心膜嚢胞様陰影を呈した結核性心外膜炎の1例

Tuberculous Pericarditis Resembling Pericardial Cyst:A case report

　心膜嚢胞様陰影を呈した稀な結核性心外膜炎の1例を報告する．症例は67歳，女性．1997年9月感冒様症状のため当科を受診し，心不全と診断され入院．検査所見上，赤沈値は45mm／h,CRP 7.1mg／dlと上昇，ツベルクリン反応は陽性．心エコー図では心外膜の肥厚，石灰化と左室・右室側壁に沿って2個の嚢胞様病変を認めた．胸部CT検査では，左室に接し5×3cm，および右室，右房に接し4×1.5cmの造影効果のない内部に液貯留した腫瘤が2個存在した．胸部MRI検査では腫瘤影の内部はT₁強調像で低信号ないし中等度の信号強度，T₂強調像で高信号で，心膜と連続していた．心膜嚢胞を疑い手術適応とした．手術時，心膜は肥厚し，心外膜も肥厚し心膜と癒着していた．2個の腫瘤内容物は淡黄色澄明で滲出性，糖は1mg／dl以下，LDHは2,204IU／l ADA活性が72IU／l上昇していた．心膜の病理組織学的検査から2個の腫瘤は結核性心外膜炎と確定診断した．

We report a rare case with tuberculous pericarditis resembling pericardial cyst. The patient was a 67-year-old woman, who consulted our hospital complaining of common cold symptoms and then was hospitalized with congestive heart failure. Laboratory data were as fol-lows : ESR ; 45 mm/h, CRP ; 7.1 mg/dl, positive PPD reaction. Echocardiogram revealed pericardial thick-ness with calcification and tumor-like pericardial cysts outside the left ventricle and right ventricle. On chest computed tomography, the two tumors were character-ized by being filled with fluid and the absence of contrast enhancement. The tumor near the left ventricle mea-sured 5×3 cm, while that near the right atrium and right ventricle measured 4×1.5 cm. On chest magnetic reso-nance image, both tumors demonstrated a low to moder-ate signal on T₁ image, a high signal on images, and continuity with the pericardium. Surgery for suspected pericardial cysts was indicated. Surgical findings showed hardening and thickening of the epicardium as well as thickening of the pericardium, which adhered to the epicardium. The fluid in the two tumors was clear, yellow, exudative, below 1 mg/dl of glucose concentra-tion, and 72 IU/l in ADA value. Histopathological diag-nosis supported tuberculous pericarditis.