Renal and hepatic angiomyolipoma.

It is now common practice to undertake ultrasonography as the initial investigation of the renal tract but the finding of multiple hyperechoic tumours was quite unexpected. Such marked hyperechogenicity indicates a markedly fatty or fibrous consistency and excludes multiple cystic disease. Multiple well defined tumours in both kidneys is very suggestive ofangiomyolipomas, a benign hamartomatous tumour most commonly associated with tuberose sclerosis. The diagnosis can be proved either by the pathognomonic arteriographic appearances or by computed tomography. The latter examination shows the adipose nature of the tumours as low density areas. The adenoma sebaceum on the face may not be remarkable when small, particularly in dark skin, and furthermore may occur in mentally normal individuals. Associated angiomyolipomas in the liver are uncommon but recognized. Diagnosis of this condition is important, particularly when the tumour is confined to one kidney, as surgery is unnecessary in this benign condition unless there is a complication such as haemorrhage. (Arteriography by Dr K. Mourad, Consultant Radiologist, Newham General Hospital and ultrasonography by Dr P. Guggiana, Newham General Hospital).