巨大心嚢胞の麻酔および外科的検討。症例報告と文献レビュー

Anesthetic and surgical considerations of giant pericardial cyst: Case report and literature review.

• Rami Alqassieh
• Mahmoud Al-Balas
• Hamzeh Al-Balas

抄録

序論:

心嚢胞は、ほとんどが偶発的に発見される稀な先天性の異常と考えられています。心嚢胞の推定発生率は10万分の1で、全縦隔腫瘤の約6％を占めています。患者は急性胸痛や右心不全に似た症状を呈する場合もあれば、無症状の場合もある。

Introduction: Pericardial cysts are considered as a rare congenital abnormality, mostly found incidentally. The estimated incidence of pericardial cyst is 1:100,000 and represent approximately 6% of all mediastinal masses. Patients can present with symptoms similar to acute chest pain or right-sided heart failure or can be asymptomatic.

プレゼンテーション:

高血圧と甲状腺機能低下症のある46歳女性が左乳房腫瘤を患って乳房クリニックに来院し、コアニードル生検で増殖性乳房病変と診断された。術前検査では、過去2年間に進行した息切れと咳嗽、両側下肢浮腫を訴えていたが、術前の胸部X線検査では、下肢浮腫が認められた。術前の胸部X線検査では右心尖角に楕円形の腫瘤のようなものが認められ、胸部CT検査で心膜由来の嚢胞性腫瘤である可能性が高いことが証明された。右横隔膜表面から発生した巨大な心嚢胞はミニ胸骨切開術で切除され、術後の回復は順調であった。術後の経過観察中に症状や生活習慣が大幅に改善したことが報告された。

Presentation: A 46-year-old female who is known to have hypertension and hypothyroidism presented to the breast clinic with left breast mass that was proved by core needle biopsy as proliferative breast lesion. During the preoperative assessment, the patient reported progressive shortness of breath and cough over the last two years and bilateral lower limb edema. Her preoperative chest X-ray showed a well-defined oval like opacification at the right cardiophrenic angle that was proved by chest computed tomography imaging as a cystic mass od most likely a pericardial origin. A huge pericardial cyst originating from the right diaphragmatic surface was excised through a mini-sternotomy incision with smooth postoperative recovery. The patient-reported significant improvement in her symptoms and her lifestyle during her follow up.

議論:

心嚢胞は全縦隔腫瘤の6～7％を占め、推定発生率は10万分の1である。心嚢胞の約70％は右心尖角に発生し、左心尖角に発生することは少なく、通常、胸部X線検査で右心尖縁の拡大輪郭が認められた場合に心嚢胞が疑われる。心膜嚢胞には多くの鑑別診断があり、術前の判断が難しい場合が多い。心嚢胞は、心臓CTでは楕円形の薄肉の均質な腫瘤として現れる。外科的介入と保存的フォローアップの選択は、主に嚢胞の大きさと嚢胞によって誘発される症状に関係している。

Discussion: Pericardial cysts represent 6%-7% of all mediastinal masses with an estimated incidence of 1:100,000. About 70% of pericardial cysts originate at the right cardiophrenic angle and less frequently at the left cardiophrenic angle, they are usually suspected when the chest x-ray shows an enlarged contour of the right heart border. Mediastinal cysts have many differential diagnoses and the preoperative decision might be challenging in many cases. Pericardial cysts appear as oval, thin-walled homogeneous masses on cardiac computed tomography. The choice between surgical intervention and conservative follow up is related mainly to the size and symptoms that are induced by the cyst.

結論:

心嚢胞は稀に診断される病理学的疾患であるため、診断には高い疑いの指標が不可欠である。巨大化・肥大化している場合や症状がある場合は外科的切除が適応となる。心嚢胞摘出術後の罹患率と死亡リスクは非常に低い。

Conclusion: As pericardial cysts are rarely diagnosed pathology, a high index of suspicion is essential for diagnosis. Surgical resection is indicated when they are huge, enlarging in size or symptomatic. Morbidity and mortality risks following pericardial cyst excision are very low.

© 2020 The Author(s).