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A Huge Adrenal Hematoma Presented as Retroperitoneal Tumor: A Study of CT Scan and Clinicopathology with Literature Review
腎上腺巨大血腫以後腹膜腔腫瘤呈現－一病例報告、電腦斷層及臨床病理研究和文獻回顧
摘要
我們提出一個病例報告－即腎上腺巨大血腫。本文主要描述一位七十六歲老先生罹患疑似後腹膜腔腫瘤達三年之久，臨床上表現腹部逐漸腫脹、貧血、便秘、尿失禁等症狀。術前超音波、血管攝影及電腦斷層掃描檢查結果發現腹腔有一巨大腫瘤自橫隔膜下延伸至骨盆腔。經腹腔探查及手術切除，發現有一25公分10.5公斤且包膜完整的腫瘤。腫瘤切開發現大多為血塊、血水、及壞死狀。組織病理診斷，證實為腎上腺血腫。由於有文獻報告腎上腺大量出血（尤其是兩側同時發生）可造成急性腎上腺功能不足甚至死亡，放射科醫師或臨床醫師要提高警覺，檢查凝血功能及腎功能，尤其病患臨床出現貧血及血小板數過少時。另外，若疑有急性大量腎上腺出血，體液容積大量減少造成急性腎衰竭、電解質不平衡、及腎上腺功能不足均須預防。雖然腎上腺血腫以腫瘤方式表現在臨床上較少見，其危險性並不亞於真正腫瘤，所以，放射學檢查之早期診斷就顯得格外重要。本文提出個案報告，主要是以放射影像學及臨床病理變化方面加以討論，並做文獻回顧。
並列摘要
A huge adrenal hematoma was reported. A 76-year-old male presented with a progressive growth of abdominal mass with anemia, constipation, and urinary incontinence for 3 years. An ultrasound and computed tomography scans demonstrated a large and heterogenous mass from the subphrenic space to pelvis. A laparotomy revealed a 25 cm diameter and 10.5 Kg tumor adjacent to left kidney. Grossly, the huge tumor mass revealed well-capsulated with cystic change, central necrosis, and massive hematoma formation. Histological examination confirmed the large hematoma arising from left adrenal gland. The radiologist must be careful of the radiological findings and consider the impression of hematoma although it was usually resembled as a large retroperitoneal tumor. To radiologist, the first step in diagnosing a cystic abdominal mass is to determine its organ of origin. To clinician, when an adrenal hemorrhage or hematoma occurred with a concurrent drop of hemoglobin, the coagulatory function should be checked and the adrenal cortical function should be monitored. Acute addisonian crisis or death might develop when an ignoring management to adrenal hemorrhage. If acute massive adrenal hemorrhage occurred, tasks to prevent and manage the hypovolemic shock with acute renal and/or adrenal failure should be immediately worked out. The renal function, electrolytes, and adrenal cortical function should be examined and body fluid be monitored as well. The early diagnosis of adrenal hematoma is important when it developed bilaterally or presented as a hunge retroperitoneal tumor mass.
延伸閱讀
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