日本新生児成育医学会雑誌　35(1)：85-90；2023　

日本新生児成育医学会雑誌　第35巻　第1号　85 ～ 90頁（2023年）

受付日：2022．01．31

受理日：2022．05．27

嚢胞性成分と充実性成分が混在するエコー像を呈した肝被膜下血腫を合併した超低出生体重児の1 例

A Case of an Extremely-Low-Birth-Weight Infant with a Subcapsular Hepatic Hemorrhage with Mixed Cystic Enhancing Echographic Features

兵庫県立尼崎総合医療センター　新生児内科

Department of Pediatrics, Hyogo Prefectural Amagasaki General Medical Center

円山牧子・松島智恵子・吉田淳史・高橋知也・北村律子・西田吉伸

Makiko MARUYAMA，Chieko MATSUSHIMA，Atsushi YOSHIDA，Tomoya TAKAHASHI，Ritsuko KITAMURA，Yoshinobu NISHIDA

Key Words：subcapsular hepatic hemorrhage，extremely low birth weight infant，hematic cyst，solid tumor

日齢0 に昇圧薬不応性の血圧低下と貧血で肝被膜下血腫を発症し，保存的療法で救命した超低出生体重児の1 例 を経験したため報告する。症例は在胎24 週2 日，出生体重694g，緊急帝王切開で出生した女児。貧血の進行と播 種性血管内凝固（disseminated intravascular coagulation：DIC）をきたしたが，血腫の破裂や腹腔内出血はなく大 量輸血による保存的加療で救命した。肝被膜下血腫は通常超音波検査でecho free space として描出されるが，本症 例では充実性成分と内部に隔壁を伴う嚢胞性成分が混在した病変として描出されたため診断に難渋した。

We report a case of a subcapsular hepatic hemorrhage in an extremely-low-birth-weight infant with consequent anemia and hypotension. The hypotension was refractory to hypertensive drugs upon birth and was treated conservatively. A female infant was delivered at gestational age of 24 weeks and 2 days via emergency cesarean section, with a birth weight of 694g. However, the patient suddenly developed anemia and disseminated intravascular coagulation, without rupture of the hematoma or occurrence of an intra-abdominal hemorrhage. The patient was rescued from the subcapsular hepatic hemorrhage with the use of massive blood transfusion. Subcapsular hepatic hemorrhage is usually seen on ultrasonography as an echo-free space. However, it was observed that in our case, a mixed lesion with substantial and cystic components with internal septa was visualized, resulting in a difficulty in diagnosing the patient.