自然回復した膝窩動脈外膜嚢腫の1例 : 過去の報告例の検討 [in Japanese] A Case of Cystic Adventitial Degeneration of the Popliteal Artery Which Spontaneously Remitted [in Japanese]
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膝窩動脈外膜嚢腫は外膜に生じた嚢腫が動脈内腔を圧排することにより下肢虚血症状を来す，外傷歴のない若年者に生じる比較的稀な疾患である．今回われわれは，運動時に生じる下肢痛を契機に診断され，加療前に自然軽快した症例を経験したので報告した．下肢に外傷の既往のない41歳の活動性の高い男性．主訴は運動時の左下腿痛．下肢造影CTで，左膝窩動脈を圧排する径19 mm，長さ48 mmの造影効果のない半月状の内部均一嚢腫を認めた．左膝窩動脈外膜嚢腫と診断し，エコーガイド下穿刺予定とした．しかし術前日になり症状の改善を認め，下肢造影CTでも嚢腫の縮小(径13 mm，長さ38 mm)と膝窩動脈内腔の拡張を認めたため経過観察することとした．膝窩動脈外膜嚢腫は稀な疾患であるが，活動性の高い年齢層に発症し治療によりADLの著明な改善が期待できる良性疾患である．下肢虚血の症例では本症例を念頭に置いて診療に当たる必要がある．
Cystic adventitial degeneration of the popliteal artery is a rare cause of lower extremity occlusive disease. In this disease, a cystoma which originates in the adventitia compresses the popliteal artery. This disease mainly affects relatively young men who have not experienced trauma in the lower extremities are mainly affected by this disease. We encountered a case of cystic adventitial degeneration of the popliteal artery which spontaneously remitted. The patient was a 41-year-old man who complained of intermittent exertional claudication but with no history of trauma in his lower extremities. On his first visit to our outpatient clinic, computed tomography (CT) showed a homogenous scimitar-shaped cystic lesion of 19 mm in width and 48 mm in length around the left popliteal artery. We diagnosed cystic adventitial disease of the popliteal artery and scheduled ultrasound-guided fine-needle aspiration of the cyst under local anesthesia. However, his symptoms improved before the scheduled procedure date and CT images obtained after the disappearance of his symptoms showed reduction of the cyst to 13 mm by 38 mm, with dilation of the lumen of the popliteal artery. We therefore decided to follow up this patient without treatment. Although this disease is very rare, it occurs in a highly active group of patients, and we can therefore expect considerable improvement in activities of daily living after treatment. This disease must be considered in cases of ischemic symptoms in the lower extremities.
- Japanese Journal of Vascular Surgery
Japanese Journal of Vascular Surgery 20(7), 937-940, 2011-12-25
JAPANESE SOCIETY FOR VASCULAR SURGERY