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59歳,男性。乳糜尿症として過去数回の腎盂内薬液注入を受けている。前回治療より,1年後の再発を認めて来科。患側部位診断として逆行性腎盂造影を施行したが腎盂外逆流像は認められず,99mTc標識ヒト血清アルブミンによるリンパシンチグラフィーを施行し左腎に異常集積像が得られ同側に対して硝酸銀の腎盂内薬液注入を施行し,乳糜尿の消失を認めた。
A 59 year old man was admitted with a dark white urine. Urinalysis indicated a urinary protein and fat globule. Cystoscopy and retrograde pyelography showed no specific findings. Lymphoscintigraphy with Tc-99m HSA was done. It showed a hot spot in the left kidney. From this observation, we diagnosed that chyluria occurred from left kidney. Intracalysinal insillation of AgNO3, in left kidney was performed. After the treatment lymphoscintigraphy with Tc-99m HSA showed no abnormal findings in the left kidney. In conclusion lymphoscintigraphy with Tc-99m HSA seems to be a new, safe, easy and accurate examination for chyluria.
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