ガス産生を伴なった心嚢内膿瘍を発症した２型糖尿病の一例

A 63-year-old male with type 2 diabetes mellitus was admitted to our hospital with fever and chest pain. An echocardiogram, chest CT and MRI showed the gas-containing pericardial abscess located posteriol to the right atrium. He was initially treated by thoracoscopic pericardial fenestration to set a drainage tube in the pericardial abscess. However, the surgical treatment was discontinued because of a large amount of bleeding from the abscess wall. The patient was then treated by continued administration of antibiotics and γ-globulin. The inflammatory reactions improved and shrinkage of the abscess was confirmed.症例は63歳，男性の２型糖尿病患者．発熱および胸痛が出現し精査加療目的で当科に入院となった．心エコー，胸部CTおよびMRI 検査にて右房後方の心嚢内にガス産生を伴った膿瘍を認めた．入院翌日，排膿目的で胸腔鏡下で心嚢内膿瘍へのドレナージ挿入術を施行したが，嚢胞壁に小切開を加えたところ大量の出血が認められ挿入術を断念した．そのため抗菌剤およびγグロブリン製剤の投与による保存的治療に変更した．その効果により次第に炎症反応も改善し，CT 上で心嚢内膿瘍は著明に縮小していった

Gas-Containing Pericardial Abscess in a Type 2 Diabetic Patient

A 63-year-old male with type 2 diabetes mellitus was admitted to our hospital with fever and chest pain. An echocardiogram, chest CT and MRI showed the gas-containing pericardial abscess located posteriol to the right atrium. He was initially treated by thoracoscopic pericardial fenestration to set a drainage tube in the pericardial abscess. However, the surgical treatment was discontinued because of a large amount of bleeding from the abscess wall. The patient was then treated by continued administration of antibiotics and γ-globulin. The inflammatory reactions improved and shrinkage of the abscess was confirmed.症例は63歳，男性の２型糖尿病患者．発熱および胸痛が出現し精査加療目的で当科に入院となった．心エコー，胸部CTおよびMRI 検査にて右房後方の心嚢内にガス産生を伴った膿瘍を認めた．入院翌日，排膿目的で胸腔鏡下で心嚢内膿瘍へのドレナージ挿入術を施行したが，嚢胞壁に小切開を加えたところ大量の出血が認められ挿入術を断念した．そのため抗菌剤およびγグロブリン製剤の投与による保存的治療に変更した．その効果により次第に炎症反応も改善し，CT 上で心嚢内膿瘍は著明に縮小していった