Paraquat에 의한 폐손상: HRCT의 장기간 추적

김영통,배원경,김일영,임한혁,Kim, Yeong-Tong,Bae, Won-Gyeong,Kim, Il-Yeong,Im, Han-Hyeok 대한영상의학회 2004 대한영상의학회지 Vol.50 No.3

목적: Paraquat에 의한 폐 손상의 장기간 추적 CT소견을 알아보고자 하였다. 대상과 방법: Paraquat 중독 환자 중에서 6개월 이상의 추적 CT사진을 얻은 6명의 CT를 분석하였다. 추적 CT는 7-84개월(평균 25.7개월)에 걸쳐 1-6번(평균: 3.3번)을 시행하였다. 1-2개월, 3-12개월, 1-2년, 2-3년, 7년이상의 CT소견들을 분석하였다. 결과: Paraquat에 의한 폐 손상의 HRCT에서 1-2개월에는 기관지 확장증을 동반한 불규칙한 모양의 경화를 보였고(5/5), 3-12개월에는 불규칙한 모양의 경화와 마쇄유리상음영을 보였고(5/5), 1년이후에는 불규칙한 모양의 경화와 마쇄유리상음영(4/5), 혹은 국소적인 벌집모양(1/5)을 보였다. 같은 환자의 추적 CT에서 병변의 방사선음영이 줄었고 국소적인 경화의 일부는 소실되었다. 결론: Paraquat에 의한 폐 손상 환자의 추적 HRCT의 소견은 중독후 1-2개월에는 불규칙한 모양의 경화를, 3-12개월이후에는 불규칙한 모양의 경화와 마쇄유리상음영, 혹은 벌집모양을 보였다. 중독후 3-12개월이후부터 Paraquat에 의한 폐 손상은 호전되었다. Purpose: To determine the long-term follow-up CT findings of paraquat-induced lung injury. Materials and Methods: Six patients who ingested paraquat underwent sequential follow-up CT scanning during a period of at least six months, and the results were analysed. Scans were obtained 1-6 (mean, 3.3) time during a 7-84 (mean, 25.7) months period, and the findings at 1-2 months, 3-12 months, 1-2 years, 2-3 years, and more than above 7 years after poisoning were analyzed. Results: We observed irregular-shaped areas of consolidation with traction bronchiectasis at 1-2 months (5/5), irregular-shaped consolidation and ground-glass opacity (5/5) at 3-12 months, and irregular-shaped consolidations/ground-glass opacity (4/5) and focal honeycombing (1/5) one year later. In the same patients, follow-up CT scans showed that some areas of focal consolidation could not be visualized and the radio-opacity of the lesions had decreased. Conclusion: The HRCT findings of paraquat-induced lung injury were irregular shaped areas of consolidation 1-2 months after ingestion, and irregular-shaped consolidation and ground-glass opacity or focal honeycombing 3-12 months later. At this thim slight improvement was observed.

증례 : 호흡기; 17세까지 천식으로 오인된 식도이완불능증

김혜진 ( Hye Jin Kim ),김명신 ( Myung Shin Kim ),임건일 ( Gune Il Lim ),박윤선 ( Youn Sun Park ),임한혁 ( Han Hyeok Im ),황헌규 ( Hun Gyu Hwang ) 대한내과학회 2013 대한내과학회지 Vol.85 No.3

식도이완불능증은 하부식도괄약근의 이완장애 및 식도체부의 연하운동부전을 특징으로 하는 식도운동장애질환으로 연하장애를 동반한다. 소아 및 청소년에서 가장 흔한 증상은 구토, 연하곤란, 체중감소, 반복적인 폐렴, 야간기침, 흉통 등이 발생할 수 있다. 4세경부터 운동시 유발되는 호흡곤란과 기침증세를 보였으며, 치료에 반응을 잘 보이지 않는 천식의 과거력이 있는 17세 환아가 내원 1주 전부터 발생한 기침, 객담, 발열을 주소로 내원하여 마침내 식도이완불능증과 식도하부확장, 폐렴, 기관지확장증으로 진단되어 풍선확장술을 시행 받고 호흡기 증세의 호전을 보여 문헌고찰과 함께 보고하는 바이다. Achalasia is a primary esophageal motility disorder characterized by functional obstruction of the distal esophagus and subsequent dilation of the proximal esophagus. The most common symptoms in children and adolescents are vomiting, progressive dysphagia, weight loss, recurrent pneumonia, nocturnal cough, and chest pain. A girl who had been diagnosed with asthma poorly responsive to inhaled steroids until age 17, presented at the hospital with cough, sputum, and fever. Finally, she was diagnosed with achalasia and underwent esophageal balloon dilatation, which relieved her GI and pulmonary symptoms. We report this case with a literature review. (Korean J Med 2013;85:308-312)

사지마비로 장기 침상안정 환자에서 폐결핵 발생부위 변화

황헌규 ( Hun Gyu Hwang ),정은정 ( Eun Jung Jung ),임건일 ( Gune Il Lim ),양승부 ( Seung Boo Yang ),임한혁 ( Han Hyeok Im ) 대한결핵 및 호흡기학회 2010 Tuberculosis and Respiratory Diseases Vol.69 No.1

Pulmonary tuberculosis has intermediate prevalence in Korea. It is known that tuberculosis infection predominantly involves the upper lobes, based on the fact that multiplication of Mycobacterium tuberculosis is favored in areas with decreased pulmonary blood flow, impaired lymphatic drainage, and high oxygen tension. We report this case of a 40-year-old man who was brought to our hospital with hemoptysis and dyspnea. Prior to admission, the patient had been in a bedridden state for 15 years due to an injury of the cervical spine 4~5. A 3-Dimensional computed tomography showed predominantly longitudinal distribution of centrilobular nodules along the anterior chest wall, in the left lung. MTB-PCR and AFB culture of bronchial washing fluid revealed pulmonary tuberculosis. This case shows that long-standing supine posture and decreased motion of the anterior chest wall may change the distribution of preferential infection site of Mycobacterium tuberculosis in the lung, resulting in a ventral predominance of tuberculosis infection in the quadriplegic patient.

증례 : 호흡기 ; Teflon 흡입으로 인해 발생한 화학성 폐렴

이지연 ( Ji Yeon Lee ),김민정 ( Min Jung Kim ),유진영 ( Jin Yong Yoo ),안병규 ( Byung Kyu Ahn ),황헌규 ( Hun Gyu Hwang ),임건일 ( Gune Il Lim ),임한혁 ( Han Hyeok Im ) 대한내과학회 2011 대한내과학회지 Vol.80 No.2S

테프론 흡입에 의한 발열, 오한, 기침 등의 임상증상은 ``중합체 연기발열``이라 하며 노출된 양상과 정도에 따라 다양한 임상양상을 보인다. 저자들은 44세 남성에서 테프론에 젖은 담배를 5분간 흡입하고 나서 발생하였고, 산소 치료 및 스테로이드 사용으로 합병증 없이 회복된 화학성 폐렴 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Chemical pneumonitis is defined as lung irritation caused by inhalation of substances toxic to the lungs. Acute chemical pneumonitis causes swelling of the lung tissue, movement of fluid into the air spaces in the lung, and a decreased ability to absorb oxygen and eliminate carbon dioxide. Teflon (polytetrafluoroethylene) is a commonly used synthetic fiber or insulator. To our knowledge, chemical pneumonitis and acute respiratory failure induced by Teflon inhalation has not been previously reported in Korea. We experienced a 44-year-old patient who had a cough and dyspnea that were aggravated 10 h after smoking tobacco wet by Teflon for 5 min at his workplace. Upon arrival at the emergency room, his blood pressure was low and his arterial blood gas analysis revealed hypoxemia. A chest radiograph showed diffuse haziness on both mid- to-lower lung fields. Following treatment by conservative therapy, including oxygen supply and steroid use, his condition was relatively good and his chest radiograph normalized. (Korean J Med 2011;80:S194-S198)

증례 : 호흡기 ; 결핵성 흉막염을 동반한 갑상선 유두암의 폐전이 1예

안병규 ( Byung Kyu Ahn ),박세윤 ( Se Yun Park ),황헌규 ( Hun Gyu Hwang ),임건일 ( Gun Il Lim ),김숙 ( Sook Kim ),양승부 ( Seung Boo Yang ),임한혁 ( Han Hyeok Im ) 대한내과학회 2010 대한내과학회지 Vol.79 No.3

저자들은 70세 여자 환자가 흉수소견으로 내원하여 흉수 천자 및 늑막 조직검사를 시행하여 결핵성 흉막염이 진단되었으나, 아데노신 탈아미노효소가 2.4 IU/L로 낮았고, 흉부 전산화단층촬영상 우하엽에 폐종괴 소견과 양측 미세결절이 관찰되었다. 경흉 세침흡입 세포검사에서 5년 전 전절제술을 받았던 갑상선 유두암의 폐전이가 진단되어, 결핵성 흉막염을 동반한 갑상선 유두암의 폐전이 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Papillary thyroid carcinoma is the most prevalent type of thyroid cancer. Metastasis of this carcinoma commonly occurs in the lung and has been reported to present 5 to 30 years after the initial diagnosis of thyroid cancer. Pleural effusion can mask this metastatic spread. In patients with pleural effusion, laboratory measurement of the adenosine deaminase (ADA) level in the pleural fluid can be effective in identifying and ranking pulmonary metastasis in the differential diagnosis. A 70-year-old female patient visited our hospital with dyspnea. She presented with a considerable amount of pleural effusion. A pleural biopsy was performed and the Ziehl-Neelsen stains revealed a few acid-fast bacilli, but the ADA level in the pleural fluid was 2.4 IU/L. After drainage of the pleural effusions, we discovered pulmonary nodules by computed tomography (CT), which were later diagnosed through histologic examination as pulmonary metastasis from papillary thyroid carcinoma. We report this case. (Korean J Med 79:311-315, 2010)

골반 골절에 동반된 동맥 출혈에서의 경피적 동맥색전술의 유용성

양승부,임한혁,최교창 순천향의학연구소 2005 Journal of Soonchunhyang Medical Science Vol.11 No.1

Purpose : To determine the usefullness of transcatheter embolization of arterial bleeding in patients with pelvic bone fracture. Materials and Methods : Between March 2003 and December 2004, we evaluated 13 injuried arteries of eight patients with pelvic bone fracture, All patients underwent angiography, followed by transcatheter arterial embolization using gelfoam. We investigated the vital sign, survival rate and complication of transcatheter arterial embolization. Results : Angiography revealed extravasation of cantrast media in six patients; extravasation and abrupt cut-off of an artery in two. The injured arteries involved(n=13) were internal pudendal(n=4), obturator(n=3), inferior gluteal(n=3), iliolumbar(n=2) and superior gluteal artery(n=1). Transcather arterial embolization was technically successful and there was no complication in all cases. Old age patients(n=2, >60years) died due to hypovolemia and pulmonary complication. Conclusion : Transcatheter arterial embolization of arterial bleeding is a useful procedure in lowering the mortality and complication in pelvic bone fracture.

경도관 동맥색전술을 이용한 비정상 자궁출혈의 치료

양승부,최교창,이상진,정영진,임한혁,한효상,황인철,조환성 순천향의학연구소 2005 Journal of Soonchunhyang Medical Science Vol.11 No.1

Objective : Our purpose of this study is to evaluate the effectiveness of the transcatheter arterial embolization for the management of abnormal uterine bleeding. Materials and Methods : 14 patients with massive or recurrent uterine bleeding underwent percutaneous transcatheter arterial embolization between February 2003 and September 2004. We reviewed 14 cases of uterine artery or internal iliac artery embolization using gelfoam or PVA particles. Results : Good management of uterine bleeding was achieved in 13 of 14(93%) cases. The cause of abnormal uterine bleeding was myoma(5 case), post D & E bleeding(3), acquired vascular malformation(3), pseudoaneurysm(1), adenomyosis(1), and endometrial hyperplasia(1). Conclusion : Transcatheter artery embolization is an effective and life-saving procedure in massive or recurrent uterine bleeding. Early diagnosis and prompt transcatheter arterial embolization is a useful mangement of uterine bleeding.