外傷性副腎出血を契機に発見された褐色細胞腫の1例

Abstract

79歳男.自転車で横転, 右側腹部を打撲した.胸部単純レントゲン写真で右第9肋骨骨折, 腹部造影CTにて右副腎から腎門部にかけて後腹膜血腫をみとめた.血管造影で活動性出血は認めなかった.塞栓術などは施行せずに保存的治療の方針とした.CTで血腫の拡大のないことを確認し一時退院となった.後日, 血中カテコラミン値より褐色細胞腫の可能性が示唆された.CT上, 血腫の吸収とともに腫瘍の存在が明確となった.131I-MIBGシンチグラフィーで高度集積を認めたことから褐色細胞腫と診断した.αブロッカー先行投与の後, 開放手術にて右副腎摘除術を施行した.組織学的に褐色細胞腫が証明された.明らかな悪性所見は認めなかった.術後経過は良好でカテコラミン値も正常化し外来フォローアップ中である

The presentation of pheochromocytoma is quite variable. We report a case of previously undiscovered pheochromocytoma which was manifested by traumatic retroperitoneal hemorrhage. A 79-year-old man fell from his bicycle and was admitted to the emergency room complaining of right flank pain. Enhanced computed tomography (CT) revealed hemorrhage around the right adrenal gland. Since the plasma catecholamine levels were elevated, we suspected the presence of pheochromocytoma. After absorption of the hematoma, the tumor appeared clearly. The diagnosis of pheochromocytoma was confirmed through urine catecholamine testing and 131I-MIBG scintigraphy. Six months after the injury, the tumor was surgically resected. Traumatic hemorrhage of pheochromocytoma is extremely rare; only 3 cases have been reported in the literature.