たこつぼ型心筋症から数日の経過で心尖部の壁肥厚を呈した1例

Ampulla Cardiomyopathy Altered Apical Wall Thickening in Several Days：A case report

要旨　患者は58歳，男性．呼吸不全を契機にショックを呈し紹介された．胸部X線写真および胸部CTによって胸水と心嚢液貯留が，心エコーで心嚢液貯留と心尖・前壁中隔の壁運動低下と内腔拡大，心基部の過収縮が認められた．約3,000ccの膿性胸水を排液したところ症状は軽減し，1週間後の心エコーでは心尖部の著明な壁肥厚と内腔狭小化が認められ，壁運動は回復しドプラ心エコーで高流速(4.5m/sec)が検出された．血行動態をより安定させる目的で心嚢液排出を行い精査を進めた結果，上部消化管内視鏡検査で末期食道癌があることが判明し，対症療法を施行したが第41病日で死亡した．本例は呼吸不全を契機に発症したたこつぼ型心筋症であるが，1週間で壁運動の回復に伴って心尖部壁肥厚を呈した点が興味深いものと思われた．

Summary

　A 58-year-old male was transferred to our hospital from his local physician because of shock triggered by respiratory failure. A plain film and computed tomography of the chest showed massive pleural effusion in the left thorax and pericardial effusion. Echocardiography revealed pericardial effusion and hypokinesis of the anteroseptal left ventricular wall and cardiac apex with dilation of the left ventricle. In addition, the left ventricular basal wall presented hyperkinesis. A thoracentesis on the left side yielded about 3,000cc of purulent liquid with consequent symptomatic improvement. On the seventh hospital day, the left ventricular wall motion returned to normal, and the cardiac apical wall thickness increased markedly with high flow signal estimated at 4.5m/sec by Doppler echocardiography. Further examinations after a pericardicentesis disclosed esophageal cancer. We diagnosed the patient as “Ampulla Cardiomyopathy” triggered by respiratory failure. The left ventricular wall motion returned to normal and the thin left ventricular wall underwent apical hypertrophy with high blood flow.