矢野 怜, 廣岡 昌史, 中村 由子, 田中 孝明, 小泉 洋平, 渡辺 崇夫, 吉田 理, 徳本 良雄, 阿部 雅則, 日浅 陽一

Ryo YANO, Masashi HIROOKA, Yoshiko NAKAMURA, Takaaki TANAKA, Yohei KOIZUMI, Takao WATANABE, Osamu YOSHIDA, Yoshio TOKUMOTO, Masanori ABE, Yoichi HIASA

愛媛大学大学院消化器・内分泌・代謝内科学

Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine

キーワード : sarcoidosis, contrast enhanced ultrasonography, postvascular phase, granuloma, macrophage

症例は78歳，女性．他院で肺サルコイドーシスにて経過観察されていた．造影CTにて肝内に多発する乏血性結節がみられ，以前の画像に比べ増大があり精査目的に紹介された．エコー画像では造影エコー検査の後血管相においてのみ明瞭に描出可能であった．造影エコー下に生検し組織採取を行い，サルコイドーシスの確定診断が得られた．サルコイドーシスは様々な臓器に非乾酪性肉芽腫をきたす原因不明の疾患である．主として肺，リンパ節，皮膚などに肉芽腫がみられるが，時に肝内にも同様の病変がみられる．肝サルコイドーシスの確定診断や肝悪性腫瘍との鑑別のために生検による組織診断が必要となるが，腹部超音波Bモード検査では明瞭な結節としてとらえられない場合が多く，組織採取がしばしば困難となる．本症例では肝結節では貪食細胞の機能低下によると思われる，後血管相における造影欠損像を呈した．炎症期を過ぎた肝サルコイドーシスでは造影超音波検査の後血管相で欠損像を呈するため，造影エコー下での生検は診断確定のために有用な方法になりうることが示唆された．

Sarcoidosis is a granulomatous disease of unknown etiology that can vary from asymptomatic to life-threatening. It is a systemic disease that can affect any organ, including the liver. Because hepatic involvement is usually asymptomatic and cannot be depicted clearly on B-mode ultrasound images, it is often underdiagnosed. Here, we report a case of a patient with hepatic sarcoidosis that was diagnosed histologically by contrast-enhanced ultrasound-guided needle biopsy. Case report: A 78-year-old woman with pulmonary sarcoidosis and multiple hepatic nodules was admitted to our hospital for diagnosis of hepatic nodules. Dynamic contrast-enhanced computed tomography demonstrated multiple hypovascular nodules in the liver. These nodules could be recognized on contrast-enhanced ultrasound but could not be depicted clearly on B-mode ultrasound images. They were shown as a perfusion defect in the postvascular phase. Thus, contrast-enhanced ultrasound-guided needle biopsy was performed, and the patient was diagnosed with hepatic sarcoidosis. Due to insufficient staining with PAS-D, dysfunction of Kupffer cells in granuloma was speculated. This case report demonstrated that it is important to perform contrast-enhanced ultrasonography, and this can be the modality used to guide biopsy for patients with hepatic sarcoidosis if the hepatic lesions cannot be depicted on routine B-mode ultrasound images.