Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
A rare case of extensive spontaneous perirenal hematoma from a ruptured angiomyolipoma is described. A 55-year-old woman was admitted to our department with a complaint of acute left flank pain. The images and clinical data of the case are presented. The imaging diagnostic techniques employed were abdominal ultrasonography, computed tomography scan and magnetic resonance imaging, which indicated the diagnosis of a large left perirenal hematoma and showed its size and extension. No tumor was suspected preoperatively. The operation was completed with nephrectomy and definite diagnosis was made on the basis of pathology findings, which revealed a relatively small angiomyolipoma on the upper pole of the left kidney wherefrom the hemorrhage had occurred. Therapeutic approach, i.e. nephrectomy or conservative therapy, remains controversial, however, concerning the prevalence of renal neoplastic lesions, most recent reports recommend nephrectomy in case of even slight doubt of renal neoplasm. The clinical, diagnostic and therapeutic aspects of this rare disease are discussed.Prikazan je slučaj velikog perirenalnog hematoma uzrokovanog rupturom angiomiolipoma u 55-godišnje bolesnice primljene na kliniku zbog akutne boli lijeve lumbalne regije. Uporabljene dijagnostičke tehnike bile su ultrazvuk, kompjutorizirana tomografija i magnetna rezonanca, a prikazale su veliki perirenalni retroperitonealni hematom, te njegov opseg i odnos prema ostalim strukturama. Prijeoperacijski se nije posumnjalo na tumor lijevog bubrega. Hitna operacija završila je nefrektomijom, a definitivna je dijagnoza dobivena patohistološkom analizom koja je otkrila relativno malen angiomiolipom na gornjem polu lijevog bubrega iz kojega je krvarenje započelo. Cilj je prikaza pokazati kako još uvijek postoje proturječja o terapiji angiomiolipoma u odnosu na njegovu veličinu te moguće komplikacije. Raspravlja se o kliničkim, dijagnostičkim i terapijskim vidovima ove rijetke bolesti
