Join us   Log in  


Pages: 0-0

Date of Publication: 11-May-2023

Print Article   Download XML

Centrally Thrombosed Renal Angiomyolipoma: A COVID-Induced Pathology?

Author: Adrian A. Naoun* (USA)

Category: Medicine


Renal angiomyolipomas (AMLs) are benign neoplastic entities paradigmatically composed of smooth muscle, blood vessels, and adipose tissue. The cornerstone of renal AML identification fundamentally entails imaging; however, findings may rarely resemble malignancy and subsequently obfuscate diagnosis. Compellingly, the comorbid effect of viral diseases such as COVID-19 on neoplasm integrity and morphology remains incompletely understood. The present case reports a 46-year-old female presenting with intermittent right flank pain persisting for three weeks. Preliminary sonographic studies revealed a predominantly echogenic, space-occupying lesion with well-defined margins in the right renal cortex undergoing angiogenesis. Shortly thereafter, the patient contracted COVID-19, and the right flank pain progressed to a debilitatingly constant nature described as sharp, stabbing, and aggravating to an eight on a scale of ten. Recovery was uncomplicated; however, the patient presented with mild thrombocytopenia. Contrast-enhanced CT scans elucidated a compelling hypodense mass center suggesting the presence of an encapsulated thrombus accompanied by further invasion of Morison’s pouch 25 days post-initial identification. Histopathological examination of the surgically excised specimen confirmed the likely diagnosis of a centrally thrombosed renal angiomyolipoma. Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection may have ostensibly contributed to neoplasm morphology alterations and subsequent thrombosis, as intrinsic renal cell damage is well-documented in the literature. Consequently, clinicians must remain vigilant that radiographic abnormalities may emerge secondary to comorbid viral infections such as COVID-19 via incompletely understood mechanism(s).

Keywords: Angiomyolipoma, COVID

DOI: 10.55828/ijcicr-22-05



1. Rajebi, H. and V. Katabathina, Renal Angiomyolipoma: What the Radiologist Needs to Know. Contemporary Diagnostic Radiology, 2020. 43(14): p. 1-5.

2. Jinzaki, M., et al., Renal angiomyolipoma: a radiological classification and update on recent developments in diagnosis and management. Abdominal Imaging, 2014. 39(3): p. 588-604.

3. Isac, V.M., et al., Renal angiomyolipoma with cardiac extension in patient with tuberous sclerosis complex. Circulation, 2011. 124(23): p. e736-8.

4. Jinzaki, M., et al., Angiomyolipoma: imaging findings in lesions with minimal fat. Radiology, 1997(0033-8419 (Print)).

5. Kim, J.K., et al., Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT. (0033-8419 (Print)).

6. Jinzaki, M., et al., Diagnosis of Renal Angiomyolipomas: Classic, Fat-Poor, and Epithelioid Types. Semin Ultrasound CT MR, 2017. 38(1): p. 37-46.

7. Flum, A.S., et al., Update on the Diagnosis and Management of Renal Angiomyolipoma. J Urol, 2015(1527-3792 (Electronic)).

8. Xu, X.F., et al., A scoring system based on clinical features for the prediction of sporadic renal angiomyolipoma rupture and hemorrhage. Medicine (Baltimore), 2020. 99(20): p. e20167.

9. Cao, H., et al., The independent indicators for differentiating renal cell carcinoma from renal angiomyolipoma by contrast-enhanced ultrasound. BMC Med Imaging, 2020. 20(1): p. 32.

10. Shamam, Y.M. and S.W. Leslie, Renal Angiomyolipoma. BTI - StatPearls.

11. Melo Abreu, E. and T.M. Cunha, Renal angiomyolipoma with renal vein thrombosis: an incidental finding. BJR Case Rep, 2016. 2(2): p. 20150218.

12. Hélénon, O., et al., Unusual fat-containing tumors of the kidney: a diagnostic dilemma. Radiographics, 1997(0271-5333 (Print)).

13. Aron, M., et al., Renal cell carcinomas with intratumoral fat and concomitant angiomyolipoma: potential pitfalls in staging and diagnosis. Am J Clin Pathol, 2010. 134(5): p. 807-12.

14. Xian, Z., et al., Clinicopathologic analysis of renal cell carcinoma containing Intratumoral fat with and without osseous metaplasia. Diagn Pathol, 2020. 15(1): p. 21.

15. Morris, H., et al., Don't be fooled by the fat: A rare case of renal cell carcinoma with intratumoural fat. Urol Case Rep, 2020. 30: p. 101112.

16. Richmond, L., et al., Renal cell carcinoma containing macroscopic fat on CT mimics an angiomyolipoma due to bone metaplasia without macroscopic calcification. Br J Radiol, 2010. 83(992): p. e179-81.

17. Batlle, D., et al., Acute Kidney Injury in COVID-19: Emerging Evidence of a Distinct Pathophysiology. (1533-3450 (Electronic)).

18. Menter, T., et al., Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology, 2020. 77(2): p. 198-209.

19. Su, H., et al., Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. Kidney Int, 2020. 98(1): p. 219-227.

20. Reddy, R., et al., Circulating angiotensin peptides levels in Acute Respiratory Distress Syndrome correlate with clinical outcomes: A pilot study. PLoS One, 2019. 14(3): p. e0213096.

21. Young, J., et al., Renal angiomyolipoma rupture in a young female with COVID-19. Am J Emerg Med, 2021. 47: p. 316 e1-316 e3.

22. Bhattacharjee, S., M. Banerjee, and R. Pal, COVID-19 Associated Hemophagocytic Lymphohistiocytosis and Coagulopathy: Targeting the Duumvirate. (0974-7559 (Electronic)).

23. Mackman, N., et al., Coagulation Abnormalities and Thrombosis in Patients Infected With SARS-CoV-2 and Other Pandemic Viruses. (1524-4636 (Electronic)).

24. Barrett, T.J., et al., Platelets contribute to disease severity in COVID-19. J Thromb Haemost, 2021. 19(12): p. 3139-3153.

25. Boccatonda, A., et al., Platelet Count in Patients with SARS-CoV-2 Infection: A Prognostic Factor in COVID-19. J Clin Med, 2022. 11(14).

26. Puelles, V.G., et al., Multiorgan and Renal Tropism of SARS-CoV-2. (1533-4406 (Electronic)).

27. Su, H., et al., Renal histopathological analysis of 26 postmortem findings of patients with COVID-19 in China. (1523-1755 (Electronic)).

28. Tanaka, T., M. Narazaki, and T. Kishimoto, Immunotherapeutic implications of IL-6 blockade for cytokine storm. (1750-7448 (Electronic)).

29. Faour, W.H., et al., Mechanisms of COVID-19-induced kidney injury and current pharmacotherapies. Inflamm Res, 2022. 71(1): p. 39-56.

30. Diao, B., et al., Human kidney is a target for novel severe acute respiratory syndrome coronavirus 2 infection. Nat Commun, 2021. 12(1): p. 2506.