Ozeki Toshikazu, Yamamoto Junichiro, Yamamoto Shigeki, Shigematsu Chisato, Tsuji Masashi
Department of Nephrology, Tsushima City Hospital, 3-73 Tachibana, Tsushima, Aichi, Japan.
Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
CEN Case Rep. 2018 May;7(1):107-109. doi: 10.1007/s13730-018-0305-6. Epub 2018 Jan 17.
An 80-year-old woman was admitted to the hospital complaining of loss of appetite. 10 days earlier, her oral intake gradually decreased with no other specific symptoms, such as abdominal pain, nausea, vomiting, headache, or low back pain. Abdominal computed tomography (CT) scan revealed a left subcapsular renal hematoma. We suspected infective subcapsular renal hematoma, so percutaneous needle aspiration and drainage were performed. Intravenous sulbactam-ampicillin was started immediately. On day 9 after admission, repeat CT scan revealed the subcapsular hematoma had reduced in size. The drain was removed, and intravenous antibiotics were discontinued. Follow-up CT scan on day 21 revealed increased subcapsular renal hematoma size. The patient also had high fever. Suspecting recurrence of infective subcapsular renal hematoma, we repeated the drainage of the hematoma and restarted intravenous antibiotics. Renal arteriography showed a renal artery microaneurysm and her condition improved with renal artery embolization. Renal arteriography was useful for detecting renal artery microaneurysm in infective subcapsular renal hematoma that did not resolve after antibiotic treatment and drainage.
一名80岁女性因食欲减退入院。10天前，她的经口摄入量逐渐减少，无腹痛、恶心、呕吐、头痛或腰痛等其他特定症状。腹部计算机断层扫描（CT）显示左肾包膜下血肿。我们怀疑是感染性肾包膜下血肿，因此进行了经皮针吸引流。立即开始静脉输注舒巴坦-氨苄西林。入院后第9天，复查CT显示包膜下血肿体积缩小。引流管拔除，静脉抗生素停用。第21天的随访CT显示肾包膜下血肿体积增大。患者还出现高热。怀疑感染性肾包膜下血肿复发，我们再次进行血肿引流并重新开始静脉使用抗生素。肾动脉造影显示肾动脉微动脉瘤，经肾动脉栓塞后病情改善。肾动脉造影对于检测抗生素治疗和引流后未消退的感染性肾包膜下血肿中的肾动脉微动脉瘤很有用。
