異時性に両側ユリノーマを形成した特発性後腹膜線維化症の1例

Abstract

68歳女性.患者は腰背部痛を主訴に近医を受診, 左水腎症および腎盂外溢流に伴うユリノーマの診断で経過観察され, 自然軽快した.しかし, その4ヵ月後に右水腎症と右後腹膜腔の新たな液体貯留が出現し, 著者らの施設へ紹介となった.入院時, 継続的な右側腹部痛を認め, 造影CTでは両側水腎症と右腎下部に長径8cmのユリノーマを認めた.また, 両側総腸骨動脈に2cm大の動脈瘤が確認され, 周囲には肥厚した軟部陰影がみられた.以上, これらの所見より, 異時性の両側性ユリノーマを形成した特発性後腹膜線維化症と診断し, プレドニゾロンの内服治療を開始したところ, ユリノーマ, 水腎症は改善した

The patient was a 68-year-old female with the complaint of left flank pain. On examination, hydronephrosis of the left kidney and the urinoma of left retroperitoneal space were disclosed by abdominal computed tomographic (CT) scan. The urinoma disappeared spontaneously, but 4 months later right hydronephrosis and the urinoma of ipsilateral retroperitoneum emerged. Enhanced CT scan revealed aneurysm of bilateral common iliac arteries and perianeurysmal fibrotic mass. After steroid therapy under the diagnosis of idiopathic retroperitoneal fibrosis (IRPF), the fibrotic mass reduced in size and the urinoma disappeared. We should be aware that urinomas, which are thought to be caused by sudden obstruction of the upper urinary tract, could be brought about by IRPF.