大動脈炎症候群による胸部大動脈瘤の手術後に大動脈気管支肺瘻を生じた1例

A Case of an Aortobronchopulmonary Fistula after Graft Replacement for a Thoracic Aortic Aneurysm due to Aortitis Syndrome

要旨

　患者は51歳，女性．大動脈炎症候群による胸部大動脈瘤に対し上行弓部置換術を施行された．術後7年目に突然吐血し意識消失，当院に搬送された．気管支鏡検査では出血を認めず，胸部造影CTでも仮性動脈瘤の形成を認めなかったため診断に至らなかった．6カ月後に大喀血を来し，病理解剖にて大動脈気管支肺瘻と診断された．大動脈炎症候群は慢性炎症疾患であり，仮性瘤を伴わなくとも，大動脈気管支肺瘻を来す恐れがあり，迅速な診断と治療が必要である．

Summary

　The patient was a 51-year-old female. She received replacement of a aortic arch for a thoracic aortic aneurysm due to aortitis syndrome. Seven years after the operation, she suddenly suffered from vomiting blood andloss of consciousness, so she was transferred to our hospital. It was hard to make a diagnosis, because bronchoscopy revealed no hemorrhage along the bronchus. Neither did thoracic CT with a contrast medium demonstrate formation of a false aneurysm. The patient suggered severe hemoptysis 6 months later, and finally, an aortobronchopulmonary fistula was diagnosed after a pathological autopsy. Aortitis syndrome is a chronic inflammatory disease that may cause an aortobronchopulmonary fistula even when not accompanied by a false aneurysm. Rapid diagnosis and suitable treatment is reguired.