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급성 신부전으로 발현한 거대 비장 가성 동맥류 1예

Giant Splenic Artery Pseudoaneurysm Presenting with Acute Kidney Injury

  • 박지현 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 송림화 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 전병우 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 정현애 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 장혜련 (성균관대학교 의과대학 삼성서울병원 신장내과) ;
  • 오하영 (성균관대학교 의과대학 삼성서울병원 신장내과) ;
  • 김윤구 (성균관대학교 의과대학 삼성서울병원 신장내과)
  • Park, Ji-Hyeon (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Song, Lim-Hwa (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jhun, Byung-Woo (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jung, Hyun-Ae (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jang, Hye-Ryoun (Department of Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Oh, Ha-Young (Department of Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Yoon-Goo (Department of Nephrology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 발행 : 2012.01.01

초록

비장 가성 동맥류는 발생 빈도는 낮지만 파열과 출혈 등의 합병증 발생률이 높으며 사망률이 매우 높은 질환이다. 생존율 향상을 위해서는 조기 진단과 적극적인 수술적 치료가 중요하나, 모호한 증상으로 인해 조기 진단이 어려운 경우가 있다. 저자들은 감염성 심내막염의 치료 4개월 후 발생한 급성신부전의 원인을 규명하던 중 발견된 거대 비장 가성 동맥류를 수술적 치료로 완치한 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Splenic artery pseudoaneurysm is a rare, but potentially lethal, vascular lesion. The mortality rate may be 75-90%, if the aneurysm ruptures. The risk for rupture of an untreated splenic artery pseudoaneurysm is about 37%. Hence, early diagnosis and prompt surgical intervention are vital to improve survival. However, vague symptoms make early diagnosis difficult. We report here a case of a giant splenic artery pseudoaneurysm presenting with acute kidney injury. The patient had been treated previously for infective endocarditis, and after 4 months, acute kidney injury developed. Imaging studies revealed a giant splenic artery pseudoaneurysm. Splenectomy and distal pancreatectomy were performed. After surgery, renal function was improved.

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참고문헌

  1. Trastek VF, Pairolero PC, Joyce JW, Hollier LH, Bernatz PE. Splenic artery aneurysms. Surgery 1982;91:694-699.
  2. Stanley JC, Thompson NW, Fry WJ. Splanchnic artery aneurysms. Arch Surg 1970;101:689-697. https://doi.org/10.1001/archsurg.1970.01340300045009
  3. Bedford PD, Lodge B. Aneurysm of the splenic artery. Gut 1960;1:312-320. https://doi.org/10.1136/gut.1.4.312
  4. Tessier DJ, Stone WM, Fowl RJ, et al. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg 2003;38:969-974. https://doi.org/10.1016/S0741-5214(03)00710-9
  5. Tessier DJ, Stone WM, Fowl RJ, et al. Clinical features and management of splenic artery pseudoaneurysm: case series and cumulative review of literature. J Vasc Surg 2003;38:969-974. https://doi.org/10.1016/S0741-5214(03)00710-9
  6. Huang IH, Zuckerman DA, Matthews JB. Occlusion of a giant splenic artery pseudoaneurysm with percutaneous thrombin-collagen injection. J Vasc Surg 2004;40:574-577. https://doi.org/10.1016/j.jvs.2004.06.020
  7. Myers SI, Wang L, Myers DJ. Loss of renal function and microvascular blood flow after suprarenal aortic clamping and reperfusion (SPACR) above the superior mesenteric artery is greatly augmented compared with SPACR above the renal arteries. J Vasc Surg 2007;45:357-366. https://doi.org/10.1016/j.jvs.2006.10.045
  8. Liu CF, Kung CT, Liu BM, Ng SH, Huang CC, Ko SF. Splenic artery aneurysms encountered in the ED: 10 years' experience. Am J Emerg Med 2007;25:430-436. https://doi.org/10.1016/j.ajem.2006.08.017
  9. Hsu RB, Chen RJ, Wang SS, Chu SH. Infected aortic aneurysms: clinical outcome and risk factor analysis. J Vasc Surg 2004;40:30-35. https://doi.org/10.1016/j.jvs.2004.03.020
  10. Dean RH, Waterhouse G, Meacham PW, Weaver FA, O'Neil JA Jr. Mycotic embolism and embolomycotic aneurysms: neglected lessons of the past. Ann Surg 1986;204:300-307. https://doi.org/10.1097/00000658-198609000-00008