清水 雅俊¹, 河田 正仁¹, 岡田 敏男¹, 宮武 博明², 下川 泰史³, 五十嵐 宣明³, 岡嶋 克則³, 高田 幸浩³, 由宇 芳才³, 水谷 哲郎³

Masatoshi SHIMIZU¹, Masahito KAWATA¹, Toshio OKADA¹, Hiroaki MIYATAKE², Yasushi SHIMOKAWA³, Nobuaki IGARASHI³, Katsunori OKAJIMA³, Yukihiro TAKADA³, Housai YUU³, Tetsuo MIZUTANI³

¹国立神戸病院循環器科 , ²国立神戸病院呼吸器科 , ³国立神戸病院内科

¹Department of Cardiology, Kobe National Hospital, 3-1-1 Nishiochiai, Suma-ku, Kobe 654-0155, Japan, ²Department of Respiratory Medicine, Kobe National Hospital, 3-1-1 Nishiochiai, Suma-ku, Kobe 654-0155, Japan, ³Department of Internal Medicine, Kobe National Hospital, 3-1-1 Nishiochiai, Suma-ku, Kobe 654-0155, Japan

キーワード : Diastolic heart failure , Doppler echocardiography , Mediastinal lipomatosis , Steroid, Two-dimensional echocardiography

Mediastinal lipomatosis is an abnormal fatty accumulation in the mediastinum. We report a case of mediastinal lipomatosis complicated with ventricular diastolic dysfunction resulting from fatty thickening of the pericardium. A 71-year-old man who had been administrated 5 to 2.5 mg of predonisolone for neurological symptoms complained of shortness of breath. The cardiothoracic ratio in the chest radiograph increased from 45% to 53% after the steroid therapy. Computed tomography and magnetic resonance imaging demonstrated mediastinal lipomatosis with thick fatty pericardium. Echocardiography showed a thick echogenic layer surrounding the heart. Doppler patterns of diastolic ventricular inflow velocities showed rapid deceleration of the early filling wave at the mitral valve and prominent respiratory variation in flow velocities at the tricuspid valve. These patterns were considered to represent ventricular diastolic dysfunction caused by the constrictive effect of the thick fatty pericardium.