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慢性閉塞性肺疾患としての検査中に診断された慢性肺血栓塞栓症の2例


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Title: 慢性閉塞性肺疾患としての検査中に診断された慢性肺血栓塞栓症の2例
Other Titles: Two cases of chronic pulmonary thromboembolism diagnosed clinically as chronic obstructive pulmonary disease / (短縮表題) COPD の検査中に診断された慢性肺血栓塞栓症の2例
Authors: 土田, 朋子 / 岩田, 敦子 / 廣瀬, 裕子 / 深堀, 範 / 河野, 哲也 / 福島, 千鶴 / 松瀬, 厚人 / 河野, 茂
Authors (alternative): Tsuchida, Tomoko / Iwata, Atsuko / Hirose, Hiroko / Fukahori, Susumu / Kawano, Tetsuya / Fukushima, Chizu / Matsuse, Hiroto / Kohno, Shigeru
Issue Date: Jan-2009
Publisher: 日本呼吸器学会
Citation: 日本呼吸器学会雑誌, 47(1), pp.16-22; 2009
Abstract: 慢性閉塞性肺疾患(COPD)としての検査中に診断された慢性肺血栓塞栓症の2例を報告する.症例1は喫煙歴のない69歳女性で労作時呼吸困難が持続し,閉塞性換気機能障害と胸部CTの気腫性変化からCOPDと診断されていた.増悪する呼吸困難の精査目的に入院中に,肺換気血流シンチと肺動脈造影で慢性肺血栓塞栓症と診断された.症例2は喫煙歴を有する70歳男性で労作時呼吸困難が持続しCOPDの診断で抗コリン薬の吸入治療を開始されるも改善しなかったため精査を行った.II型呼吸不全と胸部CT上気腫性変化は認められたが,閉塞性換気機能障害は認められなかった.肺換気血流シンチと肺動脈造影で慢性肺血栓塞栓症と診断された.これらの症例のように,慢性肺血栓塞栓症はCOPDに合併した場合診断が難しく,又COPDに類似した症状・所見を示すことも多く,症状が進行するCOPDの診療を行なう際に念頭に置くべき重要な疾患と考えられため報告する. / Two cases of chronic pulmonary thromboembolism accidentally diagnosed in the clinical evaluation of COPD are reported. Case 1, a 69-year-old woman who had never smoked, was given a diagnosis of COPD since she had exertional dyspnea with obstructive pulmonary dysfunction and multiple low attenuation areas on her chest CT. Pulmonary ventilation and perfusion scintigram showed mismatched defects and as chronic pulmonary thromboembolism (CPTE) was finally diagnosed. Case 2, a 70-year-old former smoking man had also been previously given a diagnosis of COPD. He had exertional dyspnea, hypoxemia and multiple low attenuation areas in chest CT. Nonetheless his pulmonary function was normal. Pulmonary ventilation and perfusion scintigram showed mismatched defects and pulmonary angiography identified a floating thrombus in the pulmonary artery. Thus he CPTE was diagnosed. The diagnosis of CPTE in COPD is not easy. Physicians should recognize that CPTE can be associated with COPD and perform further examinations including pulmonary ventilation and perfusion scintigram when patients do not show typical results and/or adequately respond to conventional therapy for COPD.
Keywords: 慢性閉塞性肺疾患 / 慢性肺血栓塞栓症 / 肺換気血流シンチ / Chronic obstructive pulmonary disease / Chronic pulmonary thromboembolism / Pulmonary ventilation and perfusion scintigram
URI: http://hdl.handle.net/10069/21815
ISSN: 13433490
PubMed ID: 19198230
Rights: (c) 2009 日本呼吸器学会
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/21815

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