重富 弘, 松崎 益徳, 塔間 陽一, 友近 康明, 和崎 雄一郎, 道重 博行, 時沢 郁夫, 西尾 秀樹, 藤野 尚子, 楠川 禮造

Hiroshi SHIGETOMI, Masunori MATSUZAKI, Yoichi TOMA, Yasuaki TOMOCHIKA, Yuichiro WASAKI, Hiroyuki MICHISHIGE, Ikuo TOKISAWA, Hideki NISHIO, Hisako FUJINO, Reizo KUSUKAWA

山口大学第二内科

2nd Department of Int. Med, Yamaguchi University, School of Medicine

キーワード : Transesphageal echocardiography, Pulmonary venous flow signal, Mediastinal lung cancer

A 61 year-old man suspected of having a mediastinal tumor was examined by transesophageal echocardiography (TEE). TEE showed tumorous mass around the main pulmonary artery (PA), and orifice stenosis of the left PA compressed by the tumor. The flow velocity signal in the main PA showed turbulent flow, and its peak velocity was 1.5 m/sec. TEE also showed characteristic left pulmonary venous flow pattern (PVF); reversed flow in late systole to early diastole, while the right PVF showed almost normal phasic pattern. After treatment with radiation and chemotherapy over 4 months, PA stenosis was relieved and pulmonary arterial flow velocity was reduced to 0.75 m/sec. along with almost same flow pattern in the left and right pulmonary vein.
In this article we discuss the usefulness of TEE for the diagnosis of mediastinal tumors around the pulmonary artery and for the evaluation of pulmonary venous flow dynamics connected with the stenotic pulmonary artery. Abnormal pulmonary venous flow characterized by reversed flow during late systole to early diastole may indicate the collapse of the pulmonary vein caused by reduction of pulmonary blood flow.