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Neurological Surgery No Shinkei Geka Volume 32, Issue 1 （January 2004）

Neurological Surgery 脳神経外科 32巻1号（2004年1月発行）

Japanese English

症例

8年の経過で脳膿瘍の再発を来した先天性肺動静脈瘻の1例 Recurrent Brain Abscess Associated with Congenital Pulmonary Arteriovenous Fistula : A Case Report 塩屋斉 ¹ , 菊地顕次 ¹ , 須田良孝 ¹ , 進藤健次郎 ¹ , 橋本学 ² Hitoshi SHIOYA ¹ , Kenji KIKUCHI ¹ , Yoshitaka SUDA ¹ , Kenjiro SHINDO ¹ , Manabu HASHIMOTO ² ¹由利組合総合病院脳神経外科 ²秋田大学医学部放射線科 ¹Department of Neurosurgery,Yuri Kumiai General Hospital ²Department of Radiology,Akita University School of Medicine キーワード： brain abscess , congenital pulmonary arteriovenous fistula , recurrence , coil embolization Keyword: brain abscess , congenital pulmonary arteriovenous fistula , recurrence , coil embolization pp.57-63

発行日 2004年1月1日 Published Date 2004/1/1

DOI https://doi.org/10.11477/mf.1436100346

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Abstract 文献概要
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　Ⅰ．はじめに

肺動静脈瘻は肺内の動脈と静脈の異常短絡であり，先天性の血管異常が原因と考えられている¹⁵⁾．その多くは皮膚・粘膜の多発性毛細血管拡張，その部位からの頻回の出血，家族性発症を三主徴とするRendu-Osler-Weber病（以下ROW病と略す，遺伝性出血性毛細血管拡張症）に合併するとされている¹⁵⁾．

　今回，ROW病の所見はなかったが，8年の経過で脳膿瘍を繰り返し，精査の結果先天性肺動静脈瘻が認められた1例を経験したので文献的考察を加えて報告する．

　We report a rare case of recurrent brain abscess associated with congenital pulmonary arteriovenous fistula. A 52-year-old man was admitted to our hospital in October,1999 because of a sudden stroke-like onset of right hemiparesis,right hemiparesthesia,dysarthria and sensory aphasia. He had a history of previous brain abscess in the right cerebellar hemisphere. It had been removed in 1991.

　CT scan at the time of the current admission disclosed a low-density area in the left parietal region. The mass was ring-enhanced after injection of contrast medium. On MRI the mass lesion was depicted as low-intensity on T1-weighted image and high-intensity on T2-weighted image. The mass was ring-enhanced after administration of Gd-DTPA. In spite of conservative treatment the size of the abscess increased considerably with marked surrounding edema. The brain abscess was successfully treated with aspiration and drainage,and the residual mass was resected.

　The patient also had a history of arteriovenous fistula in the lower lobe of his right lung. This had been excised in 1965. However,he had no signs,symptoms or family histories of hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease).

　Contrast enhanced CT scan of the chest showed nodular lesions connected to vascular shadows in the right lower lung field. Pulmonary angiograms also revealed multiple arteriovenous fistulas in the lower lobe of the right lung. He was not dyspneic or cyanotic,but his hypoxia,polycythemia,and recurrent brain abscess were thought to be caused by pulmonary arteriovenous fistula. The fistulas were embolized with coils via a percutaneous catheter. Pulmonary arteriovenous fistula should be treated aggressively either by surgery and/or by coil embolization in order to prevent the complication of brain abscess.