出血による心タンポナーデをきたした心外膜原発滑膜肉腫の1例  [in Japanese] A Case of Epicardial Primary Synovial Sarcoma with Cardiac Tamponade Caused by Bleeding  [in Japanese]

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Abstract

心臓・心膜に腫瘍が発生することは稀で,悪性腫瘍であればさらに頻度は少ない.また,心臓由来または心筋に浸潤する場合には完全切除が困難であり,予後は不良とされる.今回,心外膜に発生した滑膜肉腫の1例を経験したので報告する.症例は65歳の男性,前胸部痛を主訴に前医を受診し急性冠症候群は否定され,後日の精査となった.CTで心下面の腫瘍を指摘され,初回受診から2週間後に当院を紹介受診となった.当科入院の際には心窩部痛・嘔気・低血圧状態であり,症状は急速に増悪した.心腫瘍からの出血による心タンポナーデと判断し,救命と出血コントロール目的に緊急で手術を施行,心タンポナーデの解除と可及的な心腫瘍摘出を行った.患者状態が急激に悪化するなかで治療方針決定に難渋した1例であった.

Tumors rarely arise in the heart or pericardium, and malignant tumors are even more infrequent. If they arise in the heart or infiltrate the myocardium, total resection is difficult, and their prognosis is poor. The treatment of a patient with epicardial primary synovial sarcoma is reported. A 65-year-old man presented at another hospital complaining of precordial pain, and, since acute coronary syndrome was ruled out, he underwent detailed examination at a later date. Computed tomography (CT) showed a tumor on the inferior cardiac surface, and the patient was referred to our hospital 2 weeks after initial presentation. On admission to our department, the symptoms of epigastric pain, nausea, and hypotension rapidly worsened. This was considered to be due to cardiac tamponade caused by bleeding from the cardiac tumor, and emergency surgery was performed, both to save the patient's life and to control the bleeding. The cardiac tamponade was relieved, and as much of the cardiac tumor as possible was resected. This was a case in which a sudden deterioration in the patient's condition made determination of the treatment strategy difficult.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 79(10), 2032-2036, 2018

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130007640032
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • ISSN
    1345-2843
  • NDL Article ID
    029346288
  • NDL Call No.
    Z19-227
  • Data Source
    NDL  J-STAGE 
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