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.