Lu Chun-Yan, Min Peng-Qiu, Wu Bing
Department of Radiology, West China Hospital of Sichuan University , Chengdu, Sichuan 610041 , China.
Acta Radiol Short Rep. 2012 May 30;1(4). doi: 10.1258/arsr.2012.110009. eCollection 2012.
Renal angiomyolipomas (RAMLs) can spontaneously rupture and induce hemorrhage that is usually confined to the perirenal space (PS) but may spread beyond the PS into other retroperitoneal fascia and fascial spaces, including up to the subdiaphramatic and down to pelvic extra-peritoneal regions.
To evaluate the computed tomography (CT) manifestations of renal angiomyolipoma (RAML) associated with spontaneous rupture and massive hemorrhage spreading beyond the PS into other retroperitoneal fascia and fascial spaces, including up to the subdiaphramatic and down to pelvic extra-peritoneal regions.
The CT scans of seven patients with spontaneously ruptured of RAMLs and massive hemorrhage (surgically and pathologically confirmed) were retrospectively reviewed. We evaluated the CT signs of the RAML itself and the regions with extensive retroperitoneal spreading after RAML rupture.
THE CT MANIFESTATIONS OF SEVEN CASES WITH RAML SPONTANEOUS RUPTURE AND MASSIVE HEMORRHAGE INCLUDED THE FOLLOWING: (a) RAML signs: size (>4.0 cm, five patients; <4.0 cm, two patients), location (periphery, six patients; central portion, one patient), component (fat tissue included, seven patients), and boundary (poorly revealed, seven patients); and (b) signs of extensive retroperitoneal spreading after RAML rupture: involving the PS and extending beyond the PS (seven patients); spread to the pelvic extraperitoneal space (seven patients); attached to the subdiaphragmatic extraperitoneal region (four patients); and extended to the contralateral retroperitoneal spaces (six patients).
CT scans clearly depict both the primary tumor and complicated signs of a spontaneously ruptured RAML with massive hemorrhage, which can affect other fascial planes and retroperitoneal spaces and can extend upward to the subdiaphragmatic region and downward to the pelvic extraperitoneal region or communicate with the contralateral side.
肾血管平滑肌脂肪瘤（RAMLs）可自发破裂并引发出血，出血通常局限于肾周间隙（PS），但也可能超出PS扩散至其他腹膜后筋膜和筋膜间隙，包括向上至膈下和向下至盆腔腹膜外区域。
评估肾血管平滑肌脂肪瘤（RAML）自发破裂并伴有大量出血扩散至PS以外的其他腹膜后筋膜和筋膜间隙（包括向上至膈下和向下至盆腔腹膜外区域）的计算机断层扫描（CT）表现。
回顾性分析7例经手术及病理证实的RAMLs自发破裂并大量出血患者的CT扫描图像。我们评估了RAML本身的CT征象以及RAML破裂后腹膜后广泛扩散的区域。
7例RAML自发破裂并大量出血的CT表现如下：（a）RAML征象：大小（>4.0 cm，5例；<4.0 cm，2例）、位置（周边，6例；中央部分，1例）、成分（包括脂肪组织，7例）和边界（显示不清，7例）；（b）RAML破裂后腹膜后广泛扩散的征象：累及PS并超出PS（7例）；扩散至盆腔腹膜外间隙（7例）；附着于膈下腹膜外区域（4例）；延伸至对侧腹膜后间隙（6例）。
CT扫描能清晰显示自发破裂并大量出血的RAML的原发肿瘤及复杂征象，其可影响其他筋膜平面和腹膜后间隙，向上可延伸至膈下区域，向下可延伸至盆腔腹膜外区域或与对侧相通。
