診断に難渋した感染性腎嚢胞自然破裂の1例

Abstract

27歳女.妊娠31週目に37℃台の発熱と左腰部痛が出現し近医受診した.急性腎盂腎炎の診断で抗生剤投与を受けたが痛みは増強した.腹部MRIで左腎上極から腎周囲にかけて血腫を疑わせる所見を認められ, 左腎腫瘍破裂を合併したハイリスク妊娠の診断で当院に救急搬送され, 帝王切開術を行った.術後3日目に施行した腹部CTで左腎上極から周囲にかけて血腫と思われる中～高吸収域を認めたが, 原疾患は同定できなかった.その後施行した腹部CTで左腎嚢胞の存在が明らかとなり, 炎症所見の軽快とともに腎周囲の中～高吸収域が消失したことから, 感染性腎嚢胞の自然破裂と診断した

A 27-year-old gravida was referred to an other hospital complaining of left lumbago and pyrexia, and she was diagnosed with acute pyelonephritis. Left lumbago increased and magnetic resonance imaging of abdomen demonstrated a low intensity area like hematoma around the left kidney. Then the patient was transported to our hospital under the diagnosis of high-risk graviditas. She was performed cesarean section. High-grade inflammation still continued after the operation and computerized tomography revealed the increase of high density area. We performed angiography of the left kidney for hemostasis, but the tumor in the left renal upper pole revealed hypovascularity. We started medication of imipenem/cilastatin sodium (IPM/CS). Inflammation and pyrexia did not improve until we changed antibiotics from IPM/CS to amikacin sulfate. Seven days after that high density area around the left kidney disappeared and a renal cyst was recognized by computerized tomography for the first time. Finally, the current case was diagnosed as spontaneous rupture of infectious renal cyst.