自然破裂した腎血管筋脂肪腫の1例

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55歳女性.患者は突然の右側腹部痛を主訴に近医を受診,腹部CTにて右腎血腫が疑われ,著者らの施設へ紹介入院となった.入院時の腹部CTにて腎血管脂肪腫の自然破裂と診断し,右腎動脈造影にて腎下極末梢の小動脈瘤を確認後,腫瘍塞栓術を行った.しかし,第3病日目には4単位の輸血にもかかわらず,貧血の急速な進行と右胸水貯留,呼吸状態の悪化を認めたため,緊急手術を施行した.手術所見では腎下極から腎外に発育する腫瘍の破裂を認め,Gerota筋膜内には血腫の貯留がみられたため,右腎摘除術を行ったところ,良好な術後経過が得られたA 55-year-old woman presented with sudden right lower abdominal pain. Computed tomography demonstrated retroperitoneal hematoma associated with minus-density area, diagnosed as spontaneous rupture of angiomyolipoma. Super-selective transarterial embolization was performed, but anemia and right abdominal pain became worse in spite of conservative therapy including transfusion, indicating re-rupture of the renal tumor. Although partial nephrectomy was planned, right nephrectomy was finally performed because of massive intraoperative bleeding. Accurate diagnosis and prompt treatment are required when life-threatening rupture of renal tumor is suspected.
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