成人まで無症状に経過した両側性肺動静脈痩の1症例

Adult case of bilateral pulmonary arteriovenous fistula

　肺動静脈痩は，1897年Churton^1）により，その剖検例が始めて報告されて以来，その後，1939年Smith andHorton^2）が，本症の最初の血管造影を行い，1942年Hepburn ＆ Dauphinee^3）が，本症の最初の外科手術を報告しており諸外国ではかなりの数が発表されている。

　本邦では比較的稀な疾患とされていたが，近年その報告例は増加しつつある。本症の原因としては、先天性の中胚葉性血管形成不全に基づく肺動脈間の短絡形成によると考えられている。

An adult case of bilateral pulmonary arteriovenous fistula was reported. A 49-year-old woman was ad-mitted for examination of abnormal shadow on chest X-ray. She had telangiectasia in the nasal and oral mucosa, cyanosis in the lips and clubbing of fin-gers. Auscultation in all areas of the lung revealed no murmur. Peripheral blood was polycythemic, that is, hemoglobin value was 19.6 g/dl, hematocrit was 60.1% and red blood cell count was 704×10⁴/μl respectively. P_O2 was 42. 5 mmHg, P_CO2 45.3 mmHg and O₂-satulation 78.7% in gas analysis of arterial blood. Chest X-ray showed round shadows in the lower portion of right lung and the mid portion of left lung. ECG showed regular sinus rhythm and inverted T in II, III, aVF, V₅, V₆. Cardiac cathete-rization showed a normal pressure in the caridiac chambers. Pulmonary angiography demonstrated one arteriovenous fistula in right lower lung, which feeding artery was A⁵ and two arteriovenous fistulas in left upper lung, which feeding arterys were A³ and A⁵, respectively. Left ventricular angiography showed normal finding. There was not arterioveno-us fistula in the coronary artery. An adult case of bilateral pulmonary arteriovenous fistula we repor-ted is living in asymptomatic and complete healthy.