-enhanced ultrasound 12 decreased central enhancement, compared with normal cortex CT Most lesions involve the cortex and demonstrate macroscopic fat less than HU.

When small, volume averaging may make differentiation from a small cyst difficult. This is especially the case in the setting of tuberous sclerosis, where up to a third do not demonstrate macroscopic fat on CT 6. MRI MRI is excellent at evaluating fat-containing lesions, and two main sets of sequences are employed. Firstly, fat-saturated techniques demonstrate high signal intensity on non-fat-saturated sequences and loss of signal following fat saturation.

The second method is to use in-phase and out-of-phase imaging, which generates I ndia ink artifact at the interface between fat and non-fat components.

This can occur either at the interface between the angiomyolipoma and surrounding kidney or between fat and non-fat components of the mass 8. Chemical shift signal intensity loss, along with other features, may suggest a fat-poor AML The traditional convention is that intervention is considered when an angiomyolipoma reaches 40 mm in size Lesions that present with retroperitoneal hemorrhage often requires emergency embolization as a life-saving measure. Differential diagnosis When an AML has typical appearances there is essentially no differential.


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