Fig. 2

A 20-year-old male patient with TSC presented with left loin pain for 3 months and recurrent attacks of gross hematuria for 1 month. He was hemodynamically stable and was admitted with hemoglobin level of 11.5 g/dL with no need of blood transfusion. He underwent urgent SAE using microspheres and 2 microcoils; hematuria stopped, his hemoglobin level reached 12.2 mg/dl and there was a significant tumor size reduction of about (48%) on follow-up. a UECT scan of the brain (axial image): Hyperdense calcified subependymal hamartomas (tubers) (yellow arrow). b Arterial phase of CECT scan (axial image) and c Arterial phase of CECT scan coronal MIP images: Single left renal artery with midzonal intra-lesional aneurysm (yellow arrow) supplied by the middle segmental branch and multiple left renal AMLs with multiple abnormal vascularities. Left renal digital subtraction angiography (d, e, f); d Pre-embolization angiography of the left renal artery using cobra catheter showing multiple lesions with multiple abnormal vascularities, then e Superselective catheterization of the middle segmental branch supplying midzonal lesion with multiple intra-lesional aneurysms. f Post-embolization control angiogram showing no further opacification of the lesion after SAE using microspheres. g CECT scan (axial image) before SAE: Exophytic left midzonal renal AML with multiple abnormal vascularities. h UECT scan (axial image) 9 months after SAE: Significant tumor size reduction of about (48%) Note the 2 microcoils (yellow arrow)