深呼吸時における肝実質灌流血の変化がArrival-time Parametric Imagingで可視化できたBudd-Chiari症候群の1症例
東邦大学医療センター大森病院消化器内科 和久井紀貴ほか
Budd-Chiari症候群で通院中の40歳男性。カラードプラUSで門脈右枝の血流を観察中、深吸気息止めでその血流方向が求肝性から遠肝性に変化することに気が付いた。その後、肝実質灌流血の門脈・肝動脈バランスを確認するためarrival time parametric imaging（At-PI）を行った。結果、深吸気息止めでの肝実質灌流血は肝動脈からが主体であったが、深呼気息止めでは求肝性のままであり門脈血が主体であった。深呼吸による肝実質灌流血の変化がAt-PIで可視化できたBudd-Chiari症候群の1症例を経験した。
A 40 year old male who had been diagnosed with Budd-Chiari syndrome periodically goes to our hospital. Color Doppler ultrasonography (US) revealed a change in the blood flow in the right portal vein branch, from hepatopetal to hepatofugal, during deep inspiration. Arrival time parametric imaging (At-PI), using Sonazoid-enhanced US, was subsequently performed to examine the deep respiration induced changes observed in the hepatic parenchymal perfusion. US images captured during deep inspiration demonstrated hepatic parenchymal perfusion predominantly in red, indicating that the major blood supply was the hepatic artery. During deep expiration, the portal venous blood flow remained hepatopetal, and hepatic parenchymal perfusion was displayed predominantly in yellow, indicating that the portal vein was the major source of the blood flow.
2014年5月号目次に戻る
