内胸動脈とシャントを形成した末梢性肺動脈瘤

Peripheral Pulmonary Artery Aneurysm with Internal Thoracic Artery-Pulmonary Artery Shunt

末梢性肺動脈瘤は非常にまれな疾患であるが，喀血の原因となることから積極的な治療を要する．われわれは，喀血の精査で内胸動脈とシャントを形成した末梢性肺動脈瘤を認め，経カテーテル的動脈塞栓術（TAE）を施行するも喀血が再発したため，根治を目的に外科的切除を施行した1例を経験したので，文献的考察を加え報告する．

An 82-year-old woman with past history of pulmonary nontuberculous mycobacterial infection complained of hemoptysis and was pointed out the strongly stained nodule in the middle lobe of the right lung on chest enhanced computed tomography （CT）, which was suggested to be peripheral pulmonary artery aneurysm. Angiography of the right internal thoracic artery （RITA） revealed the peripheral pulmonary artery aneurysm with the shunt from the branch of the RITA, which was considered to be the cause of hemoptysis. Transcatheter arterial embolization was performed for the branch of the RITA 2 times, however, the hemoptysis recurred again after 5 months. Therefore, after the third embolization for the RITA, the right middle lobectomy with amputation of the shunt vessel was performed. The patient has been well without hemoptysis for one year and 6 months after the surgery.