Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3875-3880
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3875
Diagnostic value of ultrasound in the spontaneous rupture of renal angiomyolipoma during pregnancy: A case report
Tong Zhang, Shuai Xue, Zheng-Min Wang, Xiu-Mei Duan, Dong-Xuan Wang
Tong Zhang, Dong-Xuan Wang, Department of Ultrasound, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Shuai Xue, Zheng-Min Wang, Department of Thyroid Surgery, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Xiu-Mei Duan, Department of Pathology, The First Hospital of Jilin University, Changchun 130000, Jilin Province, China
Author contributions: Zhang T contributed to the manuscript drafting and reviewed the literature; Xue S and Wang ZM collected the patient’s clinical data and reviewed the literature; Duan XM collected the patient’s clinical data; Wang DX designed the report and revised the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: The study participant, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Dong-Xuan Wang, MD, Professor, Department of Ultrasound, The First Hospital of Jilin University, No. 71 Xinmin Road, Changchun 130021, Jilin Province, China. dongxuanwang@hotmail.com
Received: May 20, 2020
Peer-review started: May 20, 2020
First decision: June 7, 2020
Revised: June 27, 2020
Accepted: August 6, 2020
Article in press: August 6, 2020
Published online: September 6, 2020
Processing time: 106 Days and 19.2 Hours
Abstract
BACKGROUND

Spontaneous rupture and hemorrhage of renal angiomyolipoma (RAML) is a life-threatening clinical emergency. When it occurs during pregnancy, it is compared to a “bomb explosion,” which makes the diagnosis and treatment more challenging. An ultrasound examination is a quick and safe examination with the benefit of no radiation exposure, which is always preferred for pregnant women. Currently, cases of spontaneous rupture and hemorrhage of RAML during pregnancy are rare, as is the diagnostic value and characteristics of ultrasound. The lack of understanding of the condition among ultrasound doctors makes it prone to misdiagnosis. In this study, we present the case of a pregnant woman who was preliminarily diagnosed with spontaneous rupture and hemorrhage of the left RAML using ultrasound and discuss the ultrasound characteristics.

CASE SUMMARY

A 38-year-old woman in her 19th wk of pregnancy (G2P1) was referred to our clinic for a sudden, persistent pain on the left side of the waist. She had not undergone any previous related abdominal examination. Ultrasound of the urinary system revealed a giant nonhomogenous lump in the left kidney area. The diagnosis was considered spontaneous rupture and hemorrhage of the left RAML in pregnancy via ultrasound. Her left-side waist pain continued to be intense. Subsequently, she underwent computed tomography, which led to the same diagnosis. Based on many factors, the patient underwent left nephrectomy after the induction of labor. The pathological result was the rupture and hemorrhage of a vascular leiomyoma lipoma.

CONCLUSION

Ultrasound examination plays an important role in the diagnosis of the spontaneous rupture and hemorrhage of RAML during pregnancy.

Keywords: Angiomyolipoma; Kidney; Rupture; Pregnancy; Ultrasonography; Case report

Core tip: The diagnosis and treatment of spontaneous rupture and hemorrhage of renal angiomyolipoma during pregnancy are challenging because it is a life-threatening clinical emergency. We present the case of a pregnant woman who was preliminarily diagnosed with the condition using ultrasound and discuss the ultrasound characteristics. Ultrasound is a quick and safe examination with no radiation exposure and is preferred for pregnant women. Although pathology remains the gold standard for diagnosis, ultrasound can facilitate a preliminary diagnosis, leading to differential diagnosis to reduce misdiagnosis, prompting further diagnosis and treatment. Therefore, ultrasound plays a crucial role in the diagnosis of this condition.