両側肺塞栓症の症状にて発見された腎細胞癌

A Case of Renal Cell Carcinoma Detected from Symptom of Metastatic Bilateral Pulmonary Embolism

　49歳，女性。息切れ，呼吸困難，左背部痛を訴え，精査中，腹部CTにて下大静脈塞栓を伴う左腎腫瘍を認めた。諸検査より，腎細胞癌の腫瘍血栓による両側肺塞栓と診断した。肺塞栓摘除術を検討したが，完全摘除が困難で手術のリスクが極めて高いと考えられ，断念せざるを得なかった。自験例では無理であったが，肺塞栓を来した症例についても，手術的摘除を検討すべきと思われた。

A 49-year-old woman was referred to our hospital with the complaint of dyspnea and left back pain. The patient showed tachypnea and tachycardia, and blood-gas analysis showed severe hypoxyemia. Abdominal CT scan revealed left renal tumor with IVC thrombus. From chest CT scan, pulmonary blood flow scinti scan, and pulmonary angiog-raphy, we made diagnosis of bilateral pulmonary embolism. Surgical thrombectomy was not a choice of treatment because the complete removal of the thrombus extending into the peripheral branches was impossible, and operative mortality was extremely high. The patient died one month after admission.