Washco Vaughan, Engel Lee, Smith David L, McCarron Ross
Department of Internal Medicine, Louisiana State University Health Sciences Center, New Orleans, LA.
Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA.
Ochsner J. 2015 Spring;15(1):70-3.
New onset or acute worsening of bilateral lower extremity swelling is commonly caused by venous congestion from decompensated heart failure, pulmonary disease, liver dysfunction, or kidney insufficiency. A thromboembolic event, lymphatic obstruction, or even external compression of venous flow can also be the culprit.
We report the case of an 83-year-old male with a history of myelodysplastic syndrome that progressed to acute myeloid leukemia, bipolar disorder, and benign prostatic hypertrophy. He presented with altered mental status and new onset lower extremity edema caused by acute bladder outflow obstruction. Computed tomography of the abdomen and pelvis showed the patient's distended bladder compressing bilateral external iliac veins.
Insertion of a Foley catheter resulted in several liters of urine output and marked improvement in his lower extremity edema and mental status a few hours later. Our extensive workup failed to reveal a cause of the patient's acute change in mental status, and we attributed it to a concept known as cystocerebral syndrome.
双侧下肢肿胀的新发或急性加重通常由失代偿性心力衰竭、肺部疾病、肝功能障碍或肾功能不全引起的静脉充血所致。血栓栓塞事件、淋巴阻塞，甚至静脉血流的外部压迫也可能是病因。
我们报告一例83岁男性患者，有骨髓增生异常综合征病史，后进展为急性髓系白血病、双相情感障碍和良性前列腺增生。他因急性膀胱流出道梗阻出现精神状态改变和新发下肢水肿。腹部和骨盆计算机断层扫描显示患者膀胱扩张，压迫双侧髂外静脉。
插入Foley导尿管后数小时，患者尿量达数升，下肢水肿和精神状态明显改善。我们全面的检查未能揭示患者精神状态急性改变的原因，我们将其归因于一种称为膀胱脑综合征的概念。
