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Selective arterial embolization of angiomyolipoma leading to pulmonary hypertension

Franklin Lee, David S. Aaronson, Sarah Blaschko, Phil Barbosa, Alex K. Wu, Michael Eisenberg, Bradley A. Erickson, Jack W. McAninch

Department of Urology, University of California, San Francisco, California, USA
Address correspondence to Dr. Bradley A Erickson, San Francisco General Hospital, 1001 Potrero Avenue, Suite 3A20, San Francisco, CA94110 USA

Canadian Journal of Urology 2010, 17(3), 5232-5235.

Abstract

Objectives: To report two cases of secondary pulmonary hypertension resulting from microsphere extravasation following selective arterial embolization of renal angiomyolipoma, its diagnosis, and management.
Methods: We reviewed the cases of two patients at the University of California, San Francisco, treated with selective arterial embolization for management of their angiomyolipoma (AML) using Tris-Acryl Gelatin Microspheres.
Results: Both patients were women, ages 51 and 77. Indications for treatment were the following: Patient 1 was treated for a large asymptomatic AML. Patient 2 was treated for a symptomatic, bleeding AML. Both patients developed progressive hypoxia following selective arterial embolization using Tris-Acryl Gelatin Microspheres. Each patient underwent a subsequent work up including a CT chest, echocardiogram, and chest x-ray. Both demonstrated significant pulmonary hypertension following their procedure and were discharged with supplemental oxygen.
Conclusions: Selective arterial embolization of AML with microsphere extravasation into the pulmonary vasculature can lead to pulmonary hypertension and hypoxemia.

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