血尿の原因となる左腎静脈圧迫の非侵襲的画像診断 第1報: 超音波検査による検討

Abstract

特発性腎出血患者26例を含む外来患者100例を対象として, 血尿の原因となる左腎静脈異常が経腹壁的超音波検査で捕えられるのか検討した.1)左腎静脈が観察できたのは86例であった.2) 86例中23例では, 心収縮期拡張期とも左腎静脈が腹大動脈と上腸管膜動脈の間で圧迫され, 左腎静脈内腔のlow echoic zoneは途切れていわゆるnutcracker現象を呈した.3) 2例では収縮期拡張期とも左腎静脈は右腎動脈と交差する部位で圧迫されていた.4)左腎静脈の圧迫像が認められたのは特発性腎出血とされた26例中18例と, 血尿の原因となる疾患を有しかつ血尿のある27例中7例で, 血尿のない33例では左腎静脈の圧迫像をみなかった.5)経腹壁的超音波検査で血尿の原因となる左腎静脈圧迫の診断が可能である

Left renal veins of 100 out-patients were examined by transabdominal ultrasonography to evaluate its usefulness in determining left renal vein compression which is causing renal bleeding. Ultrasonography revealed the left renal vein in 86 patients. In 61 of the 86 cases, the internal cavity of left renal vein was opened at least in diastolic phase, but in 23 cases, the internal cavity was closed between the abdominal aorta and the superior mesenteric artery in both systolic and diastolic phases. In the remaining 2 cases, left renal vein was compressed at a point where it intersected the right renal artery. Left renal vein compression was observed in 18 (69%) of the 26 cases which had been classified as idiopathic renal bleeding and in 7 (26%) of the 27 cases which had urinary tract diseases causing hematuria. In 33 cases which did not have hematuria, left renal vein compression was not observed. These results suggest that diagnosis of left renal vein compression causing renal bleeding is possible by transabdominal ultrasonography.