診断に苦慮した幼児の耳前部動静脈奇形の1例

Infantile Preauricular Arteriovenous Malformation with an Elusive Diagnosis: A Case Report

はじめに

　血管腫・血管奇形には多種多様な病変が存在することはよく知られている。特に乳幼児期では，特異的な疾患の存在や画像診断の難しさから病変の診断が困難になりやすい。一般に動静脈奇形（arteriovenous malformation：以下，AVM）の臨床所見としては，初期は静止期と呼ばれ，紅斑と皮膚温上昇が代表的な所見とされている。しかし，出生直後の段階では紅斑が存在しない症例も存在する。

　今回，出生直後の段階では静脈のうっ滞所見を認め，その後患児の成長とともに病変の所見が変化し，3歳6カ月の段階で最終的にAVMの診断に至った症例を経験した。乳幼児期におけるAVM病変の初期症状の変化について観察できた症例と考えられたので，若干の文献的考察を加え報告する。

　It can be difficult to obtain a definitive diagnosis of hemangiomas and vascular malformations because of the presence of a wide variety of lesions. In infants, a precise diagnosis is even more difficult because of the presence of diseases specific to that age and the difficulty of performing imaging tests. We treated a 1-month-old boy with a vascular mass on his face that was ultimately diagnosed as an arteriovenous malformation (AVM).

　Initially, a venous malformation was suspected, and then a congenital hemangioma was suspected. A general vascular tumor was considered, but the final diagnosis was AVM, based on existence of AV shunt. Good postoperative and cosmetic results were obtained by radical excision and skin grafting.

　Generally, the initial symptom of an AVM is erythematous spots, but this patientʼs case indicates that other symptoms may be present before erythematous spots occur.