A 68-year-old man with a history of upper gastrointestinal bleeding due to aspirin and transient ischemic attack on chronic treatment with trifusal (300 mg every 12 hours) was admitted to the emergency department of the Hospital San Agustín A.
On physical examination, the patient had a blood pressure of 210/120 mm Hg, a heart rate of 80 per minute, and pain in the left iliac fossa accentuated by palpation.
Blood count (hemoglobin: 13 g/dL, platelets: 249,000), coagulation study, elemental biochemistry of blood, systematic urine, electrocardiogram and simple chest X-ray were normal.
Abdominal computed tomography showed an extensive hematoma, 12 cm in maximum diameter, in the left renal cell, without intraperitoneal free fluid; the left adrenal was encompassed and could not be identified, and the right kidney could not be identified.
Hypertension was not controlled in the emergency room, despite treatment with analgesics, with calcium antagonists and with angiotensin converting enzyme inhibitors II, so the patient, who maintained intravenous nitrobrusside tensional figures 240/160 mm Hg.
Hypertensive crisis was resolved within 24 hours and stable haemoglobin and haematocrit levels were found.
1.
With the diagnostic suspicion of non-traumatic rupture of a pre-existing pheochromocytoma, plasma metanephrines were determined, which were normal, and urinary cathodes and metanephrines.
In the 24-hour urine of the day following admission, the following results were obtained:
At 10 days, the patient was still admitted, the urinary figures had completely normalized spontaneously.
Regarding the hematoma, in July 2006 it had not reabsorbed and a pseudocystic image persisted in the left adrenal area.
In September 2006, a unilateral adrenalectomy was performed, and the histological study showed an encapsulated mass of 6 x 5 cm, with extensive hemorrhagic necrosis and some cortical cells without atypia.
