藤岡 和美¹, 藤岡 彰², 衛藤 光³, 佐貫 栄一¹, 田中 良明¹, 大石 実⁴

Kazumi FUJIOKA¹, Akira FUJIOKA², Hikaru ETO³, Eiichi SANUKI¹, Yoshiaki TANAKA¹, Minoru OISHI⁴

¹日本大学医学部放射線科, ²藤岡皮フ科クリニック, ³聖路加国際病院皮膚科, ⁴日本大学医学部神経内科

¹Department of Radiology, Nihon University School of Medicine, ²Director, Fujioka Dermatological Clinic, ³Department of Dermatology, St. Luke’s International Hospital, ⁴Department of Neurology, Nihon University School of Medicine

キーワード : Takayasu arteritis, ultrasonography, arteriosclerosis, macaroni sign

頸部腫瘤の精査目的で施行した超音波検査(ultrasonography：US) で偶然に診断された高安病(Takayasu arteritis：TA) を経験した. 自験例は比較的若年に発症したTA にもかかわらず動脈硬化を伴う稀な症例であった. 症例は32 歳, 女性. 20 代半ばより右頸部腫瘤に気付くも放置していた. 2001 年6 月皮膚科通院中に頸部腫瘤を指摘されUS 検査を施行. B モード上, 両側総頸動脈に壁の肥厚した内膜中膜複合体, いわゆるmacaroni sign の像を認めTA と診断した. 自験例の US 所見はmacaroni sign に加え血管壁の一部に不整と石灰化を, また血管拡張や狭窄を認め動脈硬化性変化を伴う進行 したTA の像であった. Vascular biology の進歩に伴いTA と動脈硬化の関連が報告されている. 自験例の画像所見, 特 にUS 像よりTA と動脈硬化との関連が示唆され, TA自身の炎症が動脈硬化を惹起し進行したTA の像を呈したと考え た.

The presence of Takayasu arteritis (TA) was detected incidentally by ultrasonography (US) performed for a detailed examination of a mass in the neck. The 32-year-old female patient was a rare case of the disease accompanied by arteriosclerosis in spite of her relatively young age. She had been aware of the mass in her right neck since her mid-20s but did not consult a doctor. In June 2001, the neck lesion was pointed out by a dermatologist during treatment of a skin disease, at which time she underwent a US examination. B-mode US demonstrated a thickened intima-media complex or the so-called macaroni sign in the wall of both common carotid arteries. The patient was thus diagnosed with TA. In addition to the macaroni sign, US findings of partial irregularity and calcification of the vascular walls as well as dilations and stenoses of the lumen suggested that she was at the chronic phase of TA with arteriosclerotic changes. With advances in vascular biology, the relationship between TA and arteriosclerosis has come to be noted. The US findings in this case indicated that the inflammation of TA caused arteriosclerosis, resulting in deterioration of the disease to the late phase.