Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2024.482
Autopsy and Case Reports
Autopsy Case Report and Review

Autopsy findings of fatal retroperitoneal hemorrhage after traumatic rupture of bilateral renal angiomyolipoma

Enrico De Dominicis; Gian Luca Marella; Gabriele Giuga; Giulia Ceccobelli; Luca Savino; Alessandro Mauro Tavone

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Abstract

The present work reports the autopsy findings of a unique case characterized by fatal retroperitoneal hemorrhage following the traumatic rupture of bilateral renal angiomyolipomas. Renal angiomyolipomas are generally benign tumors with an unpredictable clinical course, ranging from asymptomatic to sudden rupture and hemorrhagic shock. They may be associated with genetic disorders such as tuberous sclerosis complex. The case under investigation is unprecedented in the medical literature due to its bilateral nature and fatal outcome. Autopsy analysis revealed an extensive retroperitoneal hemorrhage originating from bilateral ruptured tumors. Microscopic examination found features consistent with bilateral renal angiomyolipoma. Circumstantial information identified a traffic accident before the death, considering it as the cause of the tumors’ traumatic rupture. In this case, due to the severity of the situation, immediate medical measures—such as fluid resuscitation, coagulopathy correction, and surgical treatment, which are usually lifesaving—could not be performed. This led to the patient being declared dead at the scene of the crash.

Keywords

Retroperitoneal Space, Hemorrhage, Angiomyolipoma, Fatal Outcome

References

1 Unlü C, Lamme B, Nass P, Bolhuis HW. Retroperitoneal haemorrhage caused by a renal angiomyolipoma. Emerg Med J. 2006;23(6):464-5. http://dx.doi.org/10.1136/emj.2005.033191. PMid:16714510.

2 Steiner MS, Goldman SM, Fishman EK, Marshall FF. The natural history of renal angiomyolipoma. J Urol. 1993;150(6):1782-6. http://dx.doi.org/10.1016/S0022-5347(17)35895-0. PMid:8230504.

3 Jinzaki M, Silverman SG, Akita H, Nagashima Y, Mikami S, Oya M. Renal angiomyolipoma: a radiological classification and update on recent developments in diagnosis and management. Abdom Imaging. 2014;39(3):588-604. http://dx.doi.org/10.1007/s00261-014-0083-3. PMid:24504542.

4 Oesterling JE, Fishman EK, Goldman SM, Marshall FF. The management of renal angiomyolipoma. J Urol. 1986;135(6):1121-4. http://dx.doi.org/10.1016/S0022-5347(17)46013-7. PMid:3520013.

5 Corr P, Yang WT, Tan I. Spontaneous haemorrhage from renal angiomyolipomata. Australas Radiol. 1994;38(2):132-4. http://dx.doi.org/10.1111/j.1440-1673.1994.tb00153.x. PMid:8024508.

6 Albi G, del Campo L, Tagarro D. Wünderlich’s syndrome: causes, diagnosis and radiological management. Clin Radiol. 2002;57(9):840-5. http://dx.doi.org/10.1053/crad.2002.0981. PMid:12384111.

7 Bissler JJ, Kingswood JC. Renal angiomyolipomata. Kidney Int. 2004;66(3):924-34. http://dx.doi.org/10.1111/j.1523-1755.2004.00838.x. PMid:15327383.

8 Eble JN. Angiomyolipoma of kidney. Semin Diagn Pathol. 1998;15(1):21-40. PMid:9503504.

9 Lorin de la Grandmaison G, Clairand I, Durigon M. Organ weight in 684 adult autopsies: new tables for a Caucasoid population. Forensic Sci Int. 2001;119(2):149-54. http://dx.doi.org/10.1016/S0379-0738(00)00401-1. PMid:11376980.

10 Lemaitre L, Claudon M, Dubrulle F, Mazeman E. Imaging of angiomyolipomas. Semin Ultrasound CT MR. 1997;18(2):100-14. http://dx.doi.org/10.1016/S0887-2171(97)90054-8. PMid:9163829.

11 Lane BR, Aydin H, Danforth TL, et al. Clinical correlates of renal angiomyolipoma subtypes in 209 patients: classic, fat poor, tuberous sclerosis associated and epithelioid. J Urol. 2008;180(3):836-43. http://dx.doi.org/10.1016/j.juro.2008.05.041. PMid:18635231.

12 Williamson B Jr, Bernard FK Jr. Benign neoplasmas of the renal parenchyma. In: Pollack HM, Mcclennan BL, editors. Clinical urography. 2nd ed. Philadelphia: Saunders; 2000. p. 1413-39.

13 Johnson SR, Cordier JF, Lazor R, et al. European Respiratory Society guidelines for the diagnosis and management of lymphangioleiomyomatosis. Eur Respir J. 2010;35(1):14-26. http://dx.doi.org/10.1183/09031936.00076209. PMid:20044458.

14 Avila NA, Kelly JA, Chu SC, Dwyer AJ, Moss J. Lymphangioleiomyomatosis: abdominopelvic CT and US findings. Radiology. 2000;216(1):147-53. http://dx.doi.org/10.1148/radiology.216.1.r00jl42147. PMid:10887241.

15 Yu DS, Wu CJ, Chang SY. Growth pattern of renal angiomyolipoma on computed tomography: report of two cases. J Formos Med Assoc. 2001;100(1):60-2. PMid:11265264.

16 van Baal JG, Smits NJ, Keeman JN, Lindhout D, Verhoef S. The evolution of renal angiomyolipomas in patients with tuberous sclerosis. J Urol. 1994;152(1):35-8. http://dx.doi.org/10.1016/S0022-5347(17)32809-4. PMid:8201681.

17 Redkar N, Patil MA, Dhakate T, Kolhe P. uberous sclerosis complex presenting as bilateral large renal angiomyolipomas. BMJ Case Rep. 2012;2012(aug07 1):bcr2012006412. http://dx.doi.org/10.1136/bcr-2012-006412. PMid:22878994.

18 Ali S, Lalani AS, Mukherjee D, Hashmi KN. A rare case of bilateral renal angiomyolipoma: radiological findings of tuberous sclerosis complex. Clin Case Rep. 2023;11(5):e7368. http://dx.doi.org/10.1002/ccr3.7368. PMid:37220517.

19 Heidari R, Ghadamzadeh M, Bahardoust M, et al. Association of CT scan parameters with the risk of renal angiomyolipoma rupture: a brief report. Arch Acad Emerg Med. 2022;10(1):e7. PMid:35072096.

20 Shah PJ, Gaches CG. Bilateral renal angiomyolipoma: a case report. Eur Urol. 1980;6(6):361-3. http://dx.doi.org/10.1159/000473373. PMid:7460986.

21 Tongaonkar HB, Sampat MB, Dalal AV, Dandekar NP, Kulkarni JN, Kamat MR. Bilateral renal angiomyolipoma. J Surg Oncol. 1994;57(1):65-70. http://dx.doi.org/10.1002/jso.2930570116. PMid:8065155.

22 Ciancio SJ, Vira M, Simon MA, Lerner SP, Schulam PG. Giant bilateral renal angiomyolipomas associated with tuberous sclerosis. Urology. 2001;57(3):554. http://dx.doi.org/10.1016/S0090-4295(00)01051-7. PMid:11248643.

23 Bechtold IR. Multiple bilateral renal angiomyolipoma: case report. Scand J Urol Nephrol. 1976;10(2):160-4. http://dx.doi.org/10.3109/00365597609179680. PMid:948726.

24 Lai CC, Fan WC, Chao CM, Liu WL, Hou CC. Traumatic rupture of a renal angiomyolipoma. J Emerg Med. 2012;43(5):e339-40. http://dx.doi.org/10.1016/j.jemermed.2011.05.059. PMid:21871768.

25 Renz B, Sorini P, Wachtel TL, Perry R. Traumatic rupture of a renal angiomyolipoma. Injury. 1989;20(1):50-1. http://dx.doi.org/10.1016/0020-1383(89)90047-8. PMid:2592069.

26 Beh WP, Barnhouse DH, Johnson SH 3rd, Marshall M Jr, Price SE Jr. A renal cause for massive retroperitoneal hemorrhage: renal angiomyolipoma. J Urol. 1976;116(3):372-4. http://dx.doi.org/10.1016/S0022-5347(17)58821-7. PMid:957510.

27 Tsai CK, Lin YT, Lin TC. Traumatic rupture of bilateral huge renal angiomyolipomas in tuberous sclerosis complex. J Trauma. 2010;69(2):477. http://dx.doi.org/10.1097/TA.0b013e318180a428. PMid:20699763.

28 Mantas D, Papachristodoulou A. Bilateral renal angiomyolipoma. Acta Chir Belg. 2006;106(6):707-9. http://dx.doi.org/10.1080/00015458.2006.11679987. PMid:17290701.

29 Faraji H, Nguyen BN, Mai KT. Renal epithelioid angiomyolipoma: a study of six cases and a meta-analytic study. Development of criteria for screening the entity with prognostic significance. Histopathology. 2009;55(5):525-34. http://dx.doi.org/10.1111/j.1365-2559.2009.03420.x. PMid:19912358.

30 Wang H-B, Yeh C-L, Hsu K-F. Spontaneous rupture renal angiomyolipoma with hemorrhagic shock. Intern Med. 2009;48(12):1111-2. http://dx.doi.org/10.2169/internalmedicine.48.2270. PMid:19525611.

31 Cho E, Morozumi M, Yano A, et al. Huge renal angiomyolipoma complicated with common iliac vein thrombus because of the tumor pressure. Nippon Hinyokika Gakkai Zasshi. 2017;108(2):96-100. http://dx.doi.org/10.5980/jpnjurol.108.96. PMid:29669983.
 


Submitted date:
11/03/2023

Accepted date:
02/28/2024

Publication date:
03/15/2024

65f45f10a9539543c96d5d73 autopsy Articles
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