化膿性心外膜炎に続発し感染性が疑われた胸部大動脈瘤の1例

Infected Thoracic Aortic Aneurysm Secondary to the Purulent Pericarditis；Report of a Case

はじめに　化膿性心外膜炎による心タンポナーデで緊急入院し，経過中に感染性と考えられる胸部大動脈瘤にいたった1例を経験した．感染性胸部大動脈瘤に対する胸部ステントグラフト内挿術（TEVAR）の意義についても考察を加えて報告する．

A 69-year-old man was hospitalized urgently to the department of cardiology, with the progressive general malaise. On admission, his blood pressure was 80/42 mmHg, his white cell count 13,700/μl, and C-reactive protein 25.55 mg/dl suggesting existence of aggressive infection with impaired circulation. Massive pericardial effusion was detected in echocardiography. Pericardial drainage was undergone promptly. There was drainage of 700 ml and the property was purulent. Pneumococcus was detected by the culture test of the pericardial fluid. Antibiotic administration was started by a diagnosis of the purulent pericarditis. His general condition was improved. However, a rapidly expanding saccular aneurysm was found in a descending thoracic aorta by computed tomography （CT）. As an infected thoracic aortic aneurysm secondary to the purulent pericarditis, we performed thoracic endovascular aneurysm repair （TEVAR）. The intravenous administration of antibiotics was continued for 2 weeks after TEVAR, which was followed by oral antibiotic administration for 1 year. The aneurysm completely disappeared by CT, 10 months after TEVAR. In case with an infected thoracic aortic aneurysm, TEVAR can be a 1st choice of treatment, depending on a causative organism and the morphology of the aneurysm.