左反回神経麻痺を生じた右陳旧性肺結核症例

Recurrent Nerve Paralysis Associated with Contralateral Old Pulmonary Tuberculosis:Report of a Case

はじめに

　陳旧性肺結核症例に生ずる反回神経麻痺の報告について検討すると，麻痺側はそのほとんどが左側であり，原発巣治癒後10数年の経過を経て麻痺が発症する例が多いことに気ずく。また，その原因としてリンパ節の腫脹による神経の圧迫や肺病変の治癒過程に伴う神経の牽引のいずれかであると考えられてきた。しかし，肺病変と反対側の反回神経麻痺を伴う症例もあり，この場合の麻痺発症の機序については明快な説明はなされていなかった。

　今回，我々は主たる肺病変は右側にありながら，左反回神経麻痺を生じた陳旧性肺結核の一症例を経験した。その機序について興味深いものがあり，考察を加えて報告する。

It has been said that traction or compression of the nerve is the main cause of the recurrent nerve parlaysis in old pulmonary tuberculosis. But we report a case, in which the paralysis seemed to be elicited by squeezing of nerve between the dilated pulmonary artery and the aorta.

A 75-year-old male presented with complaints of dyspnea and hoarseness. The paralysis appeared after heart failure, and dilatation of the pulmo-nary artery was observed in CT scan.

Other abnormalities that would be the cause of recurrent nerve paralysis were all ruled out. Therefore we suggested that the cause of left recurrent nerve paralysis was the compression by the dilated pulmonary artery in the right chest.