亀田 徹, 川井 夫規子

Toru KAMEDA, Fukiko KAWAI

済生会宇都宮病院超音波診断科

Department of Ultrasound Medicine, Saiseikai Utsunomiya Hospital

キーワード : rectus sheath hematoma, ultrasonography

腹直筋血腫は腹直筋鞘内に血腫を生じる疾患で, 時に外傷機転が明らかではない場合もあり急性腹症と鑑別を要することがある. 今回超音波検査が診断に有用であり, それぞれが異なった超音波像を呈した腹直筋血腫の3例を経験したので報告する. 症例1:61歳女性, 気管支喘息重積発作で入院中に強い咳嗽が持続, 左下腹部鈍痛自覚から数時間後, 排便時に左下腹部痛が増強した. 左腹部に圧痛を伴う腫瘤あり, 翌日の超音波検査にて左腹直筋背側に74×60×24 mmの不整形低エコー腫瘤像を認めた. 症例2:75歳男性, 気管支喘息発作に伴う咳嗽時に左下腹部痛を自覚した. 左下腹部に圧痛を伴う腫瘤あり. 同日救急外来受診するも診断つかず. 腹痛発症から11日目に超音波検査が施行され, 左腹直筋内に39×17 mmの低エコー腫瘤像を認めた. 発症70日目に再検し, 腫瘤の消失を確認した. 症例3:71歳男性, 脳出血で入院中に突然下腹部痛の訴えあり. 腹部に隆起所見なく圧痛のみで, 同日超音波検査施行し, 右腹直筋内に35×15 mmの低エコー領域を認めた. 上記3例はいずれも保存的に軽快した. 腹直筋血腫は, 診察時に念頭におけば病歴と身体所見で推察可能であるが, 超音波検査により容易に確診が得られ, その後の経過観察にも有用である.

Rectus sheath hematoma should be included in the differential diagnosis of patients with acute abdominal pain. We describe three patients with rectus sheath hematoma, each of which produced a different image and was effectively diagnosed with ultrasonography. Case 1. Status asthmaticus in a woman aged 61 years who was admitted to this institution because of abrupt onset of dull abdominal pain in the lower left abdominal quadrant in a fit of continuous coughing. The pain increased in intensity during defecation several hours later. Abdominal examination detected a palpable mass accompanied by tenderness on the left side. The next day, the ultrasonogram showed a 74×60×24 mm hypoechoic mass under the left rectus abdominis muscle. Case 2, pain in the left lower quadrant in a man aged 75 years who was brought to the emergency room of this institution. The pain had begun during an attack of asthma and continuous coughing. Abdominal examination detected a palpable mass in the lower-left quadrant and was accompanied by tenderness, but the patient was discharged without being correctly diagnosed. The pain continued, however, and the ultrasonogram obtained 11 days later showed a 39×17 mm hypoechoic mass in the left rectus abdominis muscle. The ultrasonogram showed disappearance of the hematoma two months later. Case 3. A man aged 71 years abruptly complained of lower abdominal pain while hospitalized for a brain hemorrhage. His abdominal examination was significant for tenderness in the lower abdomen, but no palpable mass was detected in this area. The ultrasonogram obtained on the day of admission showed a 35×15 mm hypoechoic lesion in the right rectus abdominis muscle. We administered conservative treatment to all three patients. Ultrasonography proved useful for diagnosing and following up these cases of rectus sheath hematoma with ordinary medical history and physical examination.