THE EVOLUTION OF RENAL ANGIOMYOLIPOMAS IN PATIENTS WITH TUBEROUS SCLEROSIS

In 1986, 23 patients with renal angiomyolipomas as part of tuberous sc lerosis were assessed by ultrasonography. In 1991, 20 patients in this group were reexamined with special attention paid to the renal pathol ogical condition. Ultrasonography was performed by the same radiologis t who performed the examination in 1986. Of 20 patients 7 had severe h emorrhage necessitating hospital admission (5 had a renal lesion large r than 3.5 cm. in diameter). In 2 patients the exact diameter of the r enal angiomyolipomas could not be determined and they underwent nephre ctomy. Three patients underwent successful selective embolization of t he bleeding angiomyolipoma. One patient died. The hemorrhage resolved spontaneously in 1 patient and treatment was not feasible. In 4 patien ts the lesions increased in size between 1986 and 1991. Based on these results there is a relationship between the size of the angiomyolipom as and the risk of bleeding. Penal angiomyolipomas larger than 3.5 cm. in diameter have a substantial risk for severe hemorrhage. Some angio myolipomas show progression. Periodic followup is mandatory every 6 mo nths. For angiomyolipomas larger than 3.5 cm. in diameter an aggressiv e approach is advised. Selective embolization is the initial method of choice.