A 47-year-old man was admitted to this hospital because
of abdominal pain.
The patient had had intermittent abdominal pain and constipation for 15 years.
Computed tomographic (CT) scans of the abdomen and pelvis 4.5 years before admission,
obtained after the oral and intravenous administration of contrast material,
were interpreted as normal.
CT of the abdomen and pelvis after
the intravenous administration of contrast material
revealed foci of cortical irregularity in the
midregion of the left kidney, a peripheral wedgeshaped
lesion with central low density and capsular
enhancement in the midregion of the right
kidney, and an ill-defined wedge-shaped hypodensity
in the lower pole of the right kidney.
腹痛でした。
患者はそれまで断続的な腹痛を感じており、15年間にわたって便秘に苦しんでいました。
今回の入院よりも4-5年前に
造影剤を経口投与および静脈注射して行った腹腔と骨盤のCTスキャンでは
異常なしと診断されていました。
造影剤の静脈注射後に行われた腹腔・骨盤のCTからは
左腎中部に皮質の不規則な集中が複数認められました。
また右腎中部には周辺部にV字状の病変があり、
その中心部は薄くなっていました。
また右腎の下極には不明瞭ですが
V字状に薄くなっている箇所がありました。
ECG revealed a sinus rhythm at 57
beats per minute, with T-wave inversions in the
inferolateral leads, and was otherwise normal.
The patient was admitted to the hospital.
On the first hospital day, a chest radiograph
was normal. Transthoracic echocardiography revealed
segmental apical left ventricular dysfunction
with an apical aneurysm, near obliteration of
the mid-left ventricular cavity at end systole, and
overall normal left ventricular systolic function
(estimated ejection fraction, 58%).
On the second day, cardiac telemetry showed
intermittent sinus bradycardia, with no ectopy. The
abdominal pain decreased. Constipation, with
bloating and abdominal cramping, and hypoactive
bowel sounds developed.