肺動静脈瘻と肺静脈瘤が併存し鑑別を要した1例

Requiring Differential Diagnosis of Pulmonary Arteriovenous Fistula and Pulmonary Venous Aneurysm：Report of a Case

はじめに　肺動静脈瘻は肺動脈と肺静脈とが介在する毛細血管組織なしに直接交通する動静脈シャントであり，肺静脈瘤は還流異常を伴わない肺静脈が限局的に拡張，瘤化した病態である．肺動静脈瘻はシャントを介した脳梗塞や，破裂を伴うことがあるため，手術やカテーテル塞栓術が考慮される一方，肺静脈瘤は破裂，塞栓症はまれで経過観察が推奨されるなど治療方針が異なるため，両者は慎重な鑑別を要する．肺動静脈瘻と肺静脈瘤が並存し両者の鑑別を行った症例を経験したので報告する．

A pulmonary arteriovenous fistula （PAVF） is a direct abnormal connection between the pulmonary artery and pulmonary vein, lacking capillary tissue. On the other hand, a pulmonary venous aneurysm （PVA） is a localized dilation and aneurysmal formation in the pulmonary vein without reflux issues. Treatment approaches for PAVF and PVA differ, considering surgery or catheter embolization for PAVF due to the risk of cerebral infarction or rupture caused by the abnormal shunt. PVA cases, being rare in rupture and embolism, are usually recommended for observation. Therefore, distinguishing between these two conditions is crucial. This article presents a case where both PVA and PAVF were present, necessitating a differential diagnosis.