We report a case of 65-year male patient, a known hypertensive and a chronic smoker, who presented to the Civil Hospital, Karachi with complaints of cough, hemoptysis and shortness of breath for three weeks. The chest radiograph showed left apical solitary pulmonary nodule (SPN) and aneurysmal dilatation of the descending thoracic aorta. He was further investigated with contrast enhanced computed tomography (CECT) scan of chest, which apart from demonstrating malignant pulmonary lesion, surprisingly revealed Stanford type B descending thoracic aortic dissecting aneurysm with intramural hematoma, jeopardising renal and splanchnic circulation. An asymptomatic dissecting aortic aneurysm is relatively rare. To the best of authors' knowledge, less than 15 case reports have been published in the international literature.

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Large aneurysms seen in renal angiomyolipoma are usually more common in patients with tuberous sclerosis in comparison with sporadic cases and they are more prone to hemorrhage ranging from renal hematoma to life-threatening perirenal hemorrhages. We present a case of 13-year female patient who was referred to Civil Hospital, Karachi, with bilateral flank pain, cutaneous nodule and low intelligence. Her color doppler ultrasound revealed pseudoaneurysm in left kidney on the background of bilateral renal angiomyolipomas. Contrast enhanced CT scan confirmed various radiological manifestations of tuberous sclerosis including subependymal tubers, bilateral angiomyolipomas, and pseudoaneurysm associated with perinephric hemorrhage in left kidney.