細見 恵¹, 岩崎 昭宏¹, 松本 尚子¹, 米澤 宜洋¹, 影山 敦子¹, 足立 誠己¹, 奥 成聡², 濵口 浩敏³

Megumi HOSOMI¹, Akihiro IWASAKI¹, Naoko MATSUMOTO¹, Yoshihiro YONEZAWA¹, Atsuko KAGEYAMA¹, Masami ADACHI¹, Naritoshi OKU², Hirotoshi HAMAGUCHI³

¹地方独立行政法人明石市立市民病院臨床検査課, ²地方独立行政法人明石市立市民病院血液内科, ³北播磨総合医療センター脳神経内科

¹Department of Clinical Laboratory, Akashi Municipal Hospital, ²Department of Hematology, Akashi Municipal Hospital, ³Department of Neurology, Kita-Harima Medical Center

キーワード : Takayasu arteritis, carotidynia, internal carotid artery, ultrasound diagnosis

発症初期から79週にわたって超音波検査で経過観察し得た高安動脈炎の症例を経験した．症例は26歳女性．発熱と左頸部の圧痛を主訴に受診．頸部超音波検査を施行したところ，左総頸動脈から左内頸動脈起始部にかけて外膜側の不明瞭な壁肥厚像を認めた．MRI検査では同部位の血管外膜および周囲組織にT2高信号域が見られ，炎症所見が疑われた．また，MRA検査では血管内腔の狭窄や拡張病変を認めなかった．以上の画像所見からcarotidynia（頸動脈痛）を疑い，超音波検査にて経過観察となった．23週後には左内頸動脈の壁肥厚に改善傾向が見られた．30週後には左総頸動脈血管内膜面に壁不整像が見られるようになり，55 週後には左総頸動脈起始部に壁肥厚を認めたことから高安動脈炎を疑い，プレドニゾロン30 mg/日にて内服加療を開始した．57週後のMRI検査にて，左鎖骨下動脈にも辺縁平滑な狭窄像を認め，最終的に本症例は高安動脈炎であると診断した.・高安動脈炎は症状をきたした際には壁肥厚が進行し，頸動脈においてはいわゆるマカロニサインとよばれる全周性の壁肥厚所見を呈している場合が多い．初期画像を提示した報告例は非常に少なく，超音波画像で経時的変化を追った報告例は認めない．我々は発症初期に carotidynia に類似する画像所見を呈し，経時的に経過を追うことができた症例を経験した．このことは高安動脈炎の経過において非常に重要な所見と考える．

This case of Takayasu arteritis (TA) was examined using ultrasonography (US) over a period of 79 weeks from the early phase. A 26-year-old woman presented with a fever and tenderness on the left side of her neck. The initial US revealed abnormal wall thickness and a poorly defined outer membrane from the left common carotid artery (CCA) to the left internal carotid artery (ICA). In the same vessels, the T2-weighted images of magnetic resonance imaging (MRI) indicated abnormal structure in the outer membrane and perivascular tissue, suggesting inflammation. The magnetic resonance angiography (MRA) images showed neither stenosis nor dilatation of these vessels. Based on these findings, carotidynia was suspected. The case was re-examined 23 weeks later using US, and decreased wall thickness of the left ICA was noted. In a second follow-up at 30 weeks, the US images showed surface irregularity of the intimal membrane in the left CCA, consistent with a diagnosis of TA. At 55 weeks after the initial consultation, we found increased wall thickness of the left proximal CCA, a finding which also strongly indicated TA. The patient was administrated prednisolone (30 mg/day). At 57 weeks, MRA demonstrated stenosis of the left subclavian artery with a smooth lumen. This finding led to the final diagnosis of TA. In TA, by the time a patient presents with symptoms, it is common to see advanced image findings of the vessels with circumferential wall thickening, sometimes called "macaroni sign". Therefore, there are few reports of cases with images of TA in the early phase. We could not find any reports that tracked changes over time using US. We experienced a case of TA in the early phase with images similar to carotidynia that could be followed up by US. We think is a very important a case of TA.