血管内手術にて根治し得た破裂舌動脈瘤の1例

A case of a ruptured lingual artery aneurysm treated with endovascular surgery

I．はじめに

　外頸動脈系に発生する動脈瘤は稀であり，特に舌動脈の動脈瘤はこれまで4例の報告を認めるのみである^{2,4,14，16）}．今回，われわれは下顎部腫脹にて発症した破裂舌動脈瘤の1例に対して発症直後に血管撮影を施行し，同時に血管内手術により動脈瘤の流入動脈を塞栓し得たので文献的考察を加え報告する．

A rare case of a ruptured lingual artery aneurysm treated with endovascular procedure is presented. A 67-year-old woman undergoing treatment in our hospital for right thalamic hemorrhage complained of sudden swelling in the submandibular area and breathlessness. The swelling was so rapid and progressive that her breathing was disturbed. She was intubated as soon as possible. Computed tomography (CT) showed a mas-sive subcutaneous hematoma, extending from the left submandibular area to the neck, which had compressed the trachea to the right. CT with contrast medium showed extra vasation of the medium for this lesion. Angiography showed that the aneurysm was located onthe periphery of the left ingual artery. Extra vasation of contrast medium from the aneurysm was also observed. We considered that direct surgery was difficult to per-form safely, so we chose an endovascular procedure to treat this lesion. The lingual artery was successfully embolized using four platinum coils. No rebleeding or other complication occurred after the coil embolization. Disturbance of breathing due to air way obstruction is an important symptom of a ruptured lingual artery aneurysm. Endovascular surgery may be the first choice for treatment of the bleeding origin.