Objective To investigate the features of minimal fat renal angiomyolipoma with sufficient blood supply by CT scan and to improve the diagnostic accuracy in differentiating it from clear cell renal carcinoma. Methods 24 cases of patients with postsurgery confirmed angiomyolipoma with sufficient blood supply (total of 25 tumors) in our hospital were retrospectively analyzed and were pathologically compared and studied. Results Among the 24 patients diagnosed with angiomyolipoma, there was no patients with bloody urine. Of the 96 patients diagnosed with clear cell renal cancer, 14 had bloody urine (14.6%). CT scan analysis showed 20 tumors were of similar density, and 5 of them were of higher density. Only one tumor had a few dots of calcification (4%). CT scan showed thaty adipose tissue was not visible in 9 tumors, while 16 tumors had visible dots of adipose tissue. Intensive scanning indicated that all of the tumors showed a strong enhancement in the renal corticomedullary phase. 20 tumors had significant heterogeneous enhancement in the early phase, while another 5 cases had homogenous prolonged enhancement. 19 patients had surgery to remove the angiomyolipomas, while 6 patients had single side kidney removal because of misdiagnosis for renal cancer and the renal parenchyma and sinus were severely compromised by tumors. 25 cases were classified as renal angiomyolipoma by pathological analysis. Within the 96 cases of clear cell renal cancer, 64 tumors were of relatively low density, 29 tumors of equal density, and 3 cases of relatively higher density. 14 of the tumors had calcification (14.6%), and none of them had visualized adipose tissue. Enhanced CT scans indicated that 69 cases of renal cancer showed significant enhancement in the renal corticomedullary phase, with the abnormal pattern of "fast-in-and-fast-out". Besides, 27 cases had slow and prolonged enhancement. Conclusion The key to differentiating them is to identify the adipose tissue within the tumor. Therefore, it is helpful to use thin-layer CT scans to locate the adipose tissue.