HIKASA, YORINORI

MORI, ATSUMI

OKAMOTO, YOSHIFUMI

SHIROTANI, HITOSHI

TAKEDA, JUN

YOSHIDA, YOSHIYUKI

Kyoto University Research Information Repository

Title On a Case of Foreign Body in the Pericardiac CavityAuthor(s)TAKEDA, JUN; YOSHIDA, YOSHIYUKI; OKAMOTO,YOSHIFUMI; MORI, ATSUMI; SHIROTANI, HITOSHI;HIKASA, YORINORICitation日本外科宝函 (1966), 35(5): 921-929Issue Date1966-09-01URL http://hdl.handle.net/2433/207327RightType Departmental Bulletin PaperTextversionpublisherKyoto University症例On a Case of Foreign Body in the Pericardiac Cavity by JuN TAKEDA, YosHIYUKI YOSHIDA, YosHIFUMI OKAMOTO, ATSUMI MORI, HnosHI SHI ROT ANI and YoRINORI HIKASA From the 2nd Surgical Division, Kyoto University Medi白lSchool (Director : Prof. Dr. CtUJI KIMURA) Rec日vedfor Publication June. 27, 1966 921 A 24-year-old male office-worker living in a rural district, who had also worked as a farmer from time to time was admitted to our clinic with chief complaint of obscured dul aching and discomfort in the anterior chest region as well as in the epigastrium. Family history revealed nothing contributory. At the age of ten the patient was diagnosed to have adhesive pleurisy from which, however, he was told to be recovered. He was sen by a local physician at the age of sixteen because of repeated episod田 ofcough with sputa stained by blood streaks, and was then treated medically under the diagnosis of pulmonary distomatosis. No history of trauma in the chest region was recorded. The patient and his family denied any episode of broken needles stuck and lost in his lxxly in the past. A few years prior to the present admission, he noticed discomfort and dull aching in the anterior thoracic region and (or radiating to) the upper abdominal area for the first time. Epigastric and thoracic discomfort had been gradually exacerbated thereafter in spite of repeated medical treatments and, in addition, he developed occasional episodes of palpitation upon exertion. Because of epigastralgia radiographic examination of GI series was performed at a local hospital, which was essentially negative for pathological changes, but an abnormal lesion was found incidentally in the cardiac shadow at that time. The patient was therefore referred to our clinic for further examination and surgical procedures if indicated. PHYSICAL EXAMINATION Physical examination on admission showed a well developed and well nourished ori-ental male in no acute distress. Radial pulse was 60 80 per minute with normal tension, but a slight degree of irregular rhythm was noted. Blood pr白sureon admission was 130/ 72. Bulbar and palpebral conjunctiva was neither icteric nor anemic. The pupils were round, regular, equal and reacted well and promptly to light and accommodation. The heart and lungs were essentially negative for pathology upon percussion as well as on auscultation. Abdominal organs seemed to be grossly normal and no abnormally palpable masses were proved. The extremities were also grossly normal and peripheral arterial 9:22 日本外科宝函第35巻第5号pulsations were within normal ranges. LABORATORY FINDINGS Urine and feces were negative. No parasitic eggs were found upon microscopic ex-amination of feces. Hematological examination including complete blood count and hemかgram was essentially normal with RBC (red blood cel) count of 5.4 7 million, WBC (white blood cel) count 5,000, Hematocrit 42%, and hemoglobin 91% by SAHLI’s method. Bleeding and coagulation times were 1'30" and 11' respectively. Liver function tests were reported to be within normal ranges with icterus index of 6. Electrocardiogram rev白 ledsinus bradycardia and sinus arythmia of mild degree. Biochemical Laboratory Findings ( 1 ) Electrolyte in Serum Na 140 2 mEq/L K 4.07 -9 Ca 4.94 -9 Cl 107.2ρ ( 2) Total Protein in ~erum 7.3g/dl ( 3) Total Cholesterol in Serum 130mg/dl ( 4) CRP （一）( 5) ASLO 125 Todd Unit ( 6) RAT （ー）(7) Alcali Phosphatase 4 0 K. A. Unit ( 8) Acid Phosphatase 2.0 K. A. Unit ( 9) S-GOT 18.0 (10) S-GPT 10.0 As shown in Figures 1 and 2, chest X-ray picture taken at standing position showed no dilatation (or enlargement) of the heart but an abnormal shadow, a human small finger tip in size, was demonstrated at the apex of the heart, which moved vertically towards slightly right upper direction synchronizing with cardiac rhythm. When the patient was placed on his back, the intracardial shadow was deviated towards right upper direction as shown in Figures 3 and 4. When the patient was laid on his right side with his head down, it was observed to move near-by the ascending aorta and pulmonary artery. The shadow, however, moved back to the apex as the patient was raised up to standing position. Judging from the above-described radiographic characteristics of the shadow together with his past history and clinical pictures, preoperative diagnosis of intrapericardial foreign加dywas established. OPERATIVE FINDINGS Exploratory thoracotomy with removal of the pericardial foreign body was performed on Aug. 10. 1963. Under the endotracheal general anesthesia, the patient was placed in the modified semi-right-side position and the left thoracic伺 vitywas explored through the anterφlateral 4th intercostal space incision. Generalized pleural adhesions of mild degree FOREIGN BODY IN THE PERICARDIAC CAVITY 923 Fig. 1 924 日本外科宝函第35巻第5号Fig. 2 FOREIGN BODY IN THE PERICARDIAC C:¥ VITY 925 Fig. 3 926 日本外科宝函第35巻第5号Fig. 4 FOREIGN BODY IN THE PERICARDIAC CAVITY 921 were exfoliated manually without difficulty. Pericardium looked grossly normal without any evidence of thickening or discoloration. Upon opening the pericardium, approximately 20 c・c.of yellowish mucoid foamy fluid escaped, (which seemed more yellow in color and mo陀 mucousin viscidity than usual pericardia! fluid) . Manual exploration revealed a frely movable mass of human index finger tip size at the deepest part of the pericardiac αvity, that was namely the position of IVC inflow into the right atrium. The mass was sucesfuly removed with ease. Pericardium was then closed roughly and the surgical pr附 durewas terminated by routine closure of the chest wall. The patient withstood the entire procedure well and his postoperative recovery was satisfactory. PATHOLOGICAL FINDINGS As shown in Fig. 5, the specimen consisted of an irregularly shaped mass of 2×2 x Z cmin size, weighing 3 grams as a whole, and it was yellowish white in color. The surface of the removed mass was somehow irregular, but was lustrous. The cut-surface as shown in Fig. 6, was rather uniform and (yellowish white) cheesy mass composed the major part of the content, being well encapsulated by a layer of thin membrane. With ?????? ??、??????????Fig. 5 ???? ，． ，??????? ．???Fig. 6 928 日本外科宝函第35巻第5号a drip of acid solution, the cheesy mass was found to be melted away with vesi伺tory.Microscopic examination of the specimen (Figs. 7 and 8) revealed cel infiltration of mild degree with a necrotic area in the centre. The cel infiltration was not so extensive as usually seen in四sesof inflammatory changes, but was rather of reactive nature, probably caused by parasites or their eggs. No distoma or other parasites, however, was proved by serial examination of the specimen. Fig. 7 Fig. 8 DISCUSSION Cases of intracardial foreign bodies, especially those caused by needle, have been often reported here in Japan, but al of them have either history of trauma or in a few cases history of mis-swallowing terminated by intracardial entry of the foreign bodies, penetrat-ing through the trachea or esophagus. To our knowledge, no case of foreign body entry into the pericardiac cavity without any contributory history of trauma or mis-swallowing FOREIGN BODY IN THE PERICARDIAC CAVITY 929 has ever been reported. In our case, the only contributory past history of the patient was pulmonary distomatosis, and in addition, he came from the rural district where most of the dwellers had been suffered from distomatosis. Though no parasite was proved in the serial sections of the specimen (microscopically), the foreign body removed from the pericardiac cavity might well be determined as of parasitic origin from the history and histology of the specimen as well. REFERENCES I) Decker, H. R. : Foreign Bodies in the Heart and Peri四 rdium.J. Thor. Surg., 6 : 62, 1939. 2) Bland, C. C. : Foreign Bodi田 mand about the H白 rt.Am. Heart J . 27 : 588, 1944. 3) Harken, D. E. et al. : Foreign Bodi回 inRelation to the Thoracic Blood V師団lsand H田rt.Am. Heart J., 32 : I,1964. 

心嚢内異物の1例

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心嚢内異物の1例

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