横隔神経合併切除を要した肺放線菌症の1例 A CASE OF PULMONARY ACTINOMYCOSIS SUBJECTED TO RESECTION OF THE PHRENIC NERVE

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著者

    • 桂 浩 KATSURA Hiroshi
    • 大阪府立呼吸器・アレルギー医療センター呼吸器外科 Department of Respiratory Surgery, Osaka Prefectural Organization Medical Center for Respiratory and Allergic Diseases
    • 中川 勝裕 NAKAGAWA Katsuhiro
    • 大阪府立呼吸器・アレルギー医療センター呼吸器外科 Department of Respiratory Surgery, Osaka Prefectural Organization Medical Center for Respiratory and Allergic Diseases
    • 中根 茂 NAKANE Shigeru
    • 大阪府立呼吸器・アレルギー医療センター呼吸器外科 Department of Respiratory Surgery, Osaka Prefectural Organization Medical Center for Respiratory and Allergic Diseases

抄録

症例は, 60歳,男性.主訴は血痰.持続する血痰,胸部X線異常影の精査のため当院を受診した.気管支鏡下生検の結果,器質化肺炎の診断を得た.経口抗生物質のみで,腫瘤影は縮小傾向を認めた.しかし,その後も血痰は断続的に持続し,発症後約10カ月,喀血の制御目的で手術となった.腫瘤影は上大区の縦隔側を主座として,近接した縦隔胸膜は肥厚し,横隔神経とは強固に癒着していた.そのため,上大区域切除に加えて,横隔神経合併切除を要した.迅速病理検査では悪性リンパ腫の疑いで,最終病理組織報告で,肺放線菌症と診断された.確定診断後は,約3カ月の経口ペニシリン剤の投与を行った.肺放線菌症は術前診断は困難なことが多く,血痰,喀血を反復する肺炎様症状を伴った症例に対しては,本症も念頭においた早期の外科的アプローチが望ましい.

A 60-year-old man was referred to us for a detailed evaluation of a pulmonary nodule associated with bloody sputum. He had been taking antibiotics under the diagnosis of organizing pneumonitis confirmed by transbronchial lung biopsy. Although the pulmonary nodule had markedly decreased in size, the patient intermittently showed reduced bloody sputum. But surgery for differential diagnosis and control symptoms was postponed by the patient himself for a few months.<br> Afterwards thoracotomy was performed to control a refractory massive hemoptysis. Left upper segmentectomy including resection of the phrenic nerve was needed because of rigid adhesions between the mediastinal pleura and the phrenic nerve adjacent to the pulmonary mass. The postoperative pathological diagnosis revealed pulmonary actinomycosis, although the frozen section histopathological findings indicated lymphoma. He was treated with oral antibiotics for three months after definitive diagnosis. In patients with pneumonitis showing air space consolidation and recurrent bloody sputum, it is important to consider the possibility of pulmonary actinomycosis for the differential diagnosis and to confirm the diagnosis as early as possible to avoid extended resections.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 67(10), 2341-2345, 2006-10-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10018390967
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  J-STAGE 
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