右咽頭痛を主訴とした内頸動脈瘤の1症例

An aneurysm of the internal carotid artery with pharyngeal pain：a case report

はじめに

　中咽頭側壁の腫脹は耳鼻咽喉科外来でしばしばみられる所見である。原因疾患は口蓋扁桃肥大，扁桃周囲膿瘍，扁平上皮癌，悪性リンパ腫，副咽頭間隙腫瘍など多岐に渡る^1）。副咽頭間隙に走行する内外頸動脈の動脈瘤も腫脹をきたす原因となることがある。今回，われわれは咽頭痛を主訴とした内頸動脈瘤の1例を経験したので報告する。

　A patient noticed discomfort of the pharynx and visited an ENT clinic in her neighborhood and was pointed out a swell of the right tonsil in 2004. She developed oral pain when she opened her mouth in 2005.

　On examination, the right soft plate swelled and the palatine tonsil shifted to the midline, however, no pulsation was observed. The cervical lymph nodes were not palpable. The enhanced computed tomography revealed a round shaped mass in the parapharyngeal space. The magnetic resonance image also revealed a mass, whose capsule was enhanced but no inside signals in T2-weighted image. Vascular disease was strongly suspected from examinations. Then, the angiography was performed and the aneurysm of internal carotid artery was detected.

　Endovascular surgery was performed under general anesthesia by neurosurgeons. Temporal occlusion of the internal carotid artery for 20 minutes had no affections on neurological findings and the brain wave. The coils were placed in the distal and proximal part of aneurysm. There were no ischemic changes during the surgery. The discomfort of throat and the pain disappeared 7 days after the surgery.

　The patient visited our outpatient clinic in 2007. There observed no swelling of the soft palate. She complained of no discomfort of throat and pain.