塞栓術が有効であった腎動脈瘤切迫破裂の1例

Abstract

58歳男.患者は突然の下腹部痛, 冷汗を認め, 疼痛は次第に左側腹部へと変位した.近医で左尿管結石の診断で鎮痛剤を処方されたが, 痛みが持続した.腹部単純CTでは左腎盂に石灰化を伴う直径40mmのmassを認め, 左腎腫瘍が疑われた.一方, 腹部造影CTでは左腎盂に早期に造影されるhigh density areaを認め, 紹介となった.持続する腹痛と腹部CT所見から, 腎動脈瘤切迫破裂と診断し, 緊急腎動脈塞栓術を施行した.動脈瘤頸部に着脱式coil, マイクロコイルを置き, 更に瘤内の血流を根絶するため, フェザータイプのcoil, トルネードマイクロコイルを瘤内部に留置した結果, 術後, 腹部痛は消失し, 合併症もなく経過, 軽快退院となった

Previously, renal arterial aneurysms were thought to be extremely uncommon. However, these lesions are now being detected more frequently as incidental findings on computed tomography (CT) and magnetic resonance imaging (MRI). The incidence of ruptured renal artery aneurysms is very low. A 58-year-old man presented to a physician complaining of left flank pain and was diagnosed as having a left kidney stone. Abdominal CT scan demonstrated a mass in the left renal pelvis. The mass measured 40mm in diameter and showed calcification. The patient was referred to our hospital 5 days after the first attack. Left renal mass was diagnosed as renal aneurysm based on clinical signs and perirenal findings on CT. Emergent endvascular embolization was performed. The postoperative course was uneventful. Hypertension improved after embolization.