呼吸困難，胸背部痛を初発症状とし，著しい左房圧排を認めた気管支原性嚢胞の1例

A Case Report of Dyspnea and Dorsalgia Caused by Compression of the Left Atrium by a Bronchogenic Cyst

　患者は27歳，女性．労作時呼吸困難と胸背部痛を主訴に近医を受診．胸部X線写真上，受診の2年前にはなかった右第一弓の拡大を認めたため，精査目的で当院に入院した．心エコー図検査で左房を圧排する6.7×5,8×5.5cmの腫瘤を認め，軽度の肺高血圧所見を認めた．腫瘤の表面は平滑であり，造影CTによるenhancementを受けなかった．MRIではT1,T2像ともにhigh intensityを示した．以上より腫瘤は比較的粘稠度の高い液体成分をもった？胞の可能性が強いと判断し，後日摘出術を施行した．嚢胞は左主気管支と気管軟骨様組織で連なっており，心膜との癒着が認められたが，容易に切除可能であった．組織像では，？胞壁は多列線毛円柱上皮で覆われており，気管支原性？胞と診断した．以上，？胞の左房圧排により肺静脈圧の上昇を認め，その結果，呼吸困難が出現したと考えられる気管支原性？胞を経験したので報告する．

A case report of dyspnea and dorsalgia caused bycompression of the left atrium by a bronchogenic cyst.A 27-year-old housewife consulted her doctor withdyspnea.chest and back pain on effort.Postero-anteriorchest X-ray had shown nothing in particular 2 yearpreviously but this time, chest X-ray showed a promi-nence in the right upper side of a cardiac shadow.Theechocardiography revealed a thick-walled mass whosesize was 6.7×5.8×5.5cm,compressing the wall of theleft atrium.The mass was not enhanced by contrastmedium,and showed high intensity in both T1 and T2image.Consequently,we diagnosed the mass to be amediastinal cyst with high viscosity and removal of cystwas performed later.Although the cyst had adhered tothe left primary bronchus and epicardium,it was easilyremoved. Microscopic examination of the cyst walldemonstrated a ciliated pseudostratified epithelium,thetypical features of a bronchogenic cyst.