左房粘液腫と考えられる高齢者（83歳）心房腫瘍の1例—5年間の経過観察について

A case of elderly (83-year-old) woman with possible left atrial myxoma

　症例は83歳，女性。昭和58年4月（当時78歳）心不全症状を主訴として当科に入院。心音で収縮期駆出性雑音とopening snapを欠く拡張期遠雷様雑音を聴取し，胸部X線写真では胸水と心拡大を認めた。心電図では心房細動，Mモードおよび心断層エコーにおいて左房内に腫瘤を認め，胸部CTでは平均密度が22.7　Hounsfield Unitであった。心血管シンチグラフィー，magnetic resonanceimaging（MRI）ともに同様の所見であり、他の心内腔に異常を認めないことから，左房粘液腫と診断した。

　以後，患者の手術の同意が得られず経過観察となり，周期的に心不全症状をくり返しながらも約5年を経過し健在である。

　本症の画像診断の経時比較，本邦における70歳以上の左房粘液腫手術報告例の検討を中心に，興味ある高齢者の左房粘液腫と考えられる心房腫瘍の1例を報告した。

A 78-year-old woman with exertional dyspnea (Hugh-Jones Grade III) and dry cough was admitted to our hospital in April, 1983.

She had marked cardiac cachexia and a loss of body weight due to long term heart failure. On physical examination a systolic ejection murmur and a diastolic rumbling murmur were heard without the opening snap sound.

Chest radiography revealed pleural effusion and cardiomegaly.

M-mode and two dimensional echocardiography demonstrated abnormal echoes in the left atrium, the density being 22. 7 Hounsfield Unit.

Radionuclide angiography and magnetic resonance imaging (MRI) provided similar findings.

No other mass lesion existed in the other chamb-ers.

Based on these findings, the mass was diagnosed as a left atrial myxoma. She has been well except for periodic congestive heart failure, for about five years since her discharge.

The course of her ailment is interesting because her treatment is mainly symptomatic.