前岡 悦子, 山岸 宏江, 説田 政樹, 佐藤 幸恵, 岡田 好美, 小島 祐毅, 山田 雄一郎, 清水 由貴, 有吉 彩, 湯浅 典博

Etsuko MAEOKA, Hiroe YAMAGISHI, Masaki SETTA, Yukie SATO, Yoshimi OKADA, Yuki KOJIMA, Yuichiro YAMADA, Yuki SHIMIZU, Aya ARIYOSHI, Norihiro YUASA

名古屋第一赤十字病院検査部

Department of Clinical Laboratory, Japanese Red Cross Nagoya Daiichi Hospital

キーワード : round ligament varicosity, inguinal hernia, color Doppler ultrasonography, pregnancy, delivery

子宮円索静脈瘤は鼠径部に鼠径ヘルニアに似た腫瘤を形成するため，しばしば鼠径ヘルニアと誤診されて手術をうけ術中に静脈瘤と診断される．今回，我々は鼠径部に腫瘤を形成した妊娠女性にカラードプラ超音波検査を行い，子宮円索静脈瘤と診断し得た2例を経験したので報告する．症例1は29歳，女性で，妊娠後から右鼠径部に膨隆と違和感を自覚し，妊娠30週に鼠径ヘルニアを疑われて当院外科を受診した．立位で右鼠径部に軟らかい腫瘤が出現し，臥位で消失した．超音波断層法では右鼠径部に境界明瞭な低エコーの卵形腫瘤を認め，ここから管状の低エコー領域が外側に伸び子宮まで連続していた．カラードプラ法では腫瘤内に血流を認め，腹圧をかけると血流が増加した．以上の所見から子宮円索静脈瘤と診断した．分娩2週後の超音波検査では静脈瘤は縮小していた．症例2は36歳，女性で，妊娠28週から立位で左鼠径部に疼痛を自覚し，当院外科を受診した．立位で鼠径部に軟らかい腫瘤と圧痛を認めた．超音波断層法では，左鼠径部に境界明瞭な低エコーの紡錘形腫瘤を認めた．カラードプラ法では腫瘤内部に血流を認め，腹圧をかけると血流は増加したため，子宮円索静脈瘤と診断した．妊娠中の子宮円索静脈瘤は分娩により自然に軽快することが多い．不必要な手術を避けるためにも子宮円索静脈瘤は正しく診断されるべきで，そのためにカラードプラ法による超音波検査は有用である．

Round ligament varicosities (RLV) can be easily misdiagnosed as inguinal hernia, because they share the same clinical manifestation. We report two pregnant women with a reducible groin mass in whom correct diagnosis of RLV was made by color Doppler ultrasonography. Case 1 was a 29-year-old woman. At 30 weeks gestation, she complained of inguinal swelling and discomfort. She was referred to department of surgery by her obstetrician. Physical examination revealed a soft groin mass appearing in the standing position but disappearing in the recumbent position. B-mode ultrasonography showed a well-demarcated low echoic mass (4 x 3 cm in size) with a tubular structure extending to the uterus. Color Doppler ultrasonography demonstrated blood flow in the mass, which was augmented by the Valsalva maneuver, after which the diagnosis of RLV was made. The size of the varicosities was increased to 6 x 3 cm at 34 weeks gestation. When she gave birth by cesarean section at 37 weeks gestation, the RLV was confirmed on laparotomy. After the delivery, the groin mass was remarkably reduced. Case 2 was a 36-year-old woman. She had left inguinal pain at 28 weeks gestation and came to the department of surgery. Physical examination revealed a soft groin mass appearing in the standing position but vanishing in the recumbent position. B-mode ultrasonography showed a low echoic fusiform mass in the left inguinal region, in which color Doppler ultrasonography demonstrated blood flow augmented by the Valsalva maneuver. The diagnosis of RLV was made. Because most RLV resolve spontaneously postpartum, they should be managed conservatively. Color Doppler ultrasonography is useful for correct diagnosis of RLV to avoid unnecessary surgery.