ドプラ心エコー所見が診断に有用であった収縮性心膜炎（結核性）の1例

A Case of Tuberculous Constrictive Pericarditis in which Diagnosis Doppler Echocardiography was Useful

　症例は30歳，女性．1996年1月に第1子出産後，4月に結核性胸膜炎・心膜炎を発症し近医で化学療法を開始された．8月には呼吸困難などの自覚症状は消失したが，9月より腹水貯留が出現したため，腹腔ドレナージを施行するも再貯留を繰り返した．1997年6月当院に腹水の精査加療目的にて転院となった．腹水は漏出性で結核菌などは検出されず，悪性細胞も認めなかった．胸部X線写真および胸部CTでは心膜の石灰化所見はなかったが，心エコーでは僧帽弁血流，肝静脈血流の収縮性パターンがあり，心臓カテーテル検査では両心室拡張期圧のdip and plateau型を認め，収縮性心膜炎と診断．9月に心膜切除術施行し，術後腹水は消失，心エコーおよび心臓カテーテル検査所見も正常化した．今回，収紺性心膜炎の診断および術後の評価に心エコーが有用であった症例を経験したので報告する．

Fourteen months prior to admission to our hospital, a 30-year-old woman, complaining of dyspnea, was ad-mitted to her local hospital three months after the birth of her first child. Diagnosed as having tuberculosis pleuritis and pericarditis, she underwent 3 months of chemotherapy for tuberculosis, which ameliorated her symptoms. However, massive ascites developed one month later and ascites drainage was carried out. Despite repeated drainage, ascites continued to recur and the woman was admitted to our hospital in order both to determine the cause of the ascites and to bring it under control. The ascites were exudate in nature, but no tuberculous bacilli or malignant cells were detected. Chest X-rays and thoracic CT examinations revealed no calcification of the pericardium.Doppler Echocardiography, however, did reveal a constrictive pattern in both the mitral valve and in hepatic venous flow. Cardiac catheterization revealed the “dip and plateau pattern” in the diastolic pressure of the right and left ventricles, which is typical of constrictive peri-carditis. Upon diagnosis of constrictive pericarditis, the patient underwent a pericardiectomy. Ascites never reappeared after this operation, and Doppler Echocar-diography and cardiac catheterization revealed marked improvement of cardiac functions including cardiac output. It was concluded that the ascites in this case were due to constrictive pericarditis and that Doppler Echocardiography was very useful for diagnosis and post-operative evaluation of cardiac functions.