胸腔鏡下に切除しえた上大静脈に接する特発性奇静脈瘤の1例

A case of thoracoscopic resection of an idiopathic azygos vein aneurysm adjacent to the superior vena cava

◆要旨：症例は70代，女性．健診胸部単純X線写真で増大する縦隔腫瘤陰影を指摘された．胸部造影CTで奇静脈弓部が5.3cm大の囊胞状に拡張した奇静脈瘤と診断された．血栓症や破裂の危険性を考慮し外科的切除の方針とした．術前画像所見から人工心肺下の上大静脈血管形成も想定した準備を行った．奇静脈瘤は上大静脈に接していたが，胸腔鏡下に切除しえた．胸腔鏡下手術での奇静脈瘤切除の報告が増えているが，その局在や血栓の有無により慎重な治療選択が必要とされる．

　A woman in her 70s was found to have an enlarging mediastinum on a chest X-ray of a medical examination. Contrast-enhanced chest computed tomography revealed a cystic dilatation of the azygos arc of 5.3cm in diameter. Considering the risk of thrombosis and rupture, we decided to perform surgical resection. Based on the preoperative imaging findings, preparations were made for angioplasty of the superior vena cava under cardiopulmonary bypass. Although the aneurysm was adjacent to the superior vena cava, we were able to resect it under thoracoscopic surgery. There is an increasing number of reports of varicose vein resection in thoracoscopic surgery. However, we believe that the treatment policy should be decided based on careful preoperative examination results.