笹木 優賢¹, 大野 栄三郎², 杉山 博子¹, 刑部 恵介³, 田中 浩敬², 中岡 和徳², 川部 直人², 葛谷 貞二², 伊藤 弘康¹, 廣岡 芳樹²

Yutaka SASAKI¹, Eizaburo OHNO², Hiroko SUGIYAMA¹, Keisuke OSAKABE³, Hiroyuki TANAKA², Kazunori NAKAOKA², Naoto KAWABE², Teiji KUZUYA², Hiroyasu ITO¹, Yoshiki HIROOKA²

¹藤田医科大学病院臨床検査部, ²藤田医科大学病院消化器内科学講座, ³藤田医科大学病院医療科学部医療検査学科

¹Department of Clinical Laboratory, School of Health Sciences, Fujita Health University, ²Department of Gastroenterology and Hepatology, School of Health Sciences, Fujita Health University, ³Faculty of Medical Technology, School of Health Sciences, Fujita Health University

キーワード : gallbladder torsion, contrast-enhanced ultrasonography, Sonazoid, acute cholecystitis

胆嚢捻転症は胆嚢の血流障害をきたす急性腹症であり，早期手術介入が必要である．しかし，胆嚢捻転症は急性胆嚢炎と臨床所見や超音波所見が類似しており，鑑別に苦慮する場合がある．今回我々は胆嚢捻転症の診断に造影超音波検査が有用であった1例を経験したので報告する．症例は80代，女性．心窩部痛の増悪を主訴に当院紹介受診．造影CT検査では急性胆嚢炎が疑われたが，超音波検査では胆嚢腫大と頸部高エコー腫瘤性病変を認め，胆嚢捻転症が疑われた．壁虚血確認のため，ソナゾイド造影超音波検査を施行したところ，胆嚢壁および頸部高エコー腫瘤性病変に造影剤の流入は認めず，胆嚢捻転症と診断され，緊急手術となった．手術所見でも胆嚢頸部で捻転を認め，胆嚢捻転症と最終診断された．造影超音波検査は血流有無の確認を容易に行うことができるため，壁血流の有無を鋭敏にとらえることができ，胆嚢捻転症の診断も可能であると考えられた．さらに，超音波造影剤であるソナゾイドは腎機能低下症例でも使用することができ，また，検査も通常の超音波装置でも行うことができるため，救急現場等のベッドサイドでも行うことができる．造影超音波検査は急性胆嚢炎・胆嚢捻転症の鑑別を迅速かつ容易に行うことができ，非常に有用な検査法であると考えられた．

Gallbladder torsion is an acute abdominal condition that causes obstruction of blood flow to the gallbladder and requires early surgical intervention. However, gallbladder torsion is sometimes difficult to distinguish from acute cholecystitis because the clinical symptoms and ultrasonographic findings are similar. We report a case in which contrast-enhanced ultrasonography (CEUS) was useful in the diagnosis of gallbladder torsion. The patient was a woman in her 80s who was referred to our hospital with a chief complaint of worsening pericardial pain. Contrast-enhanced computed tomography revealed acute cholecystitis, and ultrasonography showed an enlarged gallbladder and a hyperechoic lesion in the neck, suggesting gallbladder torsion. CEUS was Sonazoid performed to confirm the diagnosis, at which no contrast medium was seen flowing into the gallbladder wall or the cervical hyperechoic lesion. The operative findings also showed torsion in the neck of the gallbladder, and a final diagnosis of gallbladder torsion was made. CEUS can easily confirm the presence or absence of blood flow, and is thought to be capable of diagnosing gallbladder torsion. Furthermore, Sonazoid, an ultrasound contrast agent, can be used in patients with impaired renal function, and the examination can be performed with conventional ultrasound equipment at the bedside, such as in the emergency room. CEUS is a very useful method for quickly and easily differentiating acute cholecystitis and gallbladder torsion.