肺塞栓，肺膿瘍を合併し急死した肺動脈弁感染性心内膜炎の1例

A Sudden Death Case of Pulmonary Valve Endcarditis Complicated with Pulmonary Emboli and Abscess

　症例は55歳，男性．元来，心室中隔欠損症（VSD），右室二腔症（DCRV）の存在を指摘されていて手術を勧めるも拒否していた．1994年5月18日全身倦怠感，38℃の発熱を認め解熱剤にて経過観察していたが軽快せず，5月30日に当院循環器内科を受診．胸部X線写真にて両肺野に多発性浸潤陰影を認めた．心エコーでは肺動脈弁の数箇所に疣贅が認められ感染性心内膜炎（IE）と診断した．同年6月3日，本患者は緊急入院となりペニシリンG大量投与を開始した．その後の心エコー検査にて一部疣贅が消失していることが確認され，胸部CTにて肺病変は疣贅を栓子とする肺膿瘍と診断された．本患者は，第9病日に肺膿瘍に起因すると考えられる突然の大量肺出血を来し死亡した．予後良好とされる右心系IEでも肺膿瘍合併例においては早急かつ積極的な治療が必要であると考えられた．

A 55-year-old man, who had ventricular septal defect (VSD) and double-chamber right ventricle (DCRV) was admitted to our hospital because of general fatigue and fever for about 2 weeks. Chest X-P revealed multiple lung mass lesion, which was diagnosed as pulmonary abscess by chest CT. Echocardiography revealed vegetation of the pulmonary valve. Therefore, he was diagnosed as having pulmonary valve endcar-ditis. A part of the vegetation vanished later, so this lesion was produced by septic pulmonary emboli of the vegetation. He was treated with antibiotics and an operation was prepared for. However, the patient suddenlly died because of tracheal bleeding due topulmonary abscess. Pulmonary valve endocarditis is a rare clinical entity. Generally, prognosis of infective endocarditis involving the right side of the heart is not so bad, however when complicated with pulmonary abscess, immediate operation therapy should be perfor-med.