異なる肺葉から複数の流入動脈を認めた肺動静脈瘻の1例

A Case of Pulmonary Arteriovenous Fistula with Multiple Feeding Vessels Arising from Right Upper and Middle Lobes

要旨　症例は30歳男性．2011年2月より安静時の息切れが出現し，胸部違和感も認めたため近医を受診．胸部CT検査で異常陰影を指摘されたため，精査加療目的に当院紹介となった．肺動脈造影検査で右中葉に4cm×3cmの肺動静脈瘻を認め，右肺動脈A³より1本，A^4＋5より2本の異なる肺葉から複数の流入動脈を認めた．そのため経カテーテル塞栓術の手技面での困難さが予測され，また全身麻酔可能な孤立性肺動静脈瘻であることから，高い根治性を考えて外科的治療を選択し右中葉切除術を行った．術後症状は速やかに改善し，第8病日に退院となった．

　A 30-year-old man consulted a nearby hospital for shortness of breath at rest and chest discomfort in February 2011. Abnormal shadow was detected on chest computed tomography(CT). Pulmonary angiography showed a pulmonary arteriovenous fistula(4×3cm in size)in the middle lobe of the right lung with a feeding vessel arising from right A³ and two vesseles from right A^4＋5. Since the transcatheter embolization for pulmonary arteriovenous fistula in this case was predicted to be difficult in terms of techniques and more definitive treatment was required, we selected a surgical resection. Lobectomy of the right middle lung was performed. Symptoms were improved after surgery. The patient was discharged on the 8th post operative day.