Spontaneous angiomyolipoma rupture: A case of hemorrhagic shock and urgent embolization

This case report discusses a 64-year-old male with tuberous sclerosis complex (TSC), a genetic disorder characterized by benign tumor formation across multiple organ systems. The patient presented with a spontaneous hemorrhage from a right renal angiomyolipoma, a common and potentially life-threatening manifestation of TSC, particularly in patients with TSC2 mutations. The patient's significant comorbidities, including hypertension and dyslipidemia, further complicated his clinical course. Initial management involved aggressive fluid resuscitation and blood product transfusion, followed by urgent embolization to control active bleeding. Despite developing complications such as transfusion-associated circulatory overload (TACO), the patient was successfully stabilized. This case highlights the necessity for careful monitoring and prompt intervention in patients with TSC, given the high risk of hemorrhage from angiomyolipomas, especially those larger than 3 cm. We also emphasize the importance of differentiating TSC-associated angiomyolipomas from other renal masses, considering the variability in clinical presentation and the potential for late-onset symptoms. Additionally, it highlights the critical role of a multidisciplinary approach in managing TSC patients, addressing both acute complications and long-term surveillance to prevent recurrence and other systemic manifestations of the disease.