左室拡張障害が生じた癌性心タンポナーデの1例

Neoplastic Cardiac Tamponade Manifesting as Left Ventricular Diastolic Dysfunction：Report of a Case

はじめに　心タンポナーデにおいては心囊液が全周性に大量あるいは急速に増加して，主に右室の拡張障害を呈することが一般的で，左室のみの拡張障害で発症することはまれである1）．われわれは左室のみの限局性拡張障害が生じた，肺癌に伴う癌性心タンポナーデの1例を経験したので報告する．

Left ventricular （LV） tamponade is rare and can occur in special circumstances like regional pericardial effusion overlying LV. The therapeutic approach of LV tamponade is different according to the causative factor and the place of loculated pericardial effusion. We report a case of neoplastic cardiac tamponade manifesting as left ventricular diastolic dysfunction. A 78-year-old man with a history of aortic arch surgery and lung cancer surgery presented with dyspnea. Echocardiogram showed posterior loculated pericardial effusion and LV diastolic dysfunction. Pericardial window operation was performed, then revealed bloody effusion and cytodiagnosis examination revealed class V （adenocarcinoma）. Atypical forms of cardiac tamponade with varied clinical presentations may be seen in patients after cardiac surgery. It is important to accurately understand the pathological condition through clinical progress and echocardiography, and to select an appropriate approach and surgical procedure.