“Tissue tamponade”を呈した心外膜原発悪性中皮腫の1例

A Case of Malignant Mesothelioma of Pericardium which Developed into “Tissue Tamponade”

　64歳，男性．1994年8月より発熱が持続，10月より咳嗽，呼吸困難が出現し，心不全と診断され近医に入院したが軽快せず，1995年2月15日当科へ転院した．入院時，心電図は心房頻拍，低電位差，胸部X線写真上は肺うっ血が著明であった．心エコー図では左室のびまん性の壁運動低下と拡張能の高度の障害がみられた．右心カテーテルでは右房圧，右室拡張期圧および肺動脈楔入圧の上昇がみられ，心拍出量は1.75l／minと高度に低下していた．薬物療法に対する反応は不良で2月21日心不全死した．剖検では心外膜の肥厚と心表面との高度の癒着がみられ，組織所見では悪性中皮腫であり，心外膜原発と考えられた。心外膜原発悪性中皮腫は稀な疾患であり，腫瘍によるtissue tamponadeにより死亡した症例を経験したので報告する．

A 64-year-old man was admitted to another hospital with middle grade fever, cough and dyspnea and was treated as having congestive heart failure. Since he had not been improving, he was brought to our hospital. On admission, electrocardiogram revealed atrial tachycar-dia and low voltage and chest X-ray film showed pulmo-nary congestion rather than cardiac enlargement. Echocardiogram demonstrated decreasing left ventri-cular wall motion and severe diastolic dysfunction. Cardiac catheterization demonstrated increasing right atrial pressure, right ventricular diastolic pressure and pulmonary capillary wedge pressure and significant decrease of cardiac output, viz., 1.75 l/min. Responses to medical treatment, for example diuretics, vaso-dilators, nitroglicerin and catecholamines, were poor and he died of heart failure. Autopsy revealed malig-nant mesothelioma of the pericardium and marked adhesion of the epicardium and pericardium. To sum up, we reported a rare case of malignant mesothelioma of the pericardium which developed into cardiac tissue tamponade.