Objectives- To evaluate and describe vascular anatomy and the prevalence of vascular variants in upper abdomen in cancer patients with CT angiography to provide roadmap to surgeons to ensure safe surgery. Materials and Methods- A total of 125 cancer patients were evaluated by a Dual-slice spiral CT scanner with maximum intensity projections (MIP) and 3-D postprocessing.We compared CT angiographic findings with intra-operative findings in 62 patients who underwent surgery. Results- CT angiography was found very accurate to evaluate vascular anatomy.In our study of 125 patients 76 ( 61%) of patients showed variations:37 (30%) had single variations and 39 (31%) had more than one variation. The classic hepatic arterial anatomy,with the hepatic artery dividing into right and left hepatic arteries is seen in 53% of patients.Left hepatic artery variations in 26 (21%) patients,right hepatic artery variations in29 (23%) patients, and common hpatic artery variations in 4 (3%) patients were noted. Variations were also seen in hepatic veins, inferior phrenic arteries and, renal arteries and veins.Renal artery variations were seen in 33 (26.4) patients and renal veins variations in 19 (15%) patients. CT angiographic findings were similar to intra-operative findings in 61 (98%) patients who underwent surgery.In one patient we could not visualize an accessory right hepatic artery but it was visualized in retrosperct study arising from gastroduodenal artery. Conclusion- CT angiography is safe and highly sensitve and accurate modality for evaluation of vascular anatomy.

Carcinosarcoma is a rare type of gallbladder malignancy, the diagnosis requires the presence of both malignant epithelial and mesenchymal components. The prognosis of this disease is extremely poor. We report a case of carcinosarcoma of the gallbladder with chondroid differentiation in a 68 years old man presented as an intraluminal growth of gallbladder. MR findings, histological findings and differential diagnosis of the case were discussed.

We describe a case of 12 inches long rigid, radiolucent foreign body in a 17 year old female accidentally ingested and impacted in upper G.I. Tract. Patient was haemodynamically stable, walking-talking with presenting complaints of dysphgia and nausea. Though Radio-opaque foreign bodies are easily evident on plain radiographs but Radiolucency and midline location (overlapped by thoracic vertebral shadow) made it a difficult task to map this unusual foreign body on plain skiagram. Barium study revealed a straight, 12 inches long foreign body from mid esophagus to greater curvature of stomach with evidence of erosion at the terminal ends. Laparotomy revealed the presence of 12 inches long rigid foreign body DATUN (Neem stick -a ayurvedic remedy used for oral hygiene-cleaning and brushing teeth) impending to rupture the viscera at both ends.

Diabetic autonomic neuropathy gives rise to varied manifestations in the gastrointestinal tract i.e. gastropathies, nocturnal diarrhoea, oesophageal dysmotility, constipation and gallbladder dysfunction, being consequence of vagal neuropathy leading to reduced G.I. Motility. Gallbladder involvement in diabetic autonomic neuropathy is in the form of high incidence of gall bladder stones and a significant increase in gall bladder volume with poor concentration and poor visualization, with lack of symptoms of gallbladder disease. The present study concluded that gall bladder disease is more prevalent among type 2 diabetics. Diabetics with autonomic neuropathy tend to have larger gall bladders with poor contraction in response to fatty meals (due to vagal neuropathy), thus predisposing these patients to various forms of gall bladder disease.

Pseudoaneurysm can arise due to various etiologies and patient may presents with symptoms not related with primary location of lesion. This article describes an unusual case of pseudoaneurysm diagnosed on USG. Old aged female patient presented with episodes of altered consciousness. USG study of abdomen revealed huge multilayered lesion in left hypochondrial region with peripheral anechoic region, which showed continuous and regular pulsation on real time study. We put diagnosis of pseudoaneurysm of splenic artery. The patient was advised for CT scan and findings were confirmed. Awareness of typical sonographic appearance of pseudoaneurysm may aid in early and proper diagnosis.

Objectives: To assess the efficacy of MR imaging, with MR Cholangiography and MR Angiography in pre operative evaluation of pancreatic tumors. Materials and Methods: 30 patients suspected of having pancreatic tumors underwent MR imaging with a 1.5T unit. Images were prospectively analyzed results correlated with surgery and biopsy. Results: Of the total 30 patients, 24 were histologically proven to be malignant of which 21 underwent surgery. MR characterization - benign from malignant lesions resulted in 27 correct diagnosis (accuracy 90%). 2 patients with histologically confirmed chronic pancreatitis were wrongly considered malignant. Among patients with histologically proven malignancy (n=24), MR imaging yielded correct diagnosis in 23 of 24 patients a sensitivity of 96 %. Overall accuracy for determining vascular involvement in patients who underwent surgery (n=21) was 86% (18 out of 21) a sensitivity of 75% (6 of 8). Sensitivity for detection of lymphadenopathy and liver metastasis was only 50% and 60% respectively. Among patients with final diagnosis of malignancy (n=24) who underwent surgery (n=21), overall accuracy for determining tumor nonresectabilty was 81 % (17 out of 21). Conclusion: A comprehensive combination of MR imaging sequences with MRCP and MR Angiography offers excellent potential to depict, characterize and preoperatively determine the resectability of pancreatic masses.

Objective: Ultrasonographic characterization of intracranial pathologies with respect to acute bacterial meningitis and its sequale. Materials and methods: A prospective study of 70 cases, below 12 months of age within a period of two years, was undertaken to characterize sonographic abnormalities in acute bacterial meningitis and its sequale. Results: Echogenic sulci, ventriculomegaly and ventriculitis were the findings observed on ultrasonography in cases with acute bacterial meningitis and its sequale. Conclusion: Infantile transcranial ultrasonography is an useful diagnostic tool for rapid, safe and fairly accurate evaluation of intracranial pathologies in relation to acute bacterial meningitis and its sequale.

A rare case of ileo-colic aneurysm- branch of superior mesenteric artery is presented. Injuries to branches of superior mesenteric artery are unusual and often difficult to diagnose, yet require prompt recognition and treatment to prevent exsanguinating hemorrhage or bowel ischemia(1).The present patient was a known case of RHD with severe AS and moderate AR and was operated in 2001.Patient has a history of trauma in right iliac fossa and was diagnosed as aneurysm on color Doppler, confirmed on CT angio, MR angiography and conventional; angiography. Since Patient was asymptomatic when came to radiology deptt, intervention was deferred for a week. After a week when color Doppler was performed it showed on resolved hematoma and no aneurysm. This is a unique case of ileocolic aneurysm resolving on its own .only few cases of ileocolic artery aneurysm have been reported in literature; either they are treated with laprotomy or by interventional procedure.

Background: Many imaging modalities are available today for the evaluation of patients with suspected biliary obstruction including Ultrasonography, Computed Tomography and Invasive cholangiography. Magnetic resonance cholangiopancreatography is a relatively new technique, which has gained popularity because of its excellent diagnostic capabilities in the evaluation of biliary obstruction. Aims: The aim of the present study was to compare the diagnostic accuracy of Ultrasonography, Computed Tomography, Endoscopic retrograde cholangiopancreatography/ Percutaneous transhepatic cholangiography and Magnetic resonance cholangiopancreatography in assessing the level and cause of obstruction in patients with obstructive jaundice. Patients & Methods: One hundred patients with clinical and laboratory features suggestive of biliary obstruction were included in this study. At least two imaging modalities were used in each patient. The level and cause of obstruction was evaluated by each modality. The findings were corroborated with the operative and/or histopathological findings. Results: Magnetic resonance cholangiopancreatography showed the best results in detecting the cause of obstruction and was second only to Endoscopic retrograde cholangiopancreatography in detecting the level of biliary obstruction. Conclusions: With its excellent diagnostic capabilities, Magnetic resonance cholangiopancreatography has certainly carved a niche for itself in the non-invasive evaluation of the patient with obstructive jaundice.

To assess the role of quantitative ultrasound densitometry on person with osteoporosis fracture. We measure BUA T-score of Os-calis in a sample of 100 persons (Male 54, Female46), aged 45-99 years at Rajindra Hospital, Patiala. We observed that none of the patient in our study had normal BUA T Score measured by quantitative ultrasound densitometry. All patient had BUA T-Score range -5.5 to -1.2, mean with SD -2.60 1.07. Thus quantitative ultrasound densitometry seems to be a good predictor of fracture risks due to osteoporosis. We also observed that in osteoporotic patient with age 45 years or over there was age related decline BUA T. Score. This was higher in women compared with men. We conclude that all patients with fractures due to osteoporosis had poor bone quality. Thus quantitative ultrasound densitometry may be mandatory for a person with osteoporosis facture.

Objectives: The purpose of this study is to evaluate the role of MRI in cases of bone tumors.To determine the MRI characteristics of different primary bone tumors.Correlate and compare imaging findings with surgical and gross pathological findings whereever possible. Materials and methods: Twenty five patients (either suspected or proven cases of bone tumors) were included in this study.All patients were first evaluated with plain film examination. MRI was performed on a 1.5 Tesla Philips system (Gyroscan). Sequences and planes used were T1W and STIR sequence in coronal plane using body coil followed by T1W and T2W sequences in axial plane supplemented by sagittal and coronal planes using surface coil , second plane of imaging included STIR sequence and post contrast fat sat T1W images . Results : Sensitivity and specificity of MRI in detecting marrow involvement was 100%.MRI detected neurovascular bundle involvement with sensitivity, specificity, positive predictive value and negative predictive value of 100%, 92.8%, 75% and 100% respectively.MRI detected joint involvement with sensitivity, specificity, positive predictive value and negative predictive value of 100%, 86%, 50% and 100% respectively.MRI detected cortical break with sensitivity, specificity, positive predictive value and negative predictive value of 100%, 50%, 80% and 100% respectively. Although MRI could demonstrate different components of tumor, there was no difference in signal intensity patterns of different histological types of tumors. Conclusions : MRI is the preferred modality to image musculoskeletal tumors and should be obtained after radiographic evaluation. Its multiplanar imaging capability helps delineation of tumor and its extent in bone and soft tissues with high contrast resolution.It is an excellent modality to determine neurovascular bundle involvement ,joint involvement,local extent and staging.

Ewing's sarcoma represents 10% of all primary malignant bone tumors [1]. These are primarily seen in long bones. Primary Ewing's sarcoma involving the cranial bones are rare and only 13 cases involving the temporal bone have been reported in literature to the best of our knowledge. Considering its rarity, we report a case of Ewing's sarcoma of the temporal bone. Salient clinical, radiological and histologic features are described.

Objectives: To study biceps tendon sheath fluid collection using musculoskeletal ultrasound and evaluate its cause. Materials and Methods: A total of 15 patients with biceps tendon sheath fluid collection were studied. All these patients presented with history of shoulder pain with inability of overhead abduction of arm and painful circumduction. Discussion: Ten had history of trauma, four had acute trauma and six had an old history of trauma. Five had degenerative shoulder joint disease, out of these two had osteoarthritis and three had rheumatoid arthritis with subacromiodeltoid bursitis. All cases were evaluated on B mode high frequency ultrasound. The gray scale findings were correlated with clinical and arthroscopic findings. These patients were treated conservatively and followed up sequentially. Results: Diagnosis of tendonitis prompted us for a detailed joint examination which revealed rotator cuff tear in eight patients, these tears varied from acute to chronic and partial to complete thickness tears. Five patients had arthritis, two had osteoarthritis with erosion and pitting of the bony groove and three had bursitis secondary to rheumatoid arthritis with tendonitis. Conclusion: The utility of high frequency ultrasound as an imaging technique for biceps tendon is a useful adjunct to clinical examination. The procedure is non invasive, safe without risk of exposure to harmful radiation, cost effective, dynamic and a useful aid in diagnosis. The diagnosis of biceps tendon sheath fluid must prompt a musculoskeletal sonologist for a detailed evaluation of the shoulder.

Low backache is a common clinical presentation in medical practice and a common referral at most MRI centres. The presentation of lesions in low backache involving various lumbar spinal structures as well as sacroiliac joint often overlap and are clinically indistinguishable, necessitating evaluation by MRI. The detection and characterisation of sacroiliac lesions on MR imaging has been well established, but its presence during evaluation of low back cases has not been analysed and well documented. During routine MR imaging of patients with low back pain, the assessment of sacroiliac joint lesions is often neglected. The aim of this study was to determine the presence of sacroiliitis in MRI of cases with low back pain and analyse its prevalence and morphological patterns.

Congenital cholesteatoma is a rare entity in routine clinical practice. Secondary otitis media makes it difficult to diagnose. Chances of congenital cholesteatoma increase when it is associated with atretic ear. Appropriate imaging technique helps to diagnose and delineate the extent congenital cholesteatoma.

Objective(s): To evaluate the effect of optic nerve circulation, using color Doppler imaging (CDI) on progression of visual field damage in primary open angle glaucoma and chronic angle closure glaucoma. Material and Methods (s): The study included randomly selected 25 patients with established primary open angle glaucoma, 15 patients with chronic angle closure glaucoma, who underwent medical treatment/had undergone laser or surgical procedure for glaucoma and 15 healthy volunteers of same age group were taken as control group. Color Doppler imaging of ophthalmic artery (OA), central retinal artery (CRA) and posterior ciliary artery (PCA) were conducted and various variables recorded to determine ocular blood flow in glaucomatous patients. Result(s): Patients with stable visual field had higher diastolic velocity and lower resistivity index (RI) in all three ocular vessels (P<.001), compared with those with deteriorating visual field. Significant correlation was found between severity of glaucomatous visual field defects and degree of impairment of retrobulbar haemodynamics. Conclusion(s): Color Doppler imaging variables of OA, CRA and PCA correlate with risk of visual field deterioration in glaucomatous patients suggesting major role of vascular factor in pathogenesis of glaucomatous optic neuropathy.

Objectives: To analyse the diagnostic role of CT scan in evaluation of proptosis Material and Methods: 50 patients presenting with proptosis were evaluated by CT scan. Role of CT was evaluated in defining the cause of proptosis and the nature and extent of the lesions causing proptosis. Results: .The most common lesion causing proptosis were tumours (46%) and infections (28%) followed by inflammation (18%), trauma (6%) and vascular (2%). CT scan findings in relation with the age of the patient, the clinical picture and laboratory investigations were able to give a correct diagnosis in 82% patients. Conclusion: CT scan can be considered as a cost effective, non invasive, reliable diagnostic tool for evaluation of proptosis.

Hypertrophic Olivary degeneration (HOD) is a rare type of neuronal degeneration involving the dentatorubro-olivary pathway. It is a secondary change caused by the impairment of Guillain Mollaret triangle. We present a case of a thirty-five years old man who had head injury with MR evidence of haemorrhagic contusion at the ponto-mesencephalic junction extending into the superior cerebellar peduncle on left side. Five months after the injury he developed left upper extremity rhythmic tremor. Repeat MRI permitted visualization of hypertrophic olivary degeneration, which appeared as a characteristic high signal intensity in the right inferior olivary nucleus on T2 W and FLAIR images, with enlargement of the nucleus. The literature and imaging findings of this uncommon condition are reviewed.

Diffusion MR imaging is now a routine component of the brain MR imaging examination and is critical in the evaluation of stroke patients. However, high signal intensity on diffusion MR and hypo intensity on apparent diffusion co-efficient (ADC) images, which are features of acute cerebral infarction, have been reported in such diverse conditions as hemorrhage, abscess, tumor and even in Wernicke encephalopathy. Differentiating between there conditions is critical for determination of appropriate treatment. We present a systematic review of hyperintense lesions on diffusion MR images and their potential clinical applications.

Agenesis of corpus callosum can be associated with a midline lipoma ( LoCC ) with or without calcification of its periphery. LoCC may extend into either or both lateral ventricles. This developmental abnormality has an embryological basis. We observed this in 2 cases, and, as this is uncommon, are reporting them.

Cerebral amyloid angiopathy (CAA) is a very rare entity. This is an age related disease and is not a manifestation of systemic amyloidosis in any of its forms. Sporadic cases are most common, though hereditary cases do exist. Alzheimer's disease predispose to CAA. This condition is to be borne in mind when a spontaneous intracerebral haemorrhage with lobar pattern or one situated very superficial location in the cortical region is presented.

Material & Methods - 30 healthy volunteers (19 men; 11 women) with no cardiac; lung or liver disease were studied by Color Duplex Imaging (CDI) and portal vein (PV) was evaluated for flow pulsatility. Results - Inverse correlation was found between venous pulsatility index (VPI) and body mass index (BMI) of subjects. (R = -0.76; p<0.001). No correlation was found between VPI and age of the patients. Inverse correlation was also found between VPI and subjects position associated with increase in intra-abdominal pressure. Conclusion - PV flow pulsatility is probably due to several and often simultaneous factors; and therefore PV pulsatility should be interpreted in clinical context.

Twin-Twin transfusion syndrome leads to high rates of perinatal morbidity and mortality due to its poorly understood etiology and difficulty in diagnosing and treatment. Early diagnosis during foetal ultrasound is, therefore, important in reducing the morbidity and mortality rates. We report a case of twin-twin transfusion syndrome diagnosed on foetal ultrasound at 26 weeks of gestation.

A rare case of antenatal fetus is seen in urinary bladder on MRI on T1WI & T2WI. In sagittal section of MRI, a communication was noticed between uterus and urinary bladder which had resulted due to previous multiple caesarian section surgery for deliveries. On operation, dead fetus was located in urinary bladder & some tissue of placenta was removed from uterine cavity. The rent was repaired. Post operative event was normal.

The ultrasonographic detection of fetal hydronephrosis demands a thorough search for the presence of ureterocele. This case illustrates a classical unilateral ureterocele diagnosed at 30 weeks of gestation. The pregnancy was uneventful ending in normal vaginal delivery. The neonatal cystoscopic findings supported the definitive antenatal diagnosis.

Aims and Objectives:The aims and objectives of this study was to detect foetal malformations ultrasonographically ,to evaluate associated anomalies and to evaluate outcome of pregnancy. Material and Methods:The prospective and retrospective study was conducted on 10890 pregnant women. All pregnant women were subjected to US examination by Siemens, Sonoline SL-2 ultrasound machine. using real time system.3.5 MHz transducer. Results: Total 124 foetuses were found to have major congenital malformations.Pregnant women were referred in routine US for foetal well being or risk factor related to foetal malformations.The average incidence of malformations was 1.14% with maximum no. of malformations 96 (77.41%) during 3rd trimester of pregnancy.Majority of cases were in age group 21-25 years (51.6 %) with youngest women of 18 years and oldest 38 years. Most of the foetal malformations were seen in primigravida (45.96 %). During study 52.42% of pregnant women were at risk ofmalformed foetus in form of discrepancy of height of uterus and period of gestation, 47.58% were clinically routine cases.Majority of malformations were detected during 3rd trimester 98(79.04%) with the range of 13-41 weeks and mean gestational age of 31.16 weeks. Most common anomaly was ventriculomegaly 41 cases (27.33%) followed by anencephaly 39cases(26.00%).Neural tube defects accounted for more than 50%of the anomalies with common association withspinal deformities. Polyhydramnios 28 (71.79%) cases was common association with neural tube defects. Oligohydramnios was associated with 4 (66.66%) cases of renal anomalies.Foetal malformations had predilection female fetuses with male to female ratio of 1:1.3 . Spinal abnormalities were common in male fetuses.Overall mortality of malformed.fetuses was 90(72.58%) cases,however in anencephaly, diaphragmatic hernia and hydrops foetalis it was 100%.In skeletal dysplasias it was 80%. Most common site of encephalocele was occipital in 18(94.73%)cases.Most common renal malformation was found to be bilateral hydronephrosis in 4 patients. Skeletal dysplasia was seen in 5 cases with 3 cases had associated pulmonary hypoplasia. Achondroplasia was seen in 3 cases and achondrogenesis in 2 cases. Conclusion:We concluded in our study that ultrasound should be done between 16-20 weeks in routine and earlier in high risk pregnancy. This leaves adequate time for determining the outcome and fate of pregnancy.Hence it would be worth to aware the practitioner about advantage of early scanning in pregnancy.

Objectives- The objective of this study is to evaluate the Interstitial Lung Disease (ILD) in the patients with Rheumatoid Arthritis (RA) and to correlate clinico - spirometric profile and High Resolution Computed Tomography (HRCT) findings with regards to early detection of possible lung involvement in the study group. Materials and Methods The present study was carried out at Shree Sayajirao General Hospital (SSGH), Baroda from January 2002 to December 2002. The patients satisfying the American College of Rheumatology (ACR) criteria [1] for RA were included in this study, without regards to the presence of pulmonary symptoms or chest x-ray changes. None of our patient was on Disease Modifying Anti-Rheumatic Drugs (DMARD) therapy. All thirty patients (seven males and twenty three females) - underwent clinical, spirometric, laboratory, x-ray chest and HRCT evaluation of lung. Diagnosis of ILD was confirmed by HRCT and supported by clinical and physiological findings in all patients. All the gathered information and investigations were subjected to statistical analysis. Results Majority of the patients had duration of illness between one and three years. The mean duration of illness was 2.9 years. RA factor was positive in 25 patients (83.3%). Six of the thirty patients had respiratory complaints (20%). Spirometric evidence of lung involvement was present in eight patients (26.6%). Only four of them had abnormalities detectable on chest radiograph (13.33%). HRCT was abnormal in eleven patients (36%). Conclusion In concluding the results of our study, the interstitial lung changes affects significant proportion (36%) of the patients affected with RA. Overall, HRCT is the most sensitive parameter to detect the early interstitial changes in patients with RA. HRCT can show evidence of interstitial lung changes even when clinical and pulmonary function tests parameters are normal. HRCT is superior to plain chest radiograph in the evaluation of early interstitial lung changes associated with RA. Coexisting subcutaneous rheumatoid nodules is a high-risk factor for development of ILD in patients with RA.

Objective / Aim The aim of our article is to present our early experience to evaluate High Resolution CT (HRCT) findings in Idiopathic Pulmonary Fibrosis (IPF) and to stress upon its clinical utility. Materials & Methods A prospective study of ten patients was done at and tertiary care government hospital. Study population comprises seven women and three men. Patients with chronic respiratory symptoms, chest radiograph showing typical reticular pattern or with clinical suspicion of IPF were selected. All patients underwent HRCT examination. Chest radiograph findings were compared with the HRCT findings in all patients. HRCT findings of our study were compared with the other studies. Results From the study it was seen that IPF is most commonly manifested by the combination of HRCT findings, which includes peripheral (100%) and lower lobe predominance (80%) of the distribution of the lesions, evidences of intralobular septal thickening (100%), honeycombing (90%), traction bronchiectasis (90%) and parenchymal distortion (100%). Conclusion In conclusion, HRCT is accurate and superior in the confident diagnosis of IPF. HRCT findings in advance stage of IPF are characteristic. HRCT determines the disease activity and extent of IPF better than chest radiograph. When HRCT findings are characteristic in appropriate clinical settings, HRCT may obviate a need for open lung biopsy.

Aortopulmonary window is an opening between the aorta and the pulmonary trunk. Two distinct separated semilunar valves must exist to establish the diagnosis of aortopulmonary window, and this defect should be differentiated from truncus arteriosus. Aortopulmonary window is generally diagnosed by echocardiography or Angiocardiography. The authors present two cases of Aortopulmonary window diagnosed by helical CT.

Two patients of pulmonary sarcoidosis are reported in whom during the course of the disease, the radiological lesions evolved from the more common presentations to unusual ones. In a 70 years old man, the evolution occurred from Stage I (bilateral hilar lymphadenopathy, BHL) to Stage II with reticular pattern and BHL. This was accompanied by multiple large pulmonary nodules and pleural effusion. In the second patient, a 48-year-old woman, the picture evolved from a typical stage II (BHL with bilateral reticulonodular pattern) to a large mass-lesion simulating a malignancy. Both the patients had a variable symptom-free period between the two presentations. The diagnosis was confirmed by the demonstration of noncaseating granulomas by transbronchial biopsy and transthoracic fine needle aspiration cytology, respectively.

Objective : The aim of this study is to find out hoe effective high frequency ultrasonographic Color Doppler can be to detect the cause of erectile dysfunction. Material and Methods : The hemodynamic function of the penis can be evaluated non-invasively by performing or power Doppler US with spectral analysis following injection of a vasoactive pharmacological agent Papavarine, to induce an erection. Results : The sensitivity of PBI in the diagnosis of erectile dysfunction was 61% and the specificity was 74%. After the addition of Duplex Doppler, sonography the sensitivity increased to 89% with a specificity of 95%. On further evaluation with post- papavarine, injection the sensitivity increased to 97% and the specificity increased to 99%. The increase was significant (p<0.001). Conclusion : Papavarine induced Color Duplex Doppler Sonography is an excellent and highly accurate means of assessing patients with erectile dysfunction.

Angiomyolipomas (AMLs) are rare renal tumors, occur in majority of cases of tuberous sclerosis which are usually multiple, larger, bilateral, affecting younger age group and have tendency to bleed. Pulmonary lymphangioleiomyomatosis (LAM) is a rare, idiopathic disease, exclusively affects women of childbearing age. This entity is rarely associated with tuberous sclerosis (TS). We present a case of young female with bilateral massive renal AMLs with bleeding on the right side, pulmonary LAM with typical features of TS. Associations between renal AMLs, pulmonary LAM and TS have been discussed.