症例は67歳男性，急性大動脈解離に対して上行弓部大動脈人工血管置換術を行い周術期は問題なく退院していた．4 年後，胸部正中創部に腫張を伴う疼痛が出現した．造影CT を行ったところ，正中創に相当した前縦隔に骨侵食像を伴う膿瘍形成を認めた．術後遠隔期縦隔洞炎と考え，抗生物質を投与した上，膿瘍開放ドレナージを行う方針にした．生検を行ったところ，病理診断で悪性リンパ腫の確定診断に至った．CT 所見上，縦隔洞炎との鑑別が難しかった症例を経験したため，文献考察を加えて報告する．
Mediastinitis is the most common complication after cardiac surgery, which always induces large damagesto patients. A 67-year-old man with acute aortic dissection underwent total aortic replacement 4 years ago. He wasintroduced to our department again because he had chest wound pain and local swelling. Enhanced CT showed thatthere was abscess formation with bone encroachment, but malignant tumor could not be excluded. We considered itas mediastinitis firstly, and intended to open wound and resection abscess for antibiotic treatment. However, wefound that there were lot of swelling lymphatic nodes near to the aorta on enhanced CT reconfirmed. Definite diagnosis was diffuse large B-cell lymphoma by biopsy.
運用指針・許諾書
開心術後の創部痛を契機に発見された悪性リンパ腫の1 例
HirosakiMedJ_71(1)_79
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