Hussaini Syed A, Bakhsh Abdul Rahim Ali
Department of Internal Medicine, Zayed Military Hospital, Abu Dhabi, United Arab Emirates.
J Transl Int Med. 2020 Sep 25;8(3):195-198. doi: 10.2478/jtim-2020-0029. eCollection 2020 Sep.
Perinephric hematomas are known to present in the form of Lenk's triad with acute flank pain, flank mass and hypovolemic shock. Here, we describe a case of perinephric hematoma occurring secondary to the use of anticoagulant therapy in the setting of a renal mass. To the best of our knowledge, this is the first reported case of a perinephric hematoma occurring secondary to the use of Apixaban. The patient was an 80 year old male with a history of the presence of a left sided vascular renal mass discovered seven years ago admitted from a peripheral health center with pneumonia and a dropping hemoglobin along with acute kidney injury. Evaluation of his course revealed the use of a Factor Xa inhibitor, namely Apixaban, for new onset atrial fibrillation. The patient was stabilized with multiple units of packed red blood cell transfusions. An abdominal computed tomography abdomen demonstrated a perinephric hematoma contained in the Gerotas fascia. Due to deranged renal function, the patient was managed conservatively and made a full recovery. This case highlights the challenges associated with the diagnosis of perinephric bleeds. The use of anticoagulation therapy in the setting of a pre-existing vascular lesion remains a dilemma.
肾周血肿已知以Lenk三联征的形式出现，伴有急性胁腹痛、胁腹肿块和低血容量性休克。在此，我们描述一例在肾肿块情况下因使用抗凝治疗继发的肾周血肿病例。据我们所知，这是首例报道的因使用阿哌沙班继发肾周血肿的病例。该患者为一名80岁男性，有7年前发现左侧血管性肾肿块的病史，因肺炎、血红蛋白下降及急性肾损伤从周边健康中心入院。对其病程的评估显示，因新发房颤使用了一种Xa因子抑制剂，即阿哌沙班。通过多次输注浓缩红细胞，患者病情稳定。腹部计算机断层扫描显示肾周血肿局限于肾筋膜内。由于肾功能紊乱，对该患者采取了保守治疗，患者完全康复。本病例突出了肾周出血诊断相关的挑战。在已有血管病变的情况下使用抗凝治疗仍然是一个两难问题。
