SPONTANEOUS RUPTURE OF RENAL TUMORS - THE ROLE OF IMAGING IN DIAGNOSIS AND MANAGEMENT

This study aimed to evaluate whether patients presenting with spontane ous haemorrhage from renal tumours could be accurately diagnosed and i nitially managed conservatively, and evaluate the role of imaging in g uiding the timing and type of subsequent operation. The clinical featu res, imaging findings and management of seven patients presenting with spontaneous rupture of renal tumour over a 5-year period were reviewe d. The information from various imaging studies was evaluated in relat ion to the subsequent course of intervention. The tumours consisted of six angiomyolipomas and one renal cell carcinoma. In all cases, imagi ng studies were diagnostic, with computed tomography being the most us eful single modality. Emergency surgery was required in one patient fo r evacuation of suspected infected haematoma and wedge excision of ang iomyolipoma. Three elective nephrectomies were performed, while three other patients with ruptured angiomyolipoma were treated conservativel y and remained well, without any intervention. In conclusion, patients presenting with spontaneous rupture of renal tumour can be managed co nservatively initially. Imaging facilitates accurate pre-operative dia gnosis, which was angiomyolipoma in all but one patient in this series . The subsequent intervention can be tailored according to the lesion type and the anticipated risk of re-haemorrhage.