陶山 芳一

Yoshikazu SUYAMA

陶山医院，京都府北警察署警察医

Suyama Clinic, Part-time coroner of Kita Police Office in Kyoto

キーワード : autopsy imaging, acute aortic dissection, diagnosis of death causes, post-mortem examination, ultrasonography

目的：死因診断においてCTによるautopsy imaging が注目されているが，より簡便な検死時超音波検査autopsy ultrasonographyの有用性について急性大動脈解離（acute aortic dissection: AAD）の診断を通して検討した．対象と方法：2007‐2010年の間，検死378件中，34例がAADと診断され，26例に携帯超音波装置を用いてautopsy ultrasonographyを施行した．超音波所見とともに，経過および診断過程をも検討した．結果と考察：AAD件数は急増傾向にあり，年齢は70歳以上が77％と高齢者に多い．発症は失神・意識消失が18例，胸・背・肩・腹部の痛みが8例で，1例に嘔吐を伴った．23例が救急搬送され，22例が搬入時心肺停止，1例が救急室で死亡して検死となった．3例は搬送されずに直接検死された．2007‐2010年2月までの9例では，穿刺にて血性胸水と血性心膜液を確認した．2010年3月より胸骨上縁や胸骨右縁左縁からの観察を試み，上行大動脈・弓部の拡張，遊離した動脈壁など解離の直接所見を17例で確認できた．3例では経過とautopsy ultrasonographyの所見のみでAADと診断した．結論：autopsy ultrasonographyはAADの死因診断に有用である．

Purpose: To evaluate post-mortem ultrasonography for diagnosing acute aortic dissection (AAD) as the cause of death. Subjects and Methods: The cause of death had been diagnosed as AAD in 34 of 378 post-mortem examinations performed during the period from 2007 to 2010. In 26 of the 34 cases, a portable ultrasonographic device was used for diagnosis as autopsy ultrasonography. Ultrasonographic findings were evaluated as well as the clinical course and diagnosis. Results and Discussion: Cases of AAD are increasing in number year to year. Seventy-seven percent of AAD cases were over 70 years old. In terms of initial symptoms, syncope or consciousness disturbance was seen in 18 cases, chest or back pain was found in eight cases, and vomiting was noted in one case. Twenty-three cases were brought to the emergency room, and 22 cases suffered cardio-pulmonary-arrest. Twenty-six cases of AAD were diagnosed based on the clinical course, chest x-ray, or autopsy ultrasonography findings. In five cases in 2010, CT was also used in the diagnosis. At our institution, autopsy ultrasonography was first used for post-mortem examinations in 2007. In the initial stage, only pleural effusion was revealed in cases of AAD. Since March 2010, observation from the upper edge of the clavicle and the right edge of the sternum, dilated ascending aorta, and intimal flap was realized directly in 17 cases of AAD. Conclusion: Autopsy ultrasonography was useful for diagnosis of AAD.