Pak K, Tomoyoshi T, Tanaka H, Nakajima Y
Department of Urology, Shiga University of Medical Science.
Hinyokika Kiyo. 1988 Mar;34(3):496-501.
A 65-year-old woman was seen in September, 1986, because of general malaise and dull pain in the left flank. Physical examination was unremarkable. Murmur was not heard over the abdomen. An excretory urogram showed left hydronephrosis and a retrograde pyelogram showed extrinsic obstruction at the level of the transverse process of the 5th lumbar spine. Computed tomography (CT) showed a mass with irregular calcification in its center. The mass was assumed to be located in the left iliac artery and as it was enhanced homogeneously, iliac aneurysm was suspected. Angiography revealed an aneurysm of the left iliac artery involving common, external and internal iliac arteries. The patient was treated by ligation of aneurysm, aorto-femoral graft bypass and ureterolysis. Histopathological findings showed aneurysm due to atherosclerosis. A postoperative excretory urogram showed improvement of hydronephrosis. Ureteral obstruction due to iliac aneurysm is unusual but it should be considered when performing differential diagnosis of extrinsic ureteral obstruction. CT is a useful diagnostic tool and aortography should be done to make a final diagnosis. Treatment is based on resection or ligation of aneurysm with ureterolysis.
1986年9月，一名65岁女性因全身不适和左侧腰部钝痛前来就诊。体格检查未见异常。腹部未闻及杂音。排泄性尿路造影显示左肾积水，逆行肾盂造影显示在第5腰椎横突水平有外在梗阻。计算机断层扫描（CT）显示一个中心有不规则钙化的肿块。该肿块被认为位于左髂动脉，由于其均匀强化，怀疑为髂动脉瘤。血管造影显示左髂动脉瘤累及髂总动脉、髂外动脉和髂内动脉。患者接受了动脉瘤结扎、主动脉-股动脉移植搭桥和输尿管松解术治疗。组织病理学检查结果显示为动脉粥样硬化所致的动脉瘤。术后排泄性尿路造影显示肾积水有所改善。髂动脉瘤导致的输尿管梗阻并不常见，但在进行外在输尿管梗阻的鉴别诊断时应予以考虑。CT是一种有用的诊断工具，应进行主动脉造影以做出最终诊断。治疗基于动脉瘤的切除或结扎及输尿管松解术。
