陳旧性副腎血腫の1例

Abstract

症例は75歳男で, 高血圧の原因精査目的に施行した腹部超音波検査で偶然左副腎に約5cm大の腫瘤が発見された.CTでは同部に辺縁平滑で円形に腫大し内部が低吸収域, 辺縁が等吸収域, 造影剤で辺縁のみ陰影増強のある腫瘤を認めた.MRIでは腫瘤内部がT1強調像で均一な高信号, T2強調像で低信号を呈し, 腫瘤辺縁はT1強調像で低信号, T2強調像で高信号を示した.Gd-DTPAによるDynamic MRIでは腫瘤辺縁のみ陰影増強を認めた.これらの所見から左副腎のホルモン非活性腫瘍を疑った.悪性腫瘍の存在も否定できなかったため左副腎摘除術を施行したが, 病理組織検査の結果は陳旧性の血腫であった

A 75-year-old man was admitted to our hospital for closer examination of a left mass. Warfarin and calcium-antagonist for arrhythmia and hypertension had been administered for about 2 months before admission to our ward. Abdominal ultrasonography revealed a left adrenal mass 5 cm in diameter. Only serum noradrenalin was slightly elevated in endocrinological studies. In 131I-MIBG scintigraphy, uptake of radio-isotope at the adrenal gland was not revealed. Computed-tomographic (CT) scan showed left adrenal mass with a low density in the central area and iso-density in the peripheral area. The enhanced CT scan revealed enhancement in only the peripheral area of the left adrenal gland. Magnetic resonance imaging (MRI) showed a different intensity in the central area or peripheral area. Only the peripheral area of the mass was enhanced on dynamic MRI. Left adrenalectomy was performed. Histopathological examination revealed an old hematoma in the adrenal medulla without neoplasmic cells or vascular lesions.