An Autopsy Case of Pulmonary Embolism Due to Renal Angiomyolipoma in an Elderly Woman.

Abstract

An 86-year-old woman with a 13-year history of hypertension was admitted because of consciousness disturbance, hypotension, tachycardia, and cyanosis at her extremities. Enhanced computed tomography showed a thrombus in the truncus pulmonalis and right pulmonary artery, and also showed a left renal mass and a right renal cyst. Under a diagnosis of pulmonary embolism we started anticoagulant therapy, but the patient died five days after admission. At autopsy, a saddle-like thrombus was found in the truncus pulmonalis and bilateral trunks of pulmonary arteries. Microscopic examination showed smooth muscle cells in the thrombus. We could not find any other thrombus in the inferior vena cava, intrapelvic veins, nor in veins of lower extremities by milking. We also found tumors in both kidneys. Microscopically all tumors were diagnosed as angiomyolipoma. There were many fibrin thrombi in the sinuses of the tumors but there was no evidence of malignancy. We finally diagnosed pulmonary embolism due to renal angiomyolipoma because there was no other thrombus origin and microscopically the same smooth muscle cells were found both in the renal tumor and the pulmonary thrombus. There is only one case report concerning pulmonary embolism due to renal angiomyolipoma which happened during operative treatment. The treatment method of renal angiomyolipoma is determined by tumor size and symptoms, and usually intensive treatment is not performed in cases without symptoms. Our patient had no symptoms until the onset of severe complication of pulmonary embolism, suggesting that radical treatment is necessary for renal angiomyolipoma with a thrombus even when there are no symptoms.

Renal Angiomyolipomas with Inferior Vena cava invasion

“…More severe presentations were right-sided heart failure in a patient whose thrombus totally occluded the IVC [11] and hypotension in a patient with intratumoral hemorrhage found later on pathology [34]. Shinohara et al reported a case that presented with signs of massive PE and cardiogenic shock (hypotension, tachycardia, and cyanosis); no thrombus was found anywhere in the venous circulation of the patient except in the truncus pulmonaris and the two pulmonary arteries.…”

Preoperative inferior vena cava filter implantation to prevent pulmonary fat embolism in a patient showing renal angiomyolipoma extension into the renal vein: A case report and literature review

“…Several cases of pulmonary thrombosis have been reported in patients with AML with venous extension 5 , 6 , 7 ) . A few patients were asymptomatic; however, 1 death was reported 8 ) . Turowski reported a case of a 20-year-old patient who developed cardiac arrest secondary to pulmonary embolism during nephrectomy 6 ) .…”

Nephron Sparing Surgery for Renal Angiomyolipoma with Inferior Vena Cava Thrombus in Tuberous Sclerosis

“…Case reported by Shinohara et al presented with congestive heart failure with a thrombus extended to the right atrium [57]. …”