対側肺膿瘍を伴ったbronchomalaciaの1例

A case of bronchomalacia with contralateral pulmonary abscess

　bronchomalaciaという用語はFraserら^1）の教科書にも記載がなく，一般には気管支壁の硬性が失われた状態をさす臨床診断用語である^2,3）。その原因あるいは形態学の面からいろいろな種類のものを含み，諸外国では小児の気管支軟骨欠損例が比較的多く報告されているが，本邦ではbronchomalaciaそのものの報告例を殆んどなない。

　最近著者らは臨床的にbronchomalaciaと診断した成人症例を経験したので，若干の文献的考察を加えて報告する。

A 70-year-old man was admitted because of high fever. One week after the antibiotic therapy the fever declined. Chest X-ray film at that time showed hyperlucency in the left lung zone and rapidly growing mass shadow with air fluid level in the apical segment of the right lower lobe (S 6).

Bronchoscopy and bronchogram showed localized and encircled stenosis of the left main bronchus with normal mucosa. During expiration this stenotic segment became narrower but did not collapse. Lung perfusion scan showed markedly decreased flow to the entire left lung and in agreement with the right S 6 mass. Pulmonary arteriogram showed that the segmental branches of the left pulmonary artery appeared late and were uniformly markedly reduced in caliber. Pulmonary function test showed moderately obstructive and restrictive changes. The result of bronchospirometry and arteial blood bas studies indicated that the pulmonary function in this patient depended on the right lung quite enough.

A right S 6 segmentectomy was successfully per-formed and its pathological diagnosis was benign abscess.