急速に増大し縦隔偏位をきたした肺癌合併巨大肺囊胞

Mediastinal Shift Due to the Rapidly Expanded Giant Bulla Probably Caused by the Lung Cancer

巨大肺囊胞は，胸部X線像上で囊胞の大きさが一側胸腔の1/3以上を占めるものと定義される1）．囊胞が正常肺を圧排するために外科的治療を要することが多いが，縦隔偏位をきたす症例に対する外科的治療の報告はまれである．われわれは，肺癌の増大に伴い巨大肺囊胞が急速に増大し，縦隔偏位をきたして手術となり，術中体外式膜型人工肺（ECMO）による循環補助が必要であった症例を経験したので報告する．

A 39-year-old man was admitted to our hospital with back pain and numbness of the left leg. Computed tomography （CT） showed a giant bulla and tumor in the right lung, mediastinal shift to the left side and lesions suggestive of metastatic sacral tumor. Three days later, the patient visited the emergency room with dyspnea and tachycardia. Chest CT showed the progression of mediastinal shift due to the rapid expansion of the giant bulla, and an emergency surgery was performed. After induction of anesthesia, sudden respiratory and circulatory failure occurred. Considering further expansion of the giant bulla by positive pressure ventilation, veno-arterial （V-A） extracorporeal membrane oxygenation （ECMO） was applied. After establishing ECMO, the condition of the patient became stable and the giant bulla could be resected successfully.