食道癌術前に発熱を契機に偶然発見された上行大動脈浮遊血栓の1例

Mobile Thrombus in the Ascending Aorta Detected Incidentally in the Patient with Fever before Surgery for Esophageal Cancer：Report of a Case

はじめに　瘤化のない胸部大動脈に血栓を生じることはまれである1）．生じた血栓は脳梗塞や心筋梗塞，腸管梗塞などの塞栓症の原因となり，時には致死的になることがある．大動脈血栓症を生じる原因にはさまざまあるが，担癌患者や化学療法後に生じることが報告されている．われわれは，食道癌術前化学療法中に上行大動脈血栓症を認め，手術により合併症なく摘除でき，良好な結果を得ることができたので報告する．

A mobile thrombus in the ascending aorta is extremely rare. A 57-year-old man was referred to our hospital with suspected esophageal cancer. Following thorough evaluation, he was diagnosed with esophageal cancer （UtMt type0-Ⅱa T1b, Mt type0-Ⅱc T1a N0M0 cStageⅠ） and tongue cancer in situ. He was administered preoperative chemotherapy comprising fluorouracil and cisplatin. The patient developed fever on day four of the first course of the chemotherapy. Contrast-enhanced chest and abdominal computed tomography revealed a mobile thrombus in the ascending aorta with bilateral partial renal infarction. We initiated intravenous unfractionated heparin and oral warfarin as anticoagulant therapy. The thrombus did not disappear despite ten-day treatment；therefore, he underwent aortic thrombectomy under hypothermic circulatory arrest with retrograde cerebral perfusion. Intraoperatively, we detected a pedunculated mobile thrombus attached to the aorta. His postoperative course was uneventful and he was treated at discharge with warfarin. He underwent video-assisted thoracoscopic esophagectomy postoperatively and was discharged without any complication. Currently, he showed no recurrent thrombus or cancer.