Figure 6: Axial abdominal computed tomography, illustrating fat
attenuating lesion (white arrow) with enhancing solid component (black
arrow) in the liver.
Cystoscopy was done to relieve urinary obstruction and about 500 ml of
organized clot was removed from the urinary bladder. During the
procedure gross blood was visualized at the ureteral meatus.
Considering her findings, differential diagnosis of TS, smooth muscle
hamartomas, neurofibromas and multiple endocrine neoplasia was made. She
underwent further investigations including computed tomography (CT) of
head (patient denied MRI). Her brain scan showed multiple calcified
nodules along the margin of the ventricles largest one measuring 9 x 6
mm (subependymal hamartomas) and also in subcortical regions
(subcortical tubers) as shown in Figure 7, 8 respectively. In addition,
her CT image also showed cerebral white matter radial migration lines
which is shown in Figure 9.