腫瘍性脳動脈瘤を認めた左房粘液腫の1例—Serial angiographyの重要性について

Left Atrial Myxoma with Cerebral Oncotic Aneurysms with Special Reference to the Importance of Serial Angiography: Case report

I．はじめに

　心房粘液腫がその腫瘍栓子により脳梗塞をおこし，稀に塞栓部位に腫瘍性脳動脈瘤を形成することはよく知られているが，一旦形成された動脈瘤のnatural historyについてはfollow-upの報告もごく少数であり，いまだ不明な点が多い．今回われわれは脳梗塞で発症し腫瘍性脳動脈瘤を認めた症例に対し，左房粘液腫切除後3年にわたり追跡しこの間計3度のserial angiographyを施行しえた1例を経験したので報告する．

Abstract

A case of atrial myxoma with cerebral oncotic aneurysms was presented. A 37 year-old woman was admitted complaining of right hemiparesis, and epi-sodes of syncope. Neurological examination on admis-sion revealed a right arm monoparesis, a right hemi-sensory disturbance, and a motor aphasia.

Computed tomography (CT) demonstrated low den-sity areas in the left fronto-parietal region, and multiple discrete enhancing high density spots scattered bilaterally in the parietal lobes. Cerebral angiography showed multiple fusiform peripheral aneurysms espe-cially in the distribution of the bilateral middle cerebral arteries. Cerebral emboli from the cardiac source were suspected, and an echocardiography was performed, which disclosed a huge villous mass in the left atrium. The cardiac mass was resected uneventfully under car-diopulmonary bypass. It proved to be a left atrial myx-urns. Postoperatively, her neurological deficit persisted. After the resection of the cardiac tumor, follow-up angiographies were undertaken twice. The second angiography performed 6 months later revealed spon-taneous resolution or stabilization of most of the aneurysms detected before. On the other hand, newly-developed aneurysms were seen at the sites which had seemed normal previously on the first angiography. No remarkable changes were seen on the third one except the slight enlargement of one of the aneurysms in the middle cerebral territory. At 3 years she was neurologic-ally stable.

Because of the paucity of knowledge concerning the natural history of cerebral oncotic aneurysms and lack of definite treatment for them, longterm follow-up in-cluding serial angiography is mandatory after the resec-tion of left atrial myxoma.