Miyashita Masatsugu, Iwata Tsuyoshi, Nakanishi Hiroyuki, Soh Jintetsu
The Department of Urology, Kyoto Chubu Medical Center.
The Department of Urology, Omihachiman Community Medical Center.
Hinyokika Kiyo. 2017 Jul;63(7):263-266. doi: 10.14989/ActaUrolJap_63_7_263.
A 75-year-old man with a history of chronic kidney disease (CKD) visited our emergency room after the sudden onset of severe right lower abdominal pain and nausea. Computed tomography (CT) showed right perirenal hematoma and renal tumor, which was diagnosed as a spontaneous rupture of the right renal tumor. It was difficult to correctly diagnose the tumor as benign or malignant with magnetic resonance imaging (MRI). Because of CKD, a shunt was implanted, and dynamic enhanced CT was performed. Dynamic enhanced CT showed a slightly enhanced area of the tumor, and it was diagnosed as renal cell carcinoma (RCC). Radical nephrectomy was performed, and he has not experienced recurrence within 7 months after the surgery. Pathological diagnosis was papillary renal carcinoma. Spontaneous renal hemorrhage is relatively uncommon, but the most common cause of spontaneous renal hemorrhage is renal cell carcinoma (26.1%). CT is useful for diagnosis, but it is not highly accurate. Therefore, it is necessary to discuss surgical indication carefully.
一名75岁患有慢性肾脏病（CKD）的男性，在突然出现严重右下腹痛和恶心后前往我们的急诊室。计算机断层扫描（CT）显示右肾周血肿和肾肿瘤，诊断为右肾肿瘤自发性破裂。通过磁共振成像（MRI）难以正确诊断肿瘤是良性还是恶性。由于患有CKD，植入了分流器，并进行了动态增强CT检查。动态增强CT显示肿瘤有轻微强化区域，诊断为肾细胞癌（RCC）。进行了根治性肾切除术，术后7个月内未出现复发。病理诊断为乳头状肾癌。自发性肾出血相对少见，但自发性肾出血最常见的原因是肾细胞癌（26.1%）。CT对诊断有用，但准确性不高。因此，有必要仔细讨论手术指征。
