A 40 year old woman with a history of tuberous sclerosis presented to the accident and emergency department with severe, acute onset right sided abdominal pain. On clinical examination she looked pale, had poor capillary refill, and was tachycardic and hypotensive. Her abdomen was distended, with bilaterally tender, palpable flank masses. Her haemoglobin measured 8 g/dl. After aggressive resuscitation with intravenous fluids, she was deemed stable enough to undergo computed tomography, as an intra-abdominal source of acute haemorrhage was suspected.

Figures 1 ⇓ and 2⇓ are computed tomography images of the mid-abdomen and lower abdomen.