Radiographically, tuberous sclerosis is suspected when angiomyolipoma is found in patients with simple renal cysts. Angiomyolipomas may hemorrhage at any time, but lesions > 4 cm are often prophylactically resected because their hemorrhage risk is high. When renal lesions don't contain substantial fat in patient's with TS, the presumptive diagnosis is "fat poor" angiomyolipomas. These lesions are indistinguishable from renal cell carcinomas. However, since the lesions are multiple and bilateral and since biopsy is of limited utility, these patient's must be followed closely to exclude growth (resecting multiple bilateral lesions is contraindicated due to complication risks and risks of diminished renal function). If the lesions remain stable, the diagnosis of angiomyolipoma is confirmed, if the lesions grow, they are resected for presumed renal cell carcinoma.
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