Spontaneous rupture of renal angiomyolipoma: a case report

A 55-year-old woman presented with sudden right lower abdominal pain. Computed tomography demonstrated retroperitoneal hematoma associated with minus-density area, diagnosed as spontaneous rupture of angiomyolipoma. Super-selective transarterial embolization was performed, but anemia and right abdominal pain became worse in spite of conservative therapy including transfusion, indicating re-rupture of the renal tumor. Although partial nephrectomy was planned, right nephrectomy was finally performed because of massive intraoperative bleeding. Accurate diagnosis and prompt treatment are required when life-threatening rupture of renal tumor is suspected.     

Spontaneous rupture of renal angiomyolipoma with tuberous sclerosis during long-term follow-up: a case report]

We present a case of spontaneous rupture of bilateral renal angiomyolipoma (AML) with tuberous sclerosis. A 46-year-old woman was admitted with sudden onset of severe left flank pain. She had been diagnosed to have bilateral AML with tuberous sclerosis 15 years earlier. Four years after the initial diagnosis, spontaneous rupture of right renal AML occurred and right renal embolization of the right renal artery was performed. The treatment for the left renal AML was not performed. Eleven years later in 2000, spontaneous rupture of contralateral renal AML occurred and left renal embolization of the left renal artery was performed. We evaluated the efficacy of selective arterial embolization in right AML and the change of the tumor size during a 10-year follow up after embolization. The right AML had decreased 86% in 11 years. Selective arterial embolization is an effective and safe treatment for AML. We evaluated the natural history of left AML and calculated the doubling time to be about 1,370 days for the first period of 4 years and about 2,075 days for the second period of 11 years. Although the growth change was very slow, we should observe the tumors carefully on computed tomography or ultrasound to prevent life-threatening hemorrhage.     

巨大肝脏血管平滑肌脂肪瘤自发性破裂一例

病例 患者男性,69岁,主诉:右上腹持续性隐痛伴腹胀1周.既往无肝炎、寄生虫病史.查体:右侧腹部扪及一巨大肿块,向上与肝相续,向下达髂前上棘水平.实验室检查:肝炎病毒系列阴性,肝功能正常, AFP 1.59 U/mL,CA1998.52 U/mL,CEA 0.49 ng/mL. 腹部增强CT提示:肝脏一外生性稍低密度肿...     

Spontaneous rupture of a renal angiomyolipoma

A case of spontaneous hemorrhage in the retroperitoneal space, secondary to an angiomyolipoma of the kidney is reported in a 33 year old woman admitted with an acute abdomen. Differential diagnosis is discussed.     

Spontaneous rupture of renal cell carcinoma: a case report]

A 74-year-old man with severe right flank pain and hypochondralgia, was admitted to a hospital where he was found to have an abnormality of the right kidney on computed tomographic (CT) scan. He was referred to our department for further examination and treatment on the next day. Spontaneous rupture of the right renal cell carcinoma was mostly suspected from preoperative clinical findings obtained by ultrasonography. CT scan and angiography. Extravasation was not recognized on angiography. We chose emergent transcatheter arterial embolization prior to radical nephrectomy. The surgical specimen contained a solid and yellowish mass invading into the renal pelvis. Subcapsular rupture was identified. Histopathological diagnosis was renal cell carcinoma consisting of invasive growth of highly atypical epithelial cells with a sarcomatous pattern, and the tumor cells were present in the renal pelvis. He died of lung cancer 26 months after the operation.     

Spontaneous rupture of renal angiomyolipoma

We report a case of renal angiomyolipoma with retroperitoneal hemorrhage treated by enucleation in a 47 year-old male. The mass in the anterior side of the left kidney, revealed by sonography and CT, was diagnosed as angiomyolipoma with a retroperitoneal hematoma caused by its spontaneous rupture. Removal of hematoma and enucleation of the tumor were performed after the diagnosis. Diagnosis and treatment of ruptured renal angiomyolipoma are discussed.     

Spontaneous rupture of renal cancer: a case report

A 53-year-old man presented to our hospital as an emergency admission with sudden right flank pain. No examinations using contrast media could be performed due to allergies. Abdominal plain computed tomography and ultrasonography revealed right peri-renal hematoma, but causes were unknown. Magnetic resonance imaging (MRI) contrasted with gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA) revealed right spontaneous rupture of renal cancer and radical nephrectomy was performed. The surgical specimen displayed renal subcapsular hematoma, and histopathology revealed renal clear cell carcinoma, grade 3, INF gamma, pT1a, pV0. The patient was well and without local recurrence or distant metastasis at 14 months postoperatively. Spontaneous rupture of renal cancer is uncommon, and our case is the 68th reported in Japan. MRI is useful for diagnosis and surgical intervention is recommended. Analysis by the Kaplan-Meier method showed good prognosis in spite of spindle cell carcinoma and advanced disease (stage IV).     

Spontaneous rupture of renal leiomyosarcoma: report of a case

A case of renal leiomyosarcoma ruptured spontaneously is reported. A 36-year-old man was admitted to our clinic with the complaint of right flank pain. The urographic examination, including an excretory urography, renal CT-scan, renal angiography, and ultrasonography revealed a renal tumor with spontaneous rupture on the right side. A nephrectomy through the lumbal flank incision on the right side was performed on February 28, 1984, and histopathological diagnosis was renal leiomyosarcoma. Five courses of adjuvant chemotherapy, VCR, ADM and CPM, combined with maintenance immunochemotherapy using Tegafur and Krestin and with radiotherapy (3,000 rad) were performed post-operatively. The patient was followed for 18 months after operation as an outpatient with no evidence of local recurrence and metastasis. The 40 reported cases including our case with leiomyosarcoma in Japan is reviewed and some characteristics of this entry are discussed.     

Spontaneous rupture of infected renal cyst: a case report

A 68-year-old man who had been followed at 1-year intervals for a left giant renal cyst was referred to our hospital for left flank pain and fever elevation. Abdominal computed tomographic scan revealed a giant cystic lesion of the left kidney suspected to be communicating with the urinary tract. Percutaneous puncture of this lesion was performed and the fluid was drained. The fluid was yellowish and cloudy, and E. coli was detected by its culture. Injection of contrast medium showed communication between the cyst and the urinary tract. The patient underwent drainage for a ruptured renal cyst. Rupture of a renal cyst is uncommon, and this is the 16th case reported in Japan.     

Spontaneous rupture of the renal pelvis: a case report

A 63-year-old man admitted to our hospital with severe pain in his right flank on June 4, 1987. After admission, his pain increased progressively and he complained of tenderness from the right flank to the right lower quadrant. Computerized tomography and intravenous pyelography demonstrated spontaneous rupture of the right renal pelvis. A retrograde ureteral catheter was indwelling into the right renal pelvis. Because extravasation had disappeared on the retrograde pyelogram, the Catheter was withdrawn after 12 days. After removal of the ureteral catheter, he did not complain of pain. The 42 patients with spontaneous rupture of the renal pelvis reported in the Japanese literature and our one case were discussed.     

Spontaneous rupture of renal cell carcinoma: a case report

A 45-year-old man felt sudden pain in the left abdomen while taking a bath. Computed tomography (CT) showed a huge hematoma above the left kidney, which was diagnosed as spontaneous rupture of the kidney. Two months later, several low-density areas were observed in the liver on CT. Suspecting renal cell carcinoma (RCC) with multiple liver metastasis, we performed left radical nephrectomy and partial hepatectomy. A pathological study revealed a small RCC of 2 cm in diameter in the middle of the left kidney. In spontaneous renal rupture secondary to renal tumors, imaging studies such as CT or MRI sometimes fail to demonstrate primary lesions.     

Spontaneous rupture of a renal angiomyolipoma at 25 weeks of pregnancy treated with transarterial embolization: A case report and review of the literature

Treatment for ruptured renal angiomyolipoma in pregnancy requires immediate and appropriate decision‐making based on the condition of the mother and fetus, and gestational age. A 37‐year‐old woman at 25 weeks of pregnancy presented with severe right flank pain. Computed tomography showed a ruptured right renal angiomyolipoma (8 cm in diameter). The maternal and fetal conditions were stable. Transcatheter arterial embolization was carried out electively 4 days after the rupture. Minimization of radiation exposure to the fetus was achieved by X‐ray shielding for the fetus, low‐dose‐rate fluoroscopy, minimal angiography imaging and a color Doppler ultrasonography‐guided procedure. Although threatened premature labor occurred because of post‐embolization syndrome, the pregnancy was continued until cesarean section at 37 weeks of pregnancy.     

Spontaneous renal rupture in pregnancy

A review of the literature reveals 9 cases of spontaneous renal rupture in pregnancy, to which we add another case. Most cases occurred in hydronephrotic kidneys. Four cases consisted of renal rupture without associated infection or tumor, 3 were associated with abscesses, and 3 ruptured through renal hamartomas. Previously, all ruptured kidneys were removed. In our case the kidney was salvaged satisfactorily by prompt placement of a nephrostomy tube and drainage of the perirenal tissue. Attempt at renal salvage is urged for renal rupture in pregnancy.     

Spontaneous rupture of a left renal artery aneurysm: a case report

Rupture of a renal artery aneurysm is an acute surgical event associated with high mortality. We report a case of retroperitoneal hemorrhage from a spontaneously ruptured renal artery aneurysm. A 73-year-old woman complained of left flank and abdominal pain. She consulted our department and left retroperitoneal hemorrhage was recognized by abdominal computerized tomography. Selective left renal arteriography revealed a saccular aneurysm arising from the ventral branch of the renal artery, and did not show extravasation of contrast material from the aneurysm. Since it was difficult to remove the aneurysm with preservation of the involved renal unit, we performed left nephrectomy.     

Extrarenal angiomyolipoma with spontaneous rupture: a case report

We present a very rare case of retroperitoneal extrarenal angiomyolipoma (AML) with spontaneous rupture. A 67-year-old woman without tuberous sclerosis was admitted to our hospital complaining of sudden right flank pain. We suspected right renal AML with rupture by imaging analysis, but the diagnosis was extrarenal AML by surgery and pathological examination.     

Spontaneous tracheal rupture: a case report

We report the case of a spontaneous posterior tracheal wall rupture following a cough. A 67-year-old woman with a history of longstanding treatment with corticosteroids (8 years) for Giant Cell Arteritis had general anesthesia for cataract removal. Surgery and anesthesia were uneventful. In the recovery room, the patient coughed and soon after developed subcutaneous emphysema of the neck. Chest radiography confirmed the clinical diagnosis of marked subcutaneous emphysema and showed huge pneumomediastinum and minor right pneumothorax. A thoracic CT scan revealed a large laceration of the posterior tracheal wall (a 4 cm longitudinal tear), extending from the middle of the trachea to the level of the carina. Surgical repair consisted in closure of the dilaceration using an autologous pericardial patch. It seems reasonable to suspect the facilitating role of connective tissue fragility due to chronic corticosteroid administration in the development of this tracheal rupture following cough. Tracheal rupture is a potentially lethal injury, which can be repaired successfully if the diagnosis is made early. Risk factors, diagnosis and principles of treatment of this lesion are discussed.