後側方開胸・肋間筋弁使用術後11年目に生じた胸壁膿瘍の1例 A CHEST WALL ABSCESS DEVELOPING 11 YEARS AFTER AN INTERCOSTAL MUSCLE FLAP POSTERO-LATERAL THORACOTOMY

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38歳,男性.11年前に気管支壁発生神経鞘腫にて後側方切開,第5肋間開胸で,中間幹環状切除,肋間筋弁による吻合部被覆術を行った.2006年10月頃から微熱と前回の術創部に一致した疼痛を自覚,胸部CTで肋骨融解像を伴う胸壁の腫瘤様陰影を認めた.同部位に対するCTガイド下経皮針生検では肉芽腫と診断されたが,後日,深部の穿刺液から黄色ブドウ球菌を検出した.胸壁膿瘍と診断したが胸壁腫瘍も完全には否定出来ず,2007年2月手術を施行した.右第6肋骨床に沿う膿瘍形成があり胸腔とは交通がなく,術創の晩期膿瘍と最終診断し,掻爬・ドレナージを行い治癒せしめた.悪性腫瘍との鑑別が困難な胸壁膿瘍の報告は少なくないが術後11年を経た晩期創部感染は過去に報告はない.病因論的観点から若干の考察を加え報告する.

A 38-year-old male was admitted due to a low grade fever and pain at the site of a previous postero-lateral thoracotomy. When the patient was 27 years old he developed a bronchial schwannoma located in the intermediate trunk area. The lesion was resected ; bronchial plasty without a lung parenchyma resection was done. Four months prior to the current admission the patient developed, a low grade fever and pain in the operative scar. On chest X-ray and CT images, a chest wall mass was noted in the right chest wall along with osteolytic changes in the 7th rib. A malignant chest wall tumor was suspected. Based on the pathology of a CT-guided chest wall mass needle biopsy, a diagnosis of inflammatory granuloma was made. Specimens sent for culture grew <I>Staphylococcus aureus</I>. The diagnosis of a chest wall abscess, and a possible malignant tumor was made, for which surgery was done in February 2007. A chest wall abscess near the 6th costal bed was identified ; no tumor was found. Debridement and drainage were performed. The patient did well postoperatively, and was discharged home on the 32nd postoperative day.

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 69(7), 1643-1646, 2008-07-25 

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10021944519
  • 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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