The patient has a known history of left renal exophytic angiomyolipoma with a history of prior embolization. The renal cortical defect with a claw sign, the identified arterial supply and venous drainage, heterogeneous architecture and enhancement are consistent with a renal angiomyolipoma.

The differential diagnosis includes a renal cell carcinoma in view of the large and atypical nature and a liposarcoma, both of which were considered less likely with the ongoing remission over a lengthy period of follow-up in an external department. A renal oncocytoma was considered unlikely due to the ill-defined, heterogeneous and exophytic appearance.

Case courtesy: Dr I.A.Nagdee.