胸郭変形を生じた小児体幹部動静脈奇形の1例

A Pediatric Trunk Arteriovenous Malformation with Thoracic Deformity

はじめに

　動静脈奇形（arteriovenous malformation：以下，AVM）のうち，体幹病変は一般に大きな病変を経験することが多い。さらに，主幹血管や周囲骨格との関係性が重要となる。今回，胸郭変形を認めた小児AVM症例について詳細を報告する。

　Among the occurrences of arteriovenous malformations (AVMs), trunk AVMs have been observed to generally be large. In treatment, the relationship of a trunk AVM with the main trunk blood vessels and the skeletal structure is important from the perspective of complications. We provide the details of the surgical treatment of a pediatric AVM with thoracic deformity. A 3-year-old boy was diagnosed with an infantile hemangioma at another hospital and treated with oral propranolol. However, because the hemangioma did not shrink, he was referred to our department. The lesion was an elastic hard mass and was suspected to be a vascular tumor, and we therefore performed an incisional biopsy; the results demonstrated an AVM. Due to the compressive deformation of the patientʼs right thorax and bleeding, surgery was performed (in a hybrid operating room with the patient under general anesthesia). Segmental resection was performed after vascular embolization. Two series of surgeries were performed in total. Neither surgery required a blood transfusion. The patientʼs postoperative course was uneventful, but the lesion persisted, and careful follow-up was planned.