RCOG World Congress 2023

•Rare benign tumour – 0.13% of the general population 1

•Most commonly occur in women>50 2

•Composed of smooth muscles, adipose tissue and blood vessels 2

•Most of the above cases diagnosed pre-pregnancy 1

•Commonly bleed in the 3rdtrimester 2

Associated with Von Hipple Linday, neurofibromatosis, tuberous sclerosis, lymphangiomyomytosis

Background :39 Week old

17/40 pregnant with DCDA Twins following intrauterine insemination.

Case: This lady Presented to A+E with left sided abdominal pain, sudden onset radiating into flank, with associated nausea and vomiting.

She had both ketones and leucocytes in her urine.

Her initial blood results revealed Haemoglobin (Hb) 97, white cell count (WCC) 17.1, CRP 235

She was commenced on antibiotics for a potential pyelonephritis and Ultrasound of the kidneys requested

Renal Ultrasound revealed the left kidney was123mm in size with a mass at the hilum approximately 72x64mm

containing mixed echogenicity , indicative of blood.

Her Hb dropped to 75 and she received two units of packed red cells.

She underwent interventional radiological embolization

There were 3 renal arteries requiring embolization to cause a blush

She had ongoing pain for 6/52

In later pregnancy she developed PUPPS, PET and Obstetric cholestasis

•CT angiogram allows identification of vessels supplying the structures, prior to interventional radiology, which can be difficult in cases with anatomical variations – such as our lady.

•Shielding increases scatter and makes visualization more difficult and increases dose to the mother

RCOG World Congress 2023

'Double the trouble and triple the fun' - A bleeding Angiomyolipoma in pregnancy

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