CTガイド下経皮的生検によって診断し得た心臓血管肉腫の1例

Cardiac angiosarcoma diagnosed based on a CT-guided percutaneous biopsy

心臓血管肉腫はまれであるが，原発性心臓悪性腫瘍の中で最多であり，切除不能例での生命予後は1年未満と予後不良な疾患である。確定診断は組織診断によってなされ，経血管カテーテル的生検や外科的生検が行われることが多いが，前者は腫瘍が心腔に露出している必要があり，後者は高い侵襲を要する。今回我々は，心外膜側に発生した心臓血管肉腫に対し，CTガイド下経皮的生検によって安全に診断し得た症例を経験したので，若干の文献的考察を交えて報告する。

Biopsy for cardiac tumors is usually performed via transvascular catheterization or thoracotomy. However, for tumors located on the epicardial surface, transvascular catheter-based biopsy is technically challenging, whereas thoracotomy is highly invasive. We report a case of an epicardial cardiac angiosarcoma in which CT-guided percutaneous biopsy enabled safe histological diagnosis. Contrast-enhanced CT facilitated avoidance of the right coronary artery, which traversed the tumor, and pericardial contrast injection was effective for delineating the tumor margins. This case indicates that CT-guided biopsy may be a valuable diagnostic option when transvascular catheter-based biopsy is technically unfeasible.