ISSN 1004-4140
CN 11-3017/P

CT诊断双侧肾上腺弥漫性出血的临床案例探讨

Clinical Case Analysis of CT Diagnosis of Bilateral Adrenal Diffuse Hemorrhage

  • 摘要: 双侧肾上腺弥漫性出血(BADH)是一种由多种原因引起的罕见出血性疾病,其临床表现主要为非特异的腹胁肋部和胸背部疼痛,早期发现和诊断对医生来说是一个挑战。本文报告2例BADH病例,均为重症系统性红斑狼疮(SLE)合并肾上腺继发性出血。第1例为25岁女性患者,临床表现为持续腹痛,渐进性加重,伴恶心呕吐、发热及多器官功能受累,急查腹部CT平扫发现双侧肾上腺弥漫增粗及多发浆膜腔积液,综合评估临床诊断为重症SLE累及多系统的继发性改变。第2例为58岁女性患者,既往SLE诊断明确,入院2d后突发腹痛,急查腹部CT平扫发现腹膜后血肿,随后超声造影证实肾上腺出血。两例均以积极治疗原发病的同时,对症保守治疗后,症状明显好转,随后复查腹部CT均提示病变明显改善。本文将对BADH进行全面介绍,总结其CT表现及常见临床症状,加强医生对BADH的认识,为早期诊断提供帮助与参考价值。

     

    Abstract: Bilateral adrenal diffuse hemorrhage (BADH) is a rare hemorrhagic disease due to multiple causes, and the clinical manifestations are principally non-specific abdominal and thoracic pain. Due to its rarity, early detection and diagnosis of BADH can be challenging for physicians. We reported two cases of BADH, both of which are severe systemic lupus erythematosus (SLE) complicated with adrenal hemorrhage. The first case report was a 25-year-old female patient who presented with progressive worsening abdominal pain, nausea, vomiting, fever and multi-organ functional involvement. Abdominal CT scan revealed diffuse thickening of the adrenal glands and serous cavity effusion. The comprehensive assessment of the clinical findings suggested that it was a secondary change of severe SLE involving multiple systems. The second case was a 58-year-old female patient with SLE who occurred abdominal pain 2 days after admission. CT scan of abdomen revealed a retroperitoneal hematoma, and a subsequent contrast-enhanced ultrasound confirmed the adrenal hemorrhage. After active treatment of primary diseases, along with symptomatic and conservative treatments, the symptoms of patients were significantly relieved, and reexamination of abdominal CT scan showed obvious absorption of the lesion. This report provides a comprehensive introduction to BADH, summarizes its CT features and clinical symptoms to improve physicians’ understanding of BADH and provide some aids and references for its early diagnosis.

     

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