DOI QR코드

DOI QR Code

복부 둔상 후 발생한 일시적 고혈압 1예

A Case of Transient Hypertension after Blunt Abdominal Trauma

  • 민지연 (한양대학교 의과대학 내과학교실) ;
  • 민승연 (한양대학교 의과대학 내과학교실) ;
  • 변영재 (한양대학교 의과대학 내과학교실) ;
  • 정종헌 (한양대학교 의과대학 내과학교실) ;
  • 이용구 (한양대학교 의과대학 내과학교실) ;
  • 김배근 (한양대학교 의과대학 내과학교실) ;
  • 신정훈 (한양대학교 의과대학 내과학교실)
  • Min, Ji Yeoun (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Min, Seung Yeon (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Byun, Young Jae (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Jeong, Jong-Heon (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Lee, Yonggu (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Kim, Bae Keun (Department of Internal Medicine, Hanyang University College of Medicine) ;
  • Shin, Jeong Hun (Department of Internal Medicine, Hanyang University College of Medicine)
  • 투고 : 2012.03.30
  • 심사 : 2012.06.22
  • 발행 : 2013.03.01

초록

외상 후 우측 옆구리 통증을 주소로 내원한 63세 환자에서 새로이 고혈압이 발생하였다. 신장 피막하 혈종과 부신출혈에 의한 고혈압으로 진단하였고, 약물 치료 없이 경과관찰하였다. 24시간 활동혈압 측정과 복부 초음파를 추적관찰한 결과, 두 장기의 혈종의 크기 감소와 함께 혈압도 정상화되었다. 저자들은 복부 둔상 후 발생한 고혈압에서 신장의 피막하 혈종이나 부신 혈종에 의해 일시적 고혈압이 발생한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Arterial hypertension following blunt abdominal trauma is a rare complication that can be induced by compression of the renal parenchyma due to a perirenal or subcapsular hematoma or adrenal hemorrhage. A 63-year-old woman was admitted after blunt abdominal trauma. Abdominal computed tomography (CT) revealed a right renal subcapsular hematoma and right adrenal gland hematoma. The patient developed hypertension during conservative treatment. Pheochromocytoma, renovascular hypertension, adrenal adenoma, thyroid disease, and other causes of secondary hypertension were excluded. On following the patient, her blood pressure normalized spontaneously without prescribing any antihypertensive medications. The renal subcapsular hematoma and adrenal hemorrhage regressed progressively as the blood pressure normalized. We report this case to make physicians aware that transient hypertension can develop in patients with blunt abdominal trauma, and to prevent the use of unnecessary antihypertensive medications.

키워드

참고문헌

  1. Montgomery RC, Richardson JD, Harty JI. Posttraumatic renovascular hypertension after occult renal injury. J Trauma 1998;45:106-110. https://doi.org/10.1097/00005373-199807000-00023
  2. Chedid A, Le Coz S, Rossignol P, Bobrie G, Herpin D, Plouin PF. Blunt renal trauma-induced hypertension: prevalence, presentation, and outcome. Am J Hypertens 2006; 9:500-504.
  3. BrUckner M, Dürig M. Traumatic hematoma of the adrenal gland simulating pheochromocytoma: a case report. Unfallchirurgie 1992;18:311-314. https://doi.org/10.1007/BF02588214
  4. Engel WJ, Page IH. Hypertension due to renal compression resulting from subcapsular hematoma. J Urol 1955;73: 735-739. https://doi.org/10.1016/S0022-5347(17)67466-4
  5. Schmidt J, Mohr VD, Metzger P, Zirngibl H. Posttraumatic hypertension secondary to adrenal hemorrhage mimicking pheochromocytoma: case report. J Trauma 1999;46:973-975. https://doi.org/10.1097/00005373-199905000-00039
  6. Pimenta E, Gordon RD, Daunt N, Slater G, Stowasser M; Medscape. Hyperreninemic hypertension following presumed abdominal trauma. Nat Rev Nephrol 2011;7:730-734. https://doi.org/10.1038/nrneph.2011.127
  7. Dopson SJ, Jayakumar S, Velez JC. Page kidney as a rare cause of hypertension: case report and review of the literature. Am J Kidney Dis 2009;54:334-339. https://doi.org/10.1053/j.ajkd.2008.11.014
  8. Kirkendall WM, Fitz AE, Lawrence MS. Renal hypertension: diagnosis and surgical treatment. N Engl J Med 1967;276:479-485. https://doi.org/10.1056/NEJM196703022760901
  9. Gordon RD, Tunny TJ, Evans EB, Fisher PM, Jackson RV. Unstimulated renal venous renin ratio predicts improvement in hypertension following nephrectomy for unilateral renal disease. Nephron 1986;44(Suppl 1):25-28. https://doi.org/10.1159/000184041
  10. Rao RH, Vagnucci AH, Amico JA. Bilateral massive adrenal hemorrhage: early recognition and treatment. Ann Intern Med 1989;110:227-235. https://doi.org/10.7326/0003-4819-110-3-227

피인용 문헌

  1. Page kidney after botulinum toxin injection during chiropractic care vol.32, pp.2, 2015, https://doi.org/10.12701/yujm.2015.32.2.143