多発性脳出血を生じた左房粘液腫の1例

A Case of Cardiac Myxoma with Multiple Brain Hemorrhage

I．はじめに

　心臓由来の粘液腫は全身に転移し脳塞栓を起こしやすいことはよく知られているが，脳出血で発症することは稀である^3,16,21）．われわれは，脳出血を伴った全身塞栓の1例を経験したので，文献的考察とともに報告する．

A case of cardiac myxoma with multiple brain hemorrhage is reported. A 57-year-old male had com-plained of lower abdominal pain, diarrhea and fever for 3 days. On admission, he was in a condition of dis-seminated intravascular coagulation and sepsis. An adominal CT scan showed infarction in the right kid-ney and spleen and an echocardiogram also showed myxoma in the left atrium. Although he presented noneurological symptoms, the brain CT showed multiple brain hemorrhage in the bilateral brain hemispheres.Total resection of the tumor was carried out for the improvement of the patient's general condition.Vimentin, S-100 protein and neuron specific enolase was positive in immunological staining and the patho-logical diagnosis was myxoma. Postoperative recovery of consciousness was poor and left hemiparesis de-veloped. CT showed the increase of hematoma but angiography showed no cerebral aneurysm. The symp-toms improved with conservative therapy. However the enhanced lesion remained in the right parietal lobeand an operation was performed 5 months later. The myxoma cell could not be found in the pathologicalexamination, so tumor embolism, cerebral infarction, hemorrhagic infarction due to DIC, hematoma en-largement caused by heparinization during operation were suspected to have occurred in this order withouttumor growth.