ABSTRACT
Uterine myoma is the most common neoplasm of women and occurs in up to 20% of reproductive women. Leiomyoma may undergo secondary degeneration such as hyaline degeneration, sarcomatous change, and necrosis. This report presents a case of acute cortical necrosis(ACN) and disseminated intravascular coagulation caused by a uterine myoma necrosis. The uterine myoma of this patient was diagnosed and observed 10 months ago at other hospital. She complained of low abdominal pain with vaginal bleeding and anuria from the previous day. The laboratory findings were as follows:platelets 49,000/ mm3; prothrombin time 38%(normal control, 12 seconds); aPTT 41seconds(normal control, 26seconds); fibrinogen 81mg/dL; FDP<10 microgram/mL; BUN/sCr 23/ 2.9mg/dL. Acute cortical necrosis was diagnosed by radiologic grounds including abdominal computerized tomography(CT), which demonstrated decreased cortical contrast enhancement, normal medullary contrast enhancement, and preserved cortico-medullary differentiation. The patient was treated conservatively and underwent a CAPD operation later in her hospital course. On the 135th day after diagnosis, the ultrasonography, done in outpatient department, revealed the decreased size of both kidneys, respectively 7.5cm and 7.8cm. Urine output was about 800cc/day and the creatinine clearance of this patient was 9.2mL/ min.
Subject(s)
Female , Humans , Abdominal Pain , Acute Kidney Injury , Anuria , Creatinine , Diagnosis , Disseminated Intravascular Coagulation , Fibrinogen , Hyalin , Kidney , Leiomyoma , Necrosis , Outpatients , Peritoneal Dialysis, Continuous Ambulatory , Prothrombin Time , Ultrasonography , Uterine HemorrhageABSTRACT
Acute cortical necrosis is a rare cause of the acute renal failure. It is frequently associated with complications of pregnancy. The renal biopsy is the key of diagnosis of these disease. However, the contrast enhanced CT scan can be a tool for the diagnosis of acute renal cortical necrosis, because of its noninvasiveness and constant findings(enhancement of subcapsular rim, nonenhancement of the renal cortex, enhancement of medulla, and lack of excretion of contrast media to the collecting system). This is a case of acute renal cortical necrosis diagnosed by CT scan. She had an anuria for 16 days and feature of hemolytic uremic syndrome and polycystic kidney.