DOI: https://doi.org/10.36347/sjmcr.2026.v14i10.049

Pages: 2336-3340

Background: Renal angiomyolipomas are benign mesenchymal tumors composed of blood vessels, smooth muscle, and adipose tissue. Although generally small and asymptomatic, they can occasionally reach enormous dimensions. Bilateral giant renal angiomyolipomas associated with multiple fat-containing hepatic lesions represent an unusual radiological finding. Case Presentation: We report the case of a 64-year-old patient admitted to the intensive care unit with severe COVID-19 pneumonia. Chest computed tomography incidentally revealed markedly enlarged and distorted kidneys containing massive bilateral heterogeneous masses with abundant macroscopic fat. Subsequent noncontrast abdominal CT demonstrated that the right and left renal masses measured 318 × 260 × 187 mm and 315 × 258 × 203 mm, respectively. Based on their characteristic fat-containing appearance, the lesions were considered consistent with giant bilateral renal angiomyolipomas. The examination also revealed 10 small, well-circumscribed hepatic lesions with negative attenuation values, suggesting macroscopic fat; the largest measured 17 × 8 mm. These lesions raised the possibility of hepatic angiomyolipomas, although their nature could not be definitively established. The patient's reported renal impairment precluded intravenous contrast administration, and further evaluation was not possible because he died from COVID-19 complications a few days after admission to the intensive care unit. Conclusion: This case highlights the incidental detection of exceptionally large bilateral renal angiomyolipomas on CT performed for COVID-19 pneumonia, accompanied by multiple indeterminate fat-containing hepatic lesions. It underscores the diagnostic value of recognizing macroscopic fat on CT while acknowledging the limitations of imaging-based characterization when further investigations are unavailable.