両側総腸骨静脈から肝静脈近位部下大静脈に及ぶ広範な血栓性静脈閉塞症の1例

A Case with an Extensive Deep Venous Thrombosis Affecting the Bilateral Common Iliac Veins and the Inferior Vena Cava up to the Level of the Hepatic Vein

要旨　患者は50歳，女性．主訴は口腔内アフタ，下肢腫脹，下腿潰瘍．胸部X線検査で心拡大と肺うっ血があり，心エコーで重症の僧帽弁および三尖弁逆流，中隔の扁平化を認め肺高血圧が示唆された．RI静脈造影，CTでは両側総腸骨静脈から肝静脈近位部下大静脈まで完全閉塞しており，下肢，腹部血管造影では閉鎖静脈や卵巣静脈，副腎静脈などを介した側副血行が確認された．病歴，身体所見の一部から血管ベーチェット病が疑われたが診断基準は満たさなかった．血液・生化学的検査には異常なく，画像検査でも静脈閉塞の他は器質的な異常を認めなかった．本症例は臨床症状が軽度であり，保存的治療のみにて経過観察中であるが，その理由として側副血行の著明な発達が考えられた．今回われわれは，種々の画像検査を用いて詳細に検討し得たので報告する．

　A 50-year-old woman was admitted to our hospital complaining of oral aphtha, leg erythema, and leg edema. Chest X-ray films showed pulmonary congestion and cardiac enlargement. Echocardiography revealed severe mitral and tricuspid regurgitation, severe pulmonary hypertension and ventricular septal flattening. Nuclear venography and computed tomography demonstrated the presence of deep vein thrombosis affecting the bilateral common iliac veins and the inferior vena cava up to the level of the hepatic vein. Selective arteriography showed well developed venous collaterals consisting of the obturator, ovarian, adrenal veins and so on. Behcet's disease or other collagen diseases were unlikely. Her laboratory data showed no evidence of disturbance to the coagulo-fibrinolysis system and no etiological abnormality was documented by imaging studies. She was well treated with conservative therapy. Well developed collaterals seems to be the cause of mild clinical course. This is a rare case in which the collaterals could be examined in detail by various imaging studies.