von Recklinghausen病に合併した神経鞘腫内に形成された仮性動脈瘤からの 出血が原因と考えられた血胸の１例

A ６２‐year‐old female with von Recklinghausen disease was referred to our hospital for left chest pain due to hemothorax and a heterogeneous mass in the posterior chest wall. The complete blood count and coagulation parameters were normal. A left chest tube was inserted, and approximately５００ml of hemorrhagic pleural effusion was drained. Computed tomography and magnetic resonance imaging revealed a tumor with hematoma and fatty degeneration and a pseudoaneurysm in the posterior portion of the fourth to seventh ribs. The tumor had not invaded the vertebral body and canal and other distant organs. Percutaneous needle biopsy of the tumor showed a schwannoma with no evidence of malignancy. Surgery was performed, and the tumor was resected in combination with the chest wall. Because of its course, the tumor was considered to be a schwannoma that originated from the intercostal nerves, and rapid pathological examination revealed no malignancy. The defect of the chest wall was reconstructed using DualMesh. The clinical course was satisfactory, and the patient was discharged １０ days after surgery. The pathological diagnosis was a benign schwannoma with hematoma and pseudoaneurysm, which was suspected to have caused the hemothorax.