尿路性敗血症を発症した腎静脈奇形を伴う腎回転異常

CONGENITAL ANOMALY OF LEFT RENAL VEIN WITH MALROTATED KIDNEY PRESENTING AS UROSEPSIS

　症例は65歳，女性。先行する反復性膀胱炎の既往あり。40℃の発熱，意識消失にて入院した。左腰背部叩打痛著明で臨床検査および超音波断層法の結果，左膿腎症による尿路性敗血症と診断し，左腎痩を造設，軽快した。その後の画像検査にて，左腎回転異常（正面位）および左腎静脈奇形（大動脈周囲左腎静脈）が確認され，それらが左尿管を狭窄させていた。本症例の診断法として三次元CTによる解析が最も低侵襲で有用と思われた。

A 65-year-old woman who had foregoing recurrent cystitis presented with high grade fever and an episode of loss of consciousness. Physical examination demon-strated severe left CVA tenderness and fever of 40 C. Since laboratory examination and ultrasonography sug-gested that the patient was uroseptic due to left pyone-phrosis, percutaneous nephrostomy was introduced immediately. Convalescence was uneventful. Further radiological investigations performed later indicated that congenital anomaly on the left renal vein associated with malrotated kidney could result in urosepsis because of the left ureteral stenosis.