松原 浩, 浦野 文博, 内藤 岳人, 藤田 基和, 山田 雅弘, 山本 英子, 竹山 友章, 田中 浩敬, 田中 卓, 岡村 正造

Hiroshi MATSUBARA, Fumihiro URANO, Takehito NAITOH, Motokazu FUJITA, Masahiro YAMADA, Hideko YAMAMOTO, Tomoaki TAKEYAMA, Hiroyuki TANAKA, Taku TANAKA, Shozo OKAMURA

豊橋市民病院消化器内科

Department of Gastroenterology, Toyohashi Municipal Hospital

キーワード : pancreaticoduodenal artery aneurysm, endoscopic ultrasonography, contrast-enhanced color Doppler imaging, transabdominal ultrasonography, second-generation contrast agent

症例は70歳代男性．S状結腸癌による腸閉塞で，当院外科にて手術となった．術前の造影CT 検査で膵頭下部領域に濃染する単発の病変を偶発的に認め，S状結腸癌術後に精査目的で当科紹介となった．経腹壁超音波検査で病変は指摘されなかった．超音波内視鏡検査（EUS）では，膵頭下部近傍に5 mm大，境界明瞭で類円形の低エコー病変を認めた．病変はカラードプラEUSで血流シグナルを認めず，充実性病変を疑った．Sonazoid^®を用いて造影カラードプラEUSを行うと，強い血流シグナルを有する病変を認め，連続する拍動性の血管を認めた．血管性病変と診断し，3D-CT angiographyを撮影構築したところ，膵十二指腸動脈瘤が認められた．動脈瘤破裂に対する予防目的で，経皮的動脈瘤コイル塞栓術を施行した．超音波造影剤の投与により，ドプラ感度を上げることで診断しえた膵十二指腸動脈瘤の1例を経験した．

A male in his 70s was admitted to our hospital with symptoms of ileus. Contrast-enhanced computed tomography confirmed the wall thickness of the sigmoid colon and a small mass in the area of the pancreatic head. Surgical treatment was performed with a preoperative diagnosis of cancer of the sigmoid colon. We examined the pancreatic lesion after the surgical operation. Transabdominal ultrasonography could not detect the pancreatic lesion. Endoscopic ultrasonography identified a solid, rounded, well-demarcated low echoic lesion, measuring 5 mm in diameter on the pancreatic head and third portion of the duodenum. Color Doppler EUS demonstrated no blood flow in the lesion. Therefore, contrast-enhanced color Doppler EUS, using a second-generation contrast agent, showed strong blood flow in the lesion with pulsatile branch vessel. 3D-angiography from computed tomography revealed a pancreaticoduodenal artery aneurysm. We performed preventive transcatheter arterial aneurysm coil embolization. Contrast-enhanced color Doppler EUS is useful for a small pancreaticoduodenal artery aneurysm.