後腹膜腔に発生したchronic expanding hematomaの1例 A CASE OF CHRONIC EXPANDING HEMATOMA IN THE RETROPERITONEAL SPACE

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症例は39歳,男性.心窩部痛を主訴に近医受診.左上腹部に小児頭大の腫瘤が指摘され当院受診となった.腹部超音波検査では,94×92×111mm大のhigh echoとlow echoが混在した腫瘤が見られた.CT検査では,腫瘤の内部は低濃度と高濃度がモザイク状に混在していた.内部には造影効果は見られなかった.MRIT1強調像では,腫瘍の大半が高信号であり,MRIT2強調画像では隔壁様の構造を伴う高信号と低信号域が混在していた.造影MRI検査では腫瘤背側壁の外縁が造影された.以上より,後腹膜血腫が疑われ,再度問診を行い2カ月前に自転車で転倒し左肘骨折をした既往があると分かった.しかし,後腹膜腫瘍も否定できず開腹手術を行い腫瘤の摘出を行った.病理検査では中心部には変性,壊死に陥った凝血塊を認め,周囲は線維性の被膜で覆われている所見であった.以上よりchronic expanding hematomaと診断した.文献的考察を加え報告する.

A 39-year-old man visited a local physician with a chief complaint of epigastric pain. He visited our hospital after a mass the size of a child's head was found in his left upper quadrant. Abdominal ultrasound showed a mass, 94 mm × 92 mm × 111 mm, that contained a mixture of hyperechoic and hypoechoic regions. Computed tomography (CT) showed a mosaic pattern of low and high concentrations within the mass. No contrast enhancement was seen in the interior. T1-weighted magnetic resonance imaging (MRI) showed hyperintensity in most of the tumor, while T2-weighted MRI showed a mixture of hyperintense and hypointense regions with a septum-like structure. On contrast-enhanced MRI, the outer margin of the dorsal wall of the mass was visualized. Based on the above, a retroperitoneal hematoma was suspected, and further history taking revealed that the patient had fractured his left elbow two months earlier after falling off his bicycle. However, the possibility of retroperitoneal tumor could not be ruled out, and the mass was resected by laparotomy. Pathological findings included a denatured and necrosed clot in the center, with a fibrous capsule covering the periphery. Based on these findings, the patient was diagnosed with chronic expanding hematoma. The present case is reported along with a review of the relevant literature.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 74(8), 2306-2311, 2013-08-25

    日本臨床外科学会

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各種コード

  • NII論文ID(NAID)
    10031203108
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  J-STAGE 
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