田端 強志¹, 星 裕美¹, 蓮沼 絵里香¹, 高橋 憲子¹, 稲岡 努², 東丸 貴信³

Tsuyoshi TABATA¹, Hiromi HOSHI¹, Erika HASUNUMA¹, Noriko TAKAHASHI¹, Tsutomu INAOKA², Takanobu TOMARU³

¹東邦大学医療センター佐倉病院生理機能検査部, ²東邦大学医療センター佐倉病院放射線科, ³東邦大学医療センター佐倉病院循環器センター

¹Department of Clinical Physiology, Toho University Medical Center Sakura Hospital, ²Department of Radiology, Toho University Medical Center Sakura Hospital, ³Department of Cardiovascular Center, Toho University Medical Center Sakura Hospital

キーワード : esophageal intramural hematoma, osteogenesis imperfecta, transthoracic echocardiography

食道粘膜下血腫はまれな疾患で，保存的治療で治癒する予後良好な疾患である．症例は47歳女性．主訴は腹痛，嘔吐（吐血）．他院で骨形成不全症と診断されていた．心エコー図検査では心機能に問題なく，弁膜症も認めなかったが，左房後方に左房を軽度に圧排する腫瘤像を認めた．胸部CT検査では食道壁の肥厚を認めた．上部消化管内視鏡検査では胃噴門部に暗赤色の巨大腫瘤を認め，腫瘤は上部食道へ連続していた．食道粘膜下血腫と診断し，保存的治療を行った．第7病日には症状は改善され，心エコー図検査を利用して血腫の消褪を観察することができた．第14病日の上部内視鏡検査で血腫の消褪を確認した．

Esophageal intramural hematoma is a rare disease with a fairly good outcome. We report a case of a 47-year-old woman with osteogenesis imperfecta who was hospitalized due to stomachache and hematemesis. Transthoracic echocardiogram revealed an abnormal mass posterior to the left atrium. Chest CT scan showed extensive swelling of the wall of the whole esophagus. Upper gastrointestinal endoscopy revealed a very large and dark red mass in the cardiac region of the stomach that extended from the upper esophagus. She was diagnosed with esophageal intramural hematoma and made a smooth recovery with conservative therapy. The patient’s symptoms had resolved by the 7^th hospital day, and follow-up transthoracic echocardiogram and CT scan revealed complete resolution of the hematoma. A 2^nd esophagoscopy performed 14 days later found complete disappearance of the hematoma and only an ulcer scar in the esophagus. In this case, we were able to follow the process of hematoma disappearance by transthoracic echocardiogram.