左房粘液腫による脳塞栓の1剖検例

An Autopsy Case of Cerebral Embolism Caused by Atrial Myxoma

　I．はじめに　心臓粘液腫は脳塞栓症の稀な原因として挙げられて。いるが心臓粘液腫そのものがきわめて稀なため，そのような症例を経験することは非常に少ない．近年の診断法の進歩と開心術の向上により，心臓粘液腫の外科的治療は容易になされるようになった．脳血管障害で発症し，超音波心診断法（以下UCG）によって心臓粘液腫と診断され救命された例も報告されているので，比較的若年成人における脳血管障害の鑑別診断上重要である．今回，われわれは不幸なことに救命はできなかったが，突然の意識障害と右片麻痺で発症した14歳女子の左房粘液腫による脳を含めた全身性塞栓症の1剖検例を経験したので文献的考察を加え報告する．

We reported an autopsy case of a 14-year-old girl with cardiac myxoma, presenting sudden onset of con-sciousness disturbance and right hemiplegia while run-ning in an 800 meter race. Though CT scan showed no abnormal findings, cerebral angiogram revealed an embolic stenosis of the left middle cerebral artery, and abdominal aortogram showed complete obstruction of the bilateral common iliac artery. Histological study of emboli taken from obstructed femoral arteries showed systemic embolization of the cardiac myxoma. She died three days after admission. Autopsy was performed. Myxoma tissue was not found, but its stalk was left in the left atrial septum. The brain was very edematous, and a myxoma emboli was found in the left middle cerebral artery. Systemic embolization of myxoma to spleen, kidneys, liver, pancreas, etc. was found histolo-gically.

Left atrial myxoma is a rare but potentially treatable cause of stroke, and should be included in the differen-tial diagnosis of cerebral vascular disease, especially in young patients.