Solution: Angiomyolipoma (AML) is a rare benign mesenchymal tumor of the kidney. It is associated with a relatively high rate of hemorrhage because the associated vessels lack a complete elastic layer of vessels, which predisposes them to aneurysm formation and subsequent bleeding. Most are isolated and sporadic, but 20% are associated with tuberous sclerosis. Small lesions are asymptomatic, but if they are > 4 cm, then they will bleed spontaneously in 50-60% of lesions. If less than 4 cm, then recommend annual follow up to ensure that they do not grow. When they hemorrhage acutely, then embolization with potential follow up surgery, or in the case of this patient, ultimately ablation, is recommended.