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Ruptured AML TSC Emergency — ESENeph MCQ

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ModerateAcute Kidney InjuryRuptured AML TSC EmergencyESENeph

A 60-year-old woman develops acute onset flank pain. CT shows a 5 cm angiomyolipoma (AML) in the right kidney with evidence of active haemorrhage (retroperitoneal haematoma). She has tuberous sclerosis complex. BP is 90/60 mmHg and Hb is 72 g/L. What is the immediate management?

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Correct answer: C — Urgent selective renal artery embolisation to control haemorrhage

Ruptured angiomyolipoma with active haemorrhage is a urological emergency. Selective renal artery embolisation is the first-line intervention for haemodynamically significant bleeding, as it is minimally invasive and preserves renal parenchyma (particularly important in TSC patients who may have bilateral AMLs). Nephrectomy is reserved for failed embolisation. In TSC, mTOR inhibitors (Everolimus) are used for AML >3 cm to reduce size and bleeding risk. AMLs >4 cm are generally considered for prophylactic intervention.

Reference: NICE – TSC; EAU 2024 – Renal Tumour Guidelines