多発斑状影と血胸で発症した血管肉腫の1例

A Case of Angiosarcoma Presenting as Ⅲ-defined Opacities on Chest Roentogenogram and Hemothorax

　症例は74歳男性．胸部異常陰影の精査目的で入院．炎症反応陽性，LDH高値を示し，画像診断上，両側上中肺野に多発する境界不鮮明な結節状陰影と両側胸水（血性）を認めた．診断未定のまま第23病日に呼吸不全で死亡した．剖検で血管肉腫と診断され，肺，胸膜，腎，副腎，消化管，骨髄に腫瘍を認めたが，原発巣は同定できなかった．肺野に境界不鮮明な結節状陰影を認め，血胸を伴う病態では，本症をも鑑別にいれるべきであると考えた．

A 74-year old male was referred to the Tokai Univer-sity Hospital for evaluation of abnormal opacities on a chest roentogenogram. Laboratory tests demonstrated leukocytosis, elevated ESR and CRP, elevated LDH, and hypoxemia. The chest roentgenogram demonstrat-ed several ill-defined nodular infiltrates on the bilateral upper lung fields. In addition, a CT scan revealed bilateral pleural effusion which was found bloody ondiagnostic thoracenthesis. Administration of antibi-otics failed to improve lung infiltration or laboratory data. The patient died of respiratory failure on the 23rd hospital day.