高分解能CTで肺病変を経時的に観察し得たパラコート中毒の救命例

Pulmonary lesion of paraquat poisoning on high resolution CT

　除草剤であるパラコート中毒による肺病変の病理学的検討は多いが，放射線学的な画像診断における検討は少なく，特に救命し得た症例を経時的に画像上観察した報告はさらに少ない。また，従来の報告は，ポータブル撮影が主であり，病変の詳細な占拠部位や進展様式が把握しがたいことが欠点であった。

　今回，パラコートを服用し救命し得た症例の高分解能CTでの経過観察を経験し，その過程で，血管，気管支周囲の間質気腫の拡がり，肺門周囲からさらに前方にかけての肺の線維化の進行，などパラコート肺の形態的変化を詳細に観察することができ，病期，病態の把握，治療方針の決定に高分解能CTが有用であると考えられた。

It is well known that paraquat causes severe organ-toxicity and pulmonary damage. We observed the progress of a patient who survived paraquat poison-ing, and we recorded the changes in the lung by high resolution CT.

The patient was a 35-year-old man who attempted suicide by paraquat (Guramoxone 100ml) ingestion. At the time of hospitalization, there was no respira-tory involvement.

Five days after ingestion, an X-ray examination showed only indistinct vascularity of both lung fields, but high resolution CT showed increased density in the central part of both lung fields.

According to the clinical progress after ingestion, mediastinal and subcutaneous emphysema were noted by chest X-ray examination.

On the other hand, severe interstitial pneumonia progression of severe lung fibrosis with a decrease in lung volume and interstitial pulmonary emphysema in addition to mediastinal, subcutaneous emphysema were seen by high resolution CT.

High resolution CT is useful for detecting morpho-logic change and diagnosing clinical stages. Obser-ving the course of changes by high resolution CT is useful for deciding the course of clinical therapy, and we have no hesitation in affirming that it should be used in such cases.