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The sonographic findings observed in four patients with spontaneous rupture of a renal angiomyolipoma and perinephric haemorrhage are presented. In all cases, a hyperechoic renal mass surrounded by a large hypoechoic haematoma was identified. Furthermore, the actual site of rupture of the tumour could be seen in one case as a wedgeshaped hypoechoic structure extending from the periphery to the centre of the mass. CT has been suggested as the method of choice in the assessment o both the presence and extent ofhaemorrhagic complications of angiomyolipomas. However, since such lesions can be demonstrated and identified by ultrasound, which is often used as the first imaging procedure in abdominal complaints, the technique may also prove of value in planning further diagnostic tests and in choosing the appropriate therapeutic approach to these patients.

I am in total agreement concerning the importance of first doing a real time scan of the abdomen which can then be followed by a manual study. In our study we did not refer to real time data as our information was collected from numerous Italian medical centres some of which did not have a real time capacity or possessed older equipment yielding low quality scans.