Morgentaler A, Belville J S, Tumeh S S, Richie J P, Loughlin K R
Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Surg Gynecol Obstet. 1990 Feb;170(2):121-5.
A five year experience with spontaneous perirenal hemorrhage at the Brigham and Women's Hospital was reviewed, with 15 instances identified. Ages ranged from 17 to 80 years (mean of 56 years). Abdominal or flank pain was the presenting symptom in 13 patients; one patient was in a state of shock. Anemia and elevation of lactate dehydrogenase were uniformly present during acute evaluation. Computerized tomography (CT) identified lesions other than hematoma in ten of 14 instances. Arteriography was essential to the diagnosis of two vascular lesions not appreciated by other imaging modalities. Intravenous pyelography and ultrasound did not add significantly to findings on CT or arteriography. Six patients underwent serial CT evaluation; three with persistent nonfatty lesions had carcinoma of the kidney confirmed at operation. Carcinoma of the kidney occurred in a total of eight patients and angiomyolipoma in three patients. It was suggested that patients with clinical evidence for spontaneous perirenal hemorrhage should be evaluated by CT, with arteriography added when the underlying cause remains uncertain. Nephrectomy should be performed for CT evidence of nonfatty lesions other than hematoma. Other patients may have serial CT with nephrectomy reserved for persistent abnormalities. The protocol decreases the likelihood of nephrectomy for benign disease while addressing the high incidence of carcinoma of the kidney among patients with spontaneous perirenal hemorrhage.
回顾了布莱根妇女医院五年内自发性肾周出血的病例，共确诊15例。年龄范围为17至80岁（平均56岁）。13例患者以腹痛或侧腹痛为首发症状；1例患者处于休克状态。急性评估期间均出现贫血和乳酸脱氢酶升高。14例中有10例经计算机断层扫描（CT）发现除血肿外的其他病变。血管造影对于诊断其他成像方式未发现的2例血管病变至关重要。静脉肾盂造影和超声检查对CT或血管造影结果的补充作用不显著。6例患者接受了系列CT评估；3例持续性非脂肪性病变患者在手术中确诊为肾癌。共有8例患者患肾癌，3例患者患血管平滑肌脂肪瘤。建议对有自发性肾周出血临床证据的患者进行CT评估，当病因仍不明确时加做血管造影。对于CT显示除血肿外的非脂肪性病变患者应行肾切除术。其他患者可进行系列CT检查，仅对持续性异常患者行肾切除术。该方案降低了因良性疾病行肾切除术的可能性，同时解决了自发性肾周出血患者中肾癌的高发病率问题。
