腎周邊靜脈曲張及骨盆腔充血症候群所導致嚴重血尿及出血性休克:
血管內治療的致命性病例報告
鄭詠庭1,陳育青2,高銘鴻1,蒲永孝1,姜宜妮1
1國立台灣大學附設醫院 泌尿部,2國立台灣大學附設醫院 影像醫學部
Hemorrhagic shock due to massive hematuria caused by renal peripelvic varices and pelvic congestion syndrome: An extremely rare and life-threatening case managed by endovascular treatment
Yung-Ting Cheng1, Yu-Chin Chen2, Ming-Hong Kao1, Yeong-Shiau Pu1, I-Ni Chiang1*
1Department of Urology, National Taiwan University Hospital, 2Department of Radiology, National Taiwan University Hospital
 
Background: Gross hematuria of unknown etiology in young adults offer a challenging scenario in clinical diagnosis. Vascular abnormalities are one of the rare causes which should be considered in suspected upper urinary tract origin. Pelvic congestion syndrome and renal pelvic varices were venous abnormalities caused by venous obstruction or abnormal valves. We described an extremely rare case of a 33-year-old female with renal peripelvic varices and pelvic congestion syndrome who presented with massive hematuria.
Summary: A 33-year-old female presented with a history of intermittent painless gross hematuria for 3 months. There was no history of smoking, herbs, toxins, trauma or bleeding disorders. Her biochemical and coagulation parameters were within normal limits. Sonography showed a huge mass over the bladder without bilateral hydronephrosis. Cystoscopy revealed negative finding. Computed tomography(CT) demonstrated negative finding other than blood clot. However, continuous massive hematuria progressed to hypovolemic shock. Emergent endovascular embolization was performed after resuscitation. Angiogram revealed no definite arterial anomaly. Venography showed engorged left ovarian veins with peripelvic varices. The aberrant veins emerged from the renal hilum and then drained into the left renal vein and common iliac vein. Left lower ovarian veins and peripelvic varices were subsequently embolized by pushable coils. The patient discharged without hematuria afterwards.
Conclusion: Venous etiology should be included for the differential diagnosis of hematuria of unknown origin, which may cause life-threatening massive hematuria. Endovascular treatment can achieve optimal result.
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    台灣泌尿科醫學會
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    2017-06-05 03:14:38
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    2017-06-05 03:21:12
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