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Positron emission tomography(PET)検査は悪性腫瘍の診断,全身転移の検索などに用いられているが,組織代謝の亢進を伴う感染症や炎症でも18-fluorodeoxyglucose(FDG)の集積することが知られている.とくにPETとコンピュータ断層写真を同時に行うPET/CTは代謝亢進場所の正確な特定には著しい効力を発揮する.今回,軽度の炎症反応しか認めない,遅発性に発症したメチシリン耐性黄色ブドウ球菌(MRAS)縦隔洞炎の診断に有効であった乳児例を経験したので報告する.症例は8カ月の女児.Jatene術,右室流出路形成術後にMRSA創部感染を認め治療されていた.創部が治癒閉鎖してから4カ月後に創部発赤を認め,排膿ドレナージを行った.発熱などの全身症状はなく,白血球数増多,CRPの上昇は軽度であったが,創部培養でMRSAが同定された.核磁気共鳴検査では胸骨後部に膿瘍を疑わせる貯溜物を認めた.PET/CT検査を行ったところ胸骨後部にFDGの強い集積を認めたためMRAS縦隔洞炎と診断し,手術で確認した.
Positron emission tomography (PET) is an established imaging tool in oncology that has also been used in infectious and inflammatory diseases. PET combined with computed tomography (PET/CT) can be used to visualize metabolic activity with precise localization. We report an infant with late presentation of poststernotomy mediastinitis, the diagnosis and localization of which was confirmed by PET/CT. An 8-month old infant, who had undergone the Jatene procedure and right ventricle outflow reconstruction 6 months prior, was admitted for inflammation surrounding the superior aspect of the healed scar. Cultures from the wound grew methicillin-resistant Staphylococcus aureus (MRSA). Although the only symptom was discharge from the wound, and there were no other signs or symptoms suggestive of severe general infection, substernal abscess was suspected by magnetic resonance imaging. Since PET/CT revealed high accumulation of 18-fluorodeoxyglucose at the substernal region, the diagnosis of MRSA mediastinitis was made, which was confirmed by subsequent surgical treatment.
