右房破裂により心タンポナーデをきたした右房血管肉腫の1例

Cardiac Angiosarcoma with Cardiac Tamponade due to Ruptured Right Atrium：Report of a Case

はじめに　心臓原発の血管肉腫はまれな疾患であり，その予後は非常に不良である．臨床症状は特異的なものに乏しく，早期の診断が困難である場合も多い．治療として外科的切除の有効性が報告されているが，標準治療は確立されていない．われわれは心タンポナーデにより発症し，外科手術を施行した右房血管肉腫の症例を経験したため，文献的考察をふまえ報告する．

Primary angiosarcoma of the heart is extremely rare with poor prognosis. A 39-year-old man presented to his physician for evaluation of fever and pericardial pain and was referred to our department for further management. The patient’s condition stabilized after pericardiocentesis；however, the cause of cardiac tamponade remained undetermined on admission. Transesophageal echocardiography and electrocardiography-synchronized contrast-enhanced computed tomography （CT） revealed a suspected source of bleeding in the right atrium, necessitating open chest surgery. Preoperative imaging showed no evidence of a tumor；however, intraoperatively, we observed a suspected right atrial tumor, which was resected, followed by repair using a bovine pericardial patch. Histopathological examination confirmed diagnosis of angiosarcoma. Angiosarcoma is often diagnostically challenging in the early stages, and multiple examinations are important for early diagnosis and treatment.