心タンポナーデで発症し，短期間に急激な心機能低下を認めたが，臨床所見と剖検所見と解離を認めた1例

An Autopsy of a Case with Onset of Cardiac Tamponade, Rapid Progression ofLV Dysfunction with Only Mild Histological Change

　症例は60歳，男性．1996年11月下旬に感冒に罹患．12月上旬より労作時呼吸困難が出現したために当科外来受診し，胸部X線写真にて心拡大を指摘され入院となる．入院時心エコーにて明らかな壁運動障害は認めなかったが，心嚢液貯留および心タンポナーデの所見を認めたため，心嚢ドレナージを施行した．ドレナージ後心嚢液貯留は消失したが，以後急速に左室壁運動低下が進行した．第9病日には％FSは16％まで低下しショック状態となったためIABPを装着したが，血行動態を維持できず心室細動に移行し第10病日死亡した．IABP装着時に施行した冠動脈造影では左右冠動脈に有意狭窄は認めなかった．また，全経過を通じて心筋逸脱酵素の上昇は軽度であった．剖検では，心筋の一部に非特異的な炎症細胞浸潤を軽度に認めただけであった．以上より臨床所見と剖検所見に解離を認め興味深い症例と思われ報告した．

A 60-year-old male, who had suffered from a cold since late November, visited our hospital with dyspnea on effort on December 5, 1996. He was admitted to our hospital because of cardiomegaly discovered on chest X -ray film. At the time of admission, two-dimensional echocardiography showed normal LV function and a moderate volume of pericardial effusion with cardiac tamponade. After pericardiocentesis, echocardiography revealed no sign of cardiac tamponade. However a few days after pericardiocentesis. echocardiography showed rapid progression of LV dysfunction. 9 days after admis-sion he fell into a state of cardiogenic shock and died of ventricular fibrilation in spite of the use of IABP. CAG, just before his death, revealed no stenosis of the coro-nary arteries. Mild elevation of enzymes of myocardium occurred throughout the course of his hospitalization. Autopsy showed that, compared to the severity of his clinical course, focal invasion of inflammatory cells into the myocardium was only mild.