鈍的外傷性弓部大動脈仮性瘤の1例

Blunt Traumatic Aortic Arch Pseudoaneurysm and Literature Review：Report of a Case

はじめに　外傷による大動脈損傷は致死的で多くは現場で死にいたるが，大動脈断裂（disruption）1）・解離2）・仮性瘤3）などの救命例が知られている．われわれは，21年前の鈍的外傷によると考えられる弓部大動脈仮性瘤［鈍的外傷性弓部大動脈仮性瘤（blunt traumatic aortic arch pseudoaneurysm：BTAAPA）］のまれな1例を経験したので，文献的考察とともに報告する．

We experienced an extremely rare case of blunt traumatic aortic arch pseudoaneurysm （BTAAPA） and report it with literature review. A 40-year-old asymptomatic man with chest X-ray abnormality visited our hospital. Contrast-enhanced computed tomography （CT） scans revealed saccular aortic-isthmus aneurysm, and BTAAPA was diagnosed because of a history of multiple severe traffic trauma 21 years before. The patient underwent replacement of the distal aortic arch and proximal descending aorta under partial cardiopulmonary bypass through left posterolateral thoracotomy. The postoperative course was uneventful. BTAAPA is exceedingly uncommon, and our comprehensive literature search identified only 9 cases including the present case. The age at diagnosis was 10 to 76 years, 7 cases were males, and most of the traumas were due to traffic accidents. The present case had the longest duration （21 years） from the trauma to the diagnosis. Six patients underwent thoracic endovascular aortic repair with good prognosis.