Spontaneous intraperitoneal rupture of a kidney in a patient with tuberous sclerosis

The radiological appearances of tuberous sclerosis

Tuberous sclerosis is an autosomal dominant disorder often associated with a chromosome 9 abnormality, although up to 60% of cases occur spontaneously. The incidence of the disorder is between 1/100,000 and 1/10,000, and it leads to multiple organ and skeletal abnormalities. The classical triad of epilepsy, mental retardation and adenoma sebaceum defines the syndrome clinically. Other cutaneous associations include shagreen patches, ash leaf-shaped areas of depigmentation, subungual fibromas and café-au-lait spots. This review describes the commoner radiological manifestations of the syndrome, and briefly mentions the rarer associations that have been reported to date.

Ruptured hepatic angiolipoma in tuberous sclerosis complex

Tuberous sclerosis complex (TSC) may be associated with hepatic angiomyolipoma. In contradistinction to renal angiomyolipoma this lesion is rare, and nontraumatic hemorrhage has not so far been described. This is the first report of a spontaneously ruptured, surgically treated and histologically verified, hepatic angiomyolipoma in TSC. Anomalies of the vessel walls and consequently the hazard of bleeding are known to increase with the diameter of the tumor in other localizations. It is concluded that in cases with rapid tumor growth and marked vessel anomalies elective surgery should be considered.

[Bourneville's disease of the bones or metastasis? Apropos of a case]

Tuberous sclerosis or Bourneville's disease is a phakomatosis with common but paucisymptomatic bone localisations. Some osseous lesions, of osteosclerotic type, can be radiologically diagnosed as primary or secondary malignant disorders. We describe a case of Bourneville's disease with bone involvement, radiologically characterized by osteosclerosis areas of the spine and the pelvis. Interestingly, bone scintiscan was normal. The absence of primary malignancy, the stability of control bone X-ray films, the clinical status and the family history, together with the pathognomonic radiological feature of the hands support the diagnosis of tuberous sclerosis with bone involvement.