PMC5410478_01
Abdominal CT scans of the axial lesion, taken on the 1st (a), 3rd (b), 10th (c), 49th (d), 196th (e), 389th (f), 531st (g), and 679th (h) days [on the 3rd (b) and 389th (f) days, with coronal sections (b') (f') ]. Except on the 10th day (c), all of the images are enhanced. The left peritoneal mass gradually decreased, and continuity with the left adrenal gland became apparent (white arrows). The right adrenal gland had a normal shape (black arrows in b', f').
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Contrast-enhanced CT of the abdominal region revealed an extensive iso-intense signal portion that had a maximum area of 14x15 cm and irregular borders on the left side of the peritoneal cavity from the body of the pancreas to the kidney; this was accompanied by an internal hyperintense signal that was contrasted and appeared to be a blood vessel (Fig. 1a, white arrow, transverse section). CT images (Fig. 1b, with coronal sections in 1b') on the 3rd day of illness showed that the right adrenal gland had normal morphology on coronal sections (black arrow), with no increasing trend in the left peritoneal mass. A CT scan performed on the 10th day of illness (Fig. 1c) showed no increase in the hemorrhage. Follow-up examinations involving CT scans taken on the 49th, 389th, 531st, and 679th days (Fig. 1d-h, 1f with coronal sections 1f') showed that the fluid volume gradually decreased, and continuity with the left adrenal gland gradually became apparent. A CT scan taken approximately 1 year after hospitalization (Fig. 1f) revealed a mildly swollen left adrenal gland with post-hemorrhage scarring continuing from it.
Clinical course after admission.
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The pain could be controlled with pentazocine hydrochloride; however, the Hb level dropped to 9.6 g/dL on the following day, and so RBC transfusion was performed (red cell concentrate, leukocyte-reduced [RCC-LR] 1 pack/day for 2 days) (Fig. 2).
Three-dimensional CT angiography on the 3rd day. (a) Anterior-posterior, (b) posterior-anterior images. There were no obvious blood vessel abnormalities such as aneurysms in the abdominal region.
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Three-dimensional CT angiography on the 3rd day (Fig. 3) failed to reveal any clear blood vessel abnormalities, such as an aneurysm in the abdominal region.