コレステロール心膜炎の1治験例—心嚢液貯留の心エコー図所見

A case of cholesterol pericarditis:Echocardiographic findings of pericardial effusion

　1919年Alexander^1）が慢性心嚢液貯留の1例にコレステロール結晶を証明し，コレステロール心膜炎として報告して以来，本症は現在までに，本邦で10例報告されているにすぎない。今回我々は慢性心嚢液貯留の患者にコレステロール結晶を証明し，心膜切除術を施行し，術後良好な経過をとっている本症の一例を経験したので報告する。また，本例では術前術後の心エコー図が記録されており，心嚢液貯留の心エコー図所見についても若干の文献的考察を加えて報告する。

Cholesterol pericarditis is a rare disease and only ten cases have been reported in our country. Here we present a case of this disease that we had recently. A case was a 64-year-old man and complained of exertional dyspnea. From the findings of physical examination, radiograph of the chest, electrocardiogram and echocardiogramwe diagnosed him as chronic pericardial effusion and performed pericardocentesis. The effusion showed "gold-paint" appearance and contained cholesterol crystals. Under the diagnosis of cholesterol pericarditis, pericardocentesis combined with medical treatment was repeated several times but of no use. So we performed pericardiectomy and then this patient was improving. The resected pericardium was about 5 mm in thickness and histologically there was no specific finding for cholesterol pericarditis but only chronic inflammation. Also neither basic nor combined disease, for example hypothyroidism, rheumatism, tuberculosis and so on, was found. It is suggested that the disturbance of cholesterol absorption due to the inflammation of pericardium is responsible for cholesterol pericarditis.

Echocardiographically this case showed not only echo-free space but pendular motion which is usually recognized in a case of large pericardial effusion and prolapse-like movement of mitral valve. These findings disappeared completely after pericardiectomy. Therefore the prolapse-like movement of mitral valve echogram shown in our case was found to be "pseudo-prolapse" and it is thought that pseudo-prolapse of mitral valve is associated with the pendular motion of the whole heart.