浜崎 直樹¹, 川崎 恭¹, 須崎 康恵¹, 江川 信一¹, 鴻池 義純¹, 龍神 良忠¹, 仲川 房幸², 今井 幸子³, 大石 元⁴, 成田 亘啓⁵

Naoki HAMAZAKI¹, Kyou KAWASAKI¹, Yasue SUZAKI¹, Shinichi EGAWA¹, Yoshizumi KOUNOIKE¹, Yoshitada RYUUJIN¹, Fusayuki NAKAGAWA², Yukiko IMAI³, Hajime OHISHI⁴, Nobuhiro NARITA⁵

¹済生会奈良病院内科, ²済生会奈良病院放射線科, ³奈良県立五条病院放射線科, ⁴奈良県立医科大学腫瘍放射線科, ⁵奈良県立医科大学第2内科

¹Department of Internal Medicine Saiseikai Nara Hospital, ²Department of Radiology Saiseikai Nara Hospital, ³Department of Radiology, Nara Prefectural Gojo Hospital, ⁴Department of Oncoradiology, Nara Medical University, ⁵The second Department of Internal Medicine, Nara Medical University

キーワード : Rupture of the diaphragm, Ultrasonography, Lung cancer, Adrenal metastasis

The patient, a 57-year-old male diagnosed with lung cancer at another hospital, consulted our hospital complaining of abdominal pain. Diagnostic imaging revealed an adrenal metastasis, 8 cm in size. To treat this metastasis, TAE was administered three times. Twenty days after the third TAE treatment, the patient complained of sudden epigastric pain and hematemesis. A chest radiograph revealed a large cavity in the left lung field and ultrasonography indicated a large quantity of fluid in the left pleural cavity. Real-time observation of the chest region by ultrasonography revealed air bubbles arising steadily from the lower portions of the liquid in the pleural cavity. This findings suggested that the pleural cavity was in anatomical communication with the digestive tract. Gastric fluoroscopy and CT scanning showed prolapse of the stomach into the pleural cavity. The prolapse was thought to be due to rupture of the diaphragm.