感染性心内膜炎との鑑別を要した多発性乳頭状線維弾性腫の1例

Multiple Papillary Fibroelastomas that Required Differentiation from Infectious Endocarditis：Report of a Case

はじめに　原発性心臓腫瘍は，発生頻度が剖検例において0.02％とまれな疾患である．そのうち約3/4は良性で，乳頭状線維弾性腫は粘液腫に次いで2番目の頻度でかなりまれな疾患である1）．診断は臨床経過や経食道心エコーなどによって行われ，ほかの心臓腫瘍，血栓や感染性心内膜炎の疣腫などとの鑑別が必要となる2）．

A 74-year-old woman with several oscillating intracardiac masses on the aortic valve was admitted for fever and subacute brain infarction suggestive of infectious endocarditis （IE）. After empirical antibiotic treatment for four weeks according to the guidelines for IE, cardiac masses remained on the valve；however, blood culture tests were negative. These findings did not support our initial diagnosis of IE, and, in fact, suggested that IE was unlikely. The patient underwent tumor resection under cardiopulmonary bypass to prevent repeat embolism and obtain definitive diagnosis.

Intraoperatively, oscillating masses appeared to be primary cardiac tumors, and were resected from the non-coronary cusp and the commissure between the right and non-coronary cusp. Pathological diagnosis was papillary fibroelastoma, and currently, the patient is free from recurrence.