後腹膜出血により診断された腎動静脈瘻の1例

Abstract

51歳男性。患者は突然の右側腹部痛を主訴に, 腹部CTにて右腎を中心に血腫を伴う後腹膜腔への大量出血を認め, 精査加療目的で入院となった。選択的右腎動脈造影にて腎動静脈瘻破裂による右後腹膜腔への出血と診断され, 金属コイルを用いて選択的塞栓術が行われた。その結果, 術後, 高血圧を認めたものの, 血清の活性型レニン定量は正常範囲内であり, 内服加療を開始した。そして第27病日の造影CTでは血腫の増大は認めず, 以後, 経過良好にて退院となった。

Angiography depicted the arteriovenous fistula at the peripheral cortex of the kidney, which was treated superselective transcatheter arterial embolization (TAE). Bleeding was controlled and did not recur. The contrast-enhanced computed tomographic (CT) scan performed on the 27th day after the procedure revealed a parenchymal perfusion deficit of 3% and the return of serum creatinine concentration to pre-injury levels. We considered the selective coil embolization as the best treatment for the aneurysmal arteriovenous fistula located in the renal cortex to keep ischemic damage at a minimum and preserve renal function. To our knowledge, this is the 4th report of a spontaneous rupture in the retroperitoneum of an aneurysmal arteriovenous fistula.