膵仮性嚢腫の1例 - 腎嚢腫とのレ線学的鑑別 -

Abstract

A 22-year-old man was admitted to Osaka University Hospital with complaints of anorexia, epigastralgia and high fever. Laboratory examinations revealed evidence of acute pancreatitis with pleural effusion. Aortography demonstrated cystic mass at the left suprarenal area which was very similar to a simple renal cyst. But the cystic mass was slightly irregular, had rather thick wall with moderate vascularity compared with usual simple renal cyst. After the medical treatment for 6 months, this cystic mass was reduced in size and the crescentic angle between the cyst wall and renal cortex disappeared on left renal arteriography. The patient, however, continued to complain the upper abdominal pain and discomfort. At the time of operation, multiple thick-walled cysts were found in the upper part of left retroperitoneal space, one of which was located at suprarenal area. Surgical procedure was drainage of those cysts, resection of a part of the pancreas and splenectomy. Postoperative course was uneventful and the upper urinary tract returned to normal apperance on IVP. Histological diagnosis of the cyst was highly inflammed pseudocyst. With precise case presentation, the differential diagnosis of the pancreatic pseudocyst and the simple renal cyst was discussed as to the shape of the cyst, vascularity of the cyst wall, fluctuation in size and presence or absence of the crescentic angle between the cyst and renal cortex.