【臨床症状】10代 腹痛精査
【問題】画像所見と診断名は？
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➡ 造影MRI
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▶答えはこちら
- 右卵巣に腫瘤性病変を認める
- T1WIで低信号、T2WIで高信号、造影効果なしを認め、画像の信号強度からは漿液性嚢胞腺腫（serous cystadenoma）が最も疑われる
- また同腫瘍の軸捻転を疑う所見あり
- 上記より、漿液性腫瘍（漿液性嚢胞腺腫）による軸捻転疑いとなる
- また本検査前後の画像を経時的に見てみると、子宮と漿液性腫瘍の位置が変化しているのが分かる
- これより、軸捻転による急性腹症が発症したが、自然に捻転が解除されたと考える事ができる
- その後、他院にて保存的に加療されている
➡初回MRI
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➡初回から10か月後のMRI
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【卵巣腫瘍茎捻転】
・卵巣腫瘍茎捻転は婦人科救急疾患の約3％
・若年女性に多く見られ、閉経後や小児にも生じる
・成熟奇形腫や機能性嚢胞などに合併しやすい事が知られている
・理由は周囲との癒着が生じにくい事
・また妊娠中の発症が2～3割程度を占めるというデータもある
・主な症状は腹痛で、一過性の事もあるが、これは捻転と自然解除を繰り返していると考えられている
・画像所見は次のようなものがある
- 捻転茎の抽出
- 子宮の患側への偏位
- 卵巣腫大や浮腫、出血など
・捻転における機序は次の通り
- 何らかの原因で捻転が起きると、まず静脈うっ滞と動脈からの血液流入によって、うっ血状態に陥り、浮腫性肥厚を認めるようになる
- その後、うっ滞が進行すると静脈閉塞による出血性梗塞になり卵巣は腫大する
- さらに進行すると、動脈も閉塞し造影効果を失う
・治療は対象腫瘍の摘出術、また梗塞を伴わない場合は捻転解除のみの事もある
参考書籍：すぐ役立つ救急のCT・MRI 改定第2版
婦人科MRIアトラス 改定第2版