鼻出血との鑑別が困難であった舌動脈仮性動脈瘤の1例

A Case of Pseudoaneurysm of the Lingual Artery that was Difficult to be Distinguished from Epistaxis

Ⅰ．はじめに

　外頚動脈系に発生する仮性動脈瘤は稀ではあるが存在し，頚部腫瘍に対する放射線治療後や頚部の外科的処置後に発生することが多い^8,9)．そのほかに，頚部の外傷後に発生するという報告もある^3,7)．今回われわれは，他院にて止血困難な鼻出血と診断され，鼻腔内パッキング後にショック状態となり当院へ緊急搬送された，義歯の誤嚥による咽頭損傷からの舌動脈仮性動脈瘤の1例を経験したので報告する．

　We describe the case of a 75-year-old man with pharyngeal hemorrhage caused by a pseudoaneurysm of the lingual artery after accidentally swallowing his dentures. He developed sudden oral and nasal hemorrhage and was transported to a hospital near his residence. The doctors at the hospital diagnosed the case as epistaxis and treated the symptom with nasal packing. However, the bleeding did not stop and his blood pressure decreased. He was then transported to our hospital. We assumed that the bleeding was caused by epistaxis from branches of the internal maxillary artery, and tried to stop bleeding with the endovascular treatment using coils or liquid embolus materials. Angiography showed a pseudoaneurysm of the lingual artery. Coil embolization against the artery was effective in controlling bleeding. Correct diagnosis and appropriate treatments based on the correct diagnosis are essential in this case of swallowed dentures and bleeding of pseudoaneurysm of the lingual artery.