心嚢液貯留を初発症状とした肺腺癌の1例

A Case of cardiac tamponade as an initiai sign of lung cancer

　悪性腫瘍の心嚢転移は比較的多いが，心嚢液貯留を初発症状とする悪性腫瘍は非常に稀で，本邦での報告はわずかに数例に過ぎない。

　我々は腹部超音波検査で心嚢液貯留を認め，精査の結果，肺腺癌の転移であった1例を経験したので，文献的考察を加えて報告する。

A case of cardiac tamponade as an initial sign of lung cancer was reported. A 57-year-old male experienc-ed chill, chest pain, cough with bubbling sputum. A chest X-ray film showed a solitary round shadow in the right middle lung field and an enlarged globular heart. Echocardiogram disclosed a large pericardial effusion. Pericardial aspiration confirmed the presence of adenocarcinoma cells and slow drainage relieved symptoms.

Autopsy disclosed a tumor of adenocarcinoma (3×2.2 ×2cm) in the right lower of the lung. Tumor cells were also found in right intrapulmonary, mediastinal, hilar lymph nodes and diffusely, in the pericardial lymphatics.

These findings suggested the tumor cells were spread diffusely to pericardial lymphatics first, as is not usual, via mediastinal lymphatic flow retrogradely. Conse-quently, large pericardial effusion was an initial pre-sentation.