소아에서 발생한 비-A, B, C형 바이러스성 간염의 임상 고찰

손승국,박재홍,Son, Seung Kook,Park, Jae Hong 대한소아소화기영양학회 2005 Pediatric gastroenterology, hepatology & nutrition Vol.8 No.1

목 적: 소아에서 발생하는 급성 간염 중 많은 빈도를 차지하는 비-A, B, C 바이러스성 간염의 원인과 간염의 임상적 특징 및 경과에 대한 임상 양상에 대해 알아보고자 하였다. 방 법: 2001년 1월부터 2004년 6월까지 부산대학교병원 소아과에서 급성 간염으로 진단된 환자 중 독성, 대사성, 자가 면역성 간염과 신생아 간염은 제외하고 A형, B형, C형의 간염 바이러스 표지자 검사에서 음성 판정을 받은 총 45명의 환아를 대상으로 하여 후향적으로 원인 및 임상적 특징을 분석하였다. 결과: 1) 45명 중 원인 불명의 바이러스성 간염이 26명(57.8%)이었고, CMV 간염이 14명(31.1%), EBV와 HSV 간염이 각각 2명(4.4%), RV 간염이 1명(2.2%)이었다. 2) 남녀비는 1.8 : 1 이었고, 1세 이하가 27명(60.0%)이었다. 3) 여름에 환자 발생이 18명(40.4%)으로 가장 많았고, 동반 증상으로는 발열 13명(28.9%), 오심 또는 구토 12명(26.7%), 황달 10명(22.2%), 설사 8명(17.8%)의 순으로 많았다. 4) 신체 검사에서 간종대가 15명(33.3%), 공막 및 피부 황달 10명(22.2%), 비종대 9명(20.0%)이었다. 5) 임상 경과는 전형적인 급성 간염이 43명(95.6%), 전격성 간염이 2명(4.4%)이었으며, 한 명은 간부전으로 사망했다. 6) 혈청 ALT의 최고치는 $488.7{\pm}771.9IU/L$였고, 원인 불명의 간염이 $606.2{\pm}962.2IU/L$로 비교적 높았다. 7) 혈청 ALT는 2년 동안 경과 추적이 가능했던 38명 중 31명(81.6%)이 6개월 이내에, 4명(10.5%)이 1년 이내에 정상화되었다. 3명(7.9%)이 1년 이상 증가되었지만, 1년 6개월 이내에 모두 정상화되었다. 8) 혈액학적 이상으로 백혈구 증가증이 17명(47.2%)이었고, 재생 불량성 빈혈, 비정형적 림프구증가증, 혈소판 감소증이 각각 1명(2.8%) 있었다. 결 론: 비-A, B, C형 바이러스성 간염은 대부분 예후가 양호하나, 임상적으로 만성 간염의 경과를 보인 경우도 있고 전격성 간염으로 진행한 경우가 있으므로 면밀한 관찰이 필요하다. Purpose: Non-A, B, C viral hepatitis is the name given to the disease with clinical viral hepatitis, but in which serologic evidence of A, B, C hepatitis has not been found. Little is known about the etiology and clinical features of non-A, B, C viral hepatitis in children. Methods: A clinical analysis of 45 cases with non-A, B, C viral hepatitis who were admitted to the Department of Pediatrics, Pusan National University Hospital, from January 2001 to June 2004 was carried out retrospectively. Patients who were positive for HBsAg, anti-HAV and anti-HCV and had toxic, metabolic, autoimmune, or neonatal hepatitis were excluded in this study. Results: Among 45 cases of non-A, B, C viral hepatitis, the etiology was unknown in 26 (57.8%), CMV (cytomegalovirus) in 14 (31.1%), EBV (Epstein Barr virus) in 2 (4.4%), HSV (herpes simplex virus) in 2 (4.4%) and RV (rubella virus) in 1 (2.2%). Twenty seven out of 45 (60.0%) patients were under 1 year of age. Sixteen (33.3%) patients had no specific clinical symptoms and were diagnosed incidentally. On physical examination, twenty seven out of 45 patients (60.0%) had no abnormal findings. Forty three out of 45 patients (95.6%) showed classic clinical course of acute viral hepatitis, whereas fulminant hepatitis developed in two patients. Mean serum ALT (alanine aminotransferase) level was $448.7{\pm}771.9IU/L$. Serum ALT level was normalized in 31 out of 45 patients (81.6%) within 6 months and all patients within 18 months. Aplastic anemia was complicated in a case. Conclusion: Although most patients with non-A, B, C viral hepatitis showed a good prognosis, a careful follow-up would be necessary because some of them had a clinical course of chronic hepatitis, fulminant hepatitis and severe complication such as aplastic anemia.

대구·부산 지역에서 수술을 요하는 신생아 소화기 질환의 임상적 고찰

손승국,박재홍,최병호,최광해,이경훈,Son, Seung Kook,Park, Jae Hong,Choi, Byung Ho,Choi, Kwang Hae,Lee, Kyoung Hoon 대한소아소화기영양학회 2004 Pediatric gastroenterology, hepatology & nutrition Vol.7 No.2

목적: 대구 부산 지역에서 신생아 시기에 수술이 시행된 소화기 질환의 최근 현황과 이와 관련된 임상적 소견들을 살펴보고 현재 소아 소화기 질환의 술 후 합병증과 사망률 등의 치료성과에 대해 살펴보았다. 방법: 1996년 1월부터 2003년 7월까지 부산대학교, 경북대학교, 영남대학교 및 대구가톨릭대학교 병원에서 생후 1개월 이내에 소화기 질환으로 수술을 시행받은 202명을 대상으로 하여 임상적 소견을 분석하였다. 결과: 1) 항문 직장 기형이 48명(23.8%), 선천성 중장 폐쇄가 27명(13.4%), 비후성 유문 협착증이 27명(13.4%), 선천성 거대 결장이 22명(10.9%), 십이지장 폐쇄가 15명(7.4%) 등의 빈도순을 보였다. 2) 남녀비는 2.8 : 1로 남아가 우세하였고, 비후성 유문 협착증과 장 회전 이상에서는 남아가 10배 이상 많았다. 3) 동반 기형의 빈도는 선천성 심장 기형, 잠복 고환, 수신증 등의 순서로 많았으며, 제대 기저부 탈장에서는 50%에서 동반 기형이 있었다. 4) 20명(9.9%)의 환아가 산전에 진단되었는데, 선천성 장폐쇄, 십이지장 폐쇄, 복벽 개열증, 제대 기저부 탈장과 같이 장 내 공기 패턴이 특이 소견을 보이는 경우였다. 5) 평균 입원 기간은 22.8일이었고, 신생아 괴사성 장염이 44.7일로 가장 길었다. 6) 술 후 합병증은 주로 창상 감염 또는 문합부 누출 등 사소한 합병증으로 18례(8.9%)에서 발생하였다. 7) 사망률은 횡격막 탈장증(37.5%), 식도 폐쇄(28.6%), 제대 기저부 탈장(20.0%) 순으로 많았으며, 12명이 사망하여 5.9%의 사망률을 보였다. 결론: 대구 부산 지역에서 신생아 시기에 소화기 질환으로 수술을 받았던 환자들의 질병 종류가 다양해졌고, 술 후 합병증과 사망률이 현저히 감소함을 알 수 있었으며, 이것은 관련 분야의 발전에 기인한 것으로 판단된다. Purpose: Perinatal mortality rates have been used as a summary statistic for evaluating child health and medical status. Neonatal mortality rates have decreased over the past 30 years in Korea. To understand the current status of neonatal surgical gastrointestinal diseases in Daegu Busan area, we have studied about neonatal gastrointestinal diseases with their clinical features, postoperative outcome, and mortality rates. Methods: A clinical analysis on 202 neonates who underwent neonatal surgery from January 1996 to July 2003 at Pusan National University, Kyungpook National University, Youngnam University, and Daegu Catholic University was carried out. Results: The main diseases of surgical conditions were anorectal malformation (23.8%), atresia/stenosis of midgut (13.4%) and pyloric stenosis (13.4%). The male to female ratio was 2.8 : 1. Thirty-five cases (17.0%) had one or more associated anomalies including congenital heart disease, cryptoorchidism, hydronephrosis, and chromosomal anomaly. Twenty cases (10.0%) were diagnosed by antenatal ultrasound. Patients with esophageal atresia had the longest hospitalization for 54.6 days. Postoperative complications occurred in 18 cases (8.9%). The main postoperative complications were wound infection (3.5%) and anastomotic leakage (2.5%). Overall mortality was 5.9%. Diaphragmatic hernia showed the highest mortality rate (37.5%), and esophageal atresia (28.6%) and omphalocele (20.0%) were followed. Conclusion: The current status of neonatal surgical gastrointestinal diseases in Daegu Busan area has improved because the disease categories are various, postoperative complications and mortality rates are decreased.

청소년에서 진단된 미만성 범세기관지염 1예

김형영 ( Hyung Young Kim ),손승국 ( Seung Kook Son ),박희주 ( Hee Ju Park ) 대한천식알레르기학회(구 대한알레르기학회) 2016 Allergy Asthma & Respiratory Disease Vol.4 No.1

Diffuse panbronchiolitis (DPB) is a progressive inflammatory respiratory disease of unknown cause mainly occurring in East Asian people. Studies on causes of the disease point to a genetic predisposition unique to Asians, but the cause remains unknown. If untreated, DPB progresses to bronchiectasis, respiratory failure, and death. The age of patients at onset of the disease varies from young to elderly people with a peak at 40?60 years. A few cases of DPB have been reported in Korean adults since 1992; however, the case of DPB in children is uncommon. Herein, we describe a 16-year-old girl with DPB who presented with chronic cough and sputum. (Allergy Asthma Respir Dis 2016;4:65-69)

소아 환자에서의 괴사성 폐렴의 임상적 고찰

박경미 ( Kyung Mi Park ),손승국 ( Seung Kook Son ),김혜영 ( Hye Young Kim ),김용우 ( Yong Woo Kim ),황재연 ( Jae Yeon Hwang ),박희주 ( Hee Ju Park ) 대한소아알레르기호흡기학회 1992 소아알레르기 및 호흡기학회지 Vol.2 No.3

Purpose: Necrotizing pneumonia (NP) is a complication of invasive pneumonia. Few studies have reported on the clinical features of NP in children. Methods: Nineteen patients with NP who were admitted to Pusan National University Hospital and Pusan National University Children``s Hospital between December 2008 and March 2013, were studied in terms of sex, age at diagnosis, clinical characteristics, detected organisms, radiologic findings, treatments and clinical outcomes. Results: Twelve patients (63.2%) were males and seven patients (36.8%) were female. Eight patients (44.4%) were younger than 5 years of age, seven patients (38.9%) were at 6.10 years of age and four patients (21.1%) were older than 11 years of age. Most patients had fever and cough at the time of diagnosis. Minorganism were identified in 9 cases (47.4%): Mycoplasma pneumonia in 4 (21.1%), Streptococcus pneumonia in 1 (5.3%), Staphylococcus aureus in 1 (5.3%), G+cocci in 1 (5.3%), and M. pneumonia + S. pneumoniae coinfection in 2 (10.5%). The diagnosis of NP was established by computerized tomography. Cavitary necrosis was shown in all patients, and pleural effusion was shown in 15 patients (78.9%). Six patients (31.6%) presented local atelectasis and 2 patients (10.5%) presented pneumothorax. Five patients (26.3%) treated with only antibiotics were cured completely. Invasive treatment was needed by 14 patients (73.7%): 10 patients (52.6%) needed chest tubing, and 5 patients (26.3%) needed surgery. Only one patient (5.3%) expired. Conclusion: NP is a rare complication of pneumonia in children and has a good prognosis, typically resolving completely with medical treatment alone. However, patients who present with the worsening of clinical status or pleural complications despite the use of appropriate antibiotics should be evaluated for surgical indications. (Allergy Asthma Respir Dis 2014;2:208-212)

소아 환자에서의 괴사성 폐렴의 임상적 고찰

박경미 ( Kyung Mi Park ),손승국 ( Seung Kook Son ),김혜영 ( Hye Young Kim ),김용우 ( Yong Woo Kim ),황재연 ( Jae Yeon Hwang ),박희주 ( Hee Ju Park ) 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.3

Purpose: Necrotizing pneumonia (NP) is a complication of invasive pneumonia. Few studies have reported on the clinical features of NP in children. Methods: Nineteen patients with NP who were admitted to Pusan National University Hospital and Pusan National University Children``s Hospital between December 2008 and March 2013, were studied in terms of sex, age at diagnosis, clinical characteristics, detected organisms, radiologic findings, treatments and clinical outcomes. Results: Twelve patients (63.2%) were males and seven patients (36.8%) were female. Eight patients (44.4%) were younger than 5 years of age, seven patients (38.9%) were at 6-10 years of age and four patients (21.1%) were older than 11 years of age. Most patients had fever and cough at the time of diagnosis. Minorganism were identified in 9 cases (47.4%): Mycoplasma pneumonia in 4 (21.1%), Streptococcus pneumonia in 1(5.3%), Staphylococcus aureus in 1 (5.3%), G+cocci in 1 (5.3%), and M. pneumonia + S. pneumoniae coinfection in 2 (10.5%). The diagnosis of NP was established by computerized tomography. Cavitary necrosis was shown in all patients, and pleural effusion was shown in 15 patients (78.9%). Six patients (31.6%) presented local atelectasis and 2 patients (10.5%) presented pneumothorax. Five patients (26.3%) treated with only antibiotics were cured completely. Invasive treatment was needed by 14 patients (73.7%): 10 patients (52.6%) needed chest tubing, and 5 patients (26.3%) needed surgery. Only one patient (5.3%) expired. Conclusion: NP is a rare complication of pneumonia in children and has a good prognosis, typically resolving completely with medical treatment alone. However, patients who present with the worsening of clinical status or pleural complications despite the use of appropriate antibiotics should be evaluated for surgical indications.

새로운 CPS1 유전자 돌연변이에 의한 신생아형 carbamoyl phosphate synthetase 1 결핍 1례

서승현,김유미,변신연,손승국,김성헌,김형태,김구환,유한욱,Suh, Seung-hyun,Kim, Yoo-Mi,Byun, Shin Yun,Son, Seung Kook,Kim, Seong Heon,Kim, Hyung Tae,Kim, Gu-Hwan,Yoo, Han-Wook 대한유전성대사질환학회 2016 대한유전성대사질환학회지 Vol.16 No.2

Carbamoyl phosphate synthetase 1 (CPS1) 결핍은 상염색체 열성 유전을 하는 매우 드문 유전질환으로, 요소 회로의 첫 번째 효소인 carbamoyl phosphate synthetase의 결핍에 의해 고암모니아혈증을 유발한다. CPS1 결핍은 신생아시기부터 성인까지 다양한 시기에 고암모니아혈증이 발현될 수 있으나 대부분 신생아 시기의 치명적인 고암모니아혈증으로 발현하여 예후가 불량하며 응급 투석 및 집중 치료가 필요하다. 본 증례는 드문 유전 질환인 CPS1 결핍 신생아에서 새로운 CPS1 유전자의 돌연변이를 발견하였고 조직적인 팀 접근을 통해 심각한 고암모니아혈증에 대한 신속한 투석 및 집중 치료를 시행하여 심한 뇌 병변 및 사망을 예방하고 양호한 경과를 보였음을 보고하는 바이다. Carbamoyl phosphate synthetase 1 (CPS1) deficiency is an autosomal recessive urea cycle disorder which causes hyperammonemia. CPS1 is the first enzyme step in the urea cycle and almost patients present their symptoms during neonatal period. We report a case of CPS1 deficiency in a boy who developed symptoms including lethargy and seizure at 3 days of age. The ammonia level was up to $2,325{\mu}mol/L$, sodium benzoate (250 mg/kg/d) and high calories of both dextrose and lipid was promptly administered. Central access by experienced pediatric surgeon and emergent continuous hemodialysis by pediatric nephrologist was performed within 3 hours and ammonia was less than $100{\mu}mol/L$ at 5 days of age. Currently, he has showed excellent response to treatments including scavenging drugs and a low-protein diet. Despite of diffuse increasing signal intensity on cerebral white matters and basal ganglia on brain MRI, his development and weight gain were good at the last follow-up at 11 months of age. Molecular assay of the CPS1 gene demonstrated that patient had compound heterozygous for c.1529del ($p.Gly510Alafs^*5$) in exon 14 and c.3142-1G>C (IVS25(-1)G>C) in intron 25 and exon 26 boundary. The splicing mutation was novel mutation and inherited from patient's mother. Here, we report a neonatal lethal type CPS1 deficiency patient having novel mutation.

소아의 폐렴과 중추신경계 감염에서 급성 저나트륨혈증의 발생 양상

신성현,엄태민,이윤진,손승국,김성헌,김수영,Shin, Sung Hyun,Um, Tea Min,Lee, Yun Jin,Son, Seung Kook,Kim, Seong Heon,Kim, Su Yung 대한소아신장학회 2012 Childhood kidney diseases Vol.16 No.2

목적: 소아 입원 환자에서 유지용액을 기존의 저장성 수액 대신 등장성 수액으로 대체해야 된다는 주장이 제기되어왔다. 소아에서의 폐렴과 중추신경계 감염은 항이뇨 호르몬의 분비 자극으로 인해 저나트륨혈증이 흔히 발생할 수 있는 임상적인 상황으로 알려져 있다. 이에 저자들은 소아에서 폐렴과 중추신경계 감염질환에서 저나트륨혈증의 발생률을 확인하고 유지용액 선택의 중요성과 관련 인자들에 대해 조사하고자 본 연구를 시행하게 되었다. 방법: 부산대학교 어린이병원에 2008년 11월부터 2011년 8월까지 폐렴과 중추신경계 감염질환진단하에 입원하여 유지용액을 투여받고 혈장 나트륨 농도가 측정된 1992명의 환아를 대상으로 하였다. 저나트륨혈증은 혈장 나트륨 농도가 135 mEq/L 미만일 때로 정의하였다. 검사결과를 포함한 임상적 자료는 후향적으로 분석되었다. 결과: 연구기간 동안 1,992명 중 218명의 환아가 급성 저나트륨혈증으로 확인되었다. 따라서 총 발생률은 10.9%였다. 저나트륨혈증의 발생률은 뇌염에서 가장 높았고 세균성 뇌수막염, 바이러스성 뇌수막염, 세균성 폐렴, mycoplasma성 폐렴, 바이러스성 폐렴 순으로 발생률의 차이를 나타내었다. 세균성 폐렴에서의 발생률은 바이러스성 폐렴의 발생률에 비해 의미있게 높은 결과를 보였다. 또한 뇌염에서의 발생률은 바이러스성 뇌수막염의 발생률에 비해 의미있게 높은 결과를 보였다. 평균발생연령은 저나트륨혈증 환아군이 정상나트륨혈증 환아군에 비해 의미있게 높았다. 저나트륨혈증의 발생률은 D5 0.18% NS 투여군이 D5 1/2NS 투여군에 비해 의미있게 높았다. 입원기간 중 저나트륨혈증이 발생한 82명의 환아 중 78명이 SIADH의 진단에 필요한 모든 검사를 시행하였고, 이중 20.5%에서 진단되었다. 결론: 저나트륨혈증의 발생률은 폐렴과 중추신경계 감염질환에서 높게 나타나며 저장성 수액의 투여는 입원 후에 발생하는 저나트륨혈증의 중요한 원인이다. 따라서 저자들은 폐렴과 중추신경계 질환이 있는 환아에서 유지용액으로 D5 0.18% NS 보다 D5 1/2NS의 투여를 권장하는 바이다. Purpose: The option of selecting isotonic rather than hypotonic fluids for maintenance fluid in children has been advocated by some authors. Pneumonia and CNS infections are frequent clinical settings for acute hyponatremia because of nonosmotic anti-diuretic hormone stimuli in children. We conducted the present study to identify the incidence of hyponatremia in pneumonia and CNS infection of children and to determine the importance of maintenance intravenous fluid therapy regimen and other related factors. Methods: The study included 1,992 patients admitted to the Department of Pediatrics at Pusan National University Children's Hospital between November 2008 and August 2011, who were diagnosed with pneumonia or CNS infections and checked for serum sodium concentration. Their clinical data including laboratory findings were reviewed retrospectively. Results: During the study period, 218 patients were identified to have acute hyponatremia among 1,992 patients. The overall incidence of hyponatremia was 10.9%. The incidence of hyponatremia in encephalitis (37.3%) was highest and the incidence in bacterial meningitis (27.4%), viral meningitis (20.0%), bacterial pneumonia (11.1%), mycoplasma pneumonia (9.2%), and viral pneumonia (6.8%) were in descending order. The mean age was higher in hyponatremic patients than in isonatremic patients. The incidence of hyponatremia was higher in who had 0.18% NaCl in 5% dextrose (D5 0.18% NS) than 0.45% NaCl in 5% dextrose infusion (D5 1/2NS) (9.0% vs. 2.2%). SIADH was identified in 20.5% among hospital acquired hyponatremic patients after adequate evaluation for SIADH. Conclusion: We recommend D5 1/2NS rather than D5 0.18% NS as the maintenance fluid given to children with pneumonia or infectious CNS diseases.

비의인성 종격동기종 소아의 임상적 특성

이나래 ( Na Rae Lee ),손승국 ( Seung Kook Son ),김형영 ( Hyung Young Kim ),김혜영 ( Hye Young Kim ),박희주 ( Hee Ju Park ) 대한천식알레르기학회 2015 Allergy Asthma & Respiratory Disease Vol.3 No.2

Purpose: Pneumomediastinum is rare in children and adolescents, and its causes have not yet been clearly determined. We aimed to identify the causes, clinical manifestations and prognosis of noniatrogenic pneumomediastinum in children. Methods: From February 2007 to June 2014, we retrospectively investigated 121 patients with pneumomediastinum under 18 years of age in 2 hospitals. Eighteen patients with pneumomediastinum after thoracotomy and 35 patients with iatrogenic pneu￢momediastinum were excluded. Results: Sixty-eight patients were divided into 4 age groups: those under 1 year of age (n=9, 13.2%), those 1 to 5 years of age (n=9, 13.2%), those 6 to 10 years of age (n=17, 25.0%) and those over 11 years of age (n=33, 48.5%). Chest pain (n=43, 63.2%) was the most common initial complaint and subcutaneous emphysema was identified in 18 patients (26.5%). Chest x-ray was diagnostic in all except 9 patients (13.2%). Predisposing causes of pneumomediastinum were idiopathic (n=26, 38.2%), respiratory tract infection (n=23, 33.8%), asthma exacerbation (n=4, 5.9%), trauma (n=4, 5.9%), endobronchial foreign body (n=2, 2.9%), interstitial lung dis￢ease (n=5, 7.4%), and neonatal respiratory disease (n=4, 5.9%). Chest pain (P<0.001) and idiopathic cause (P=0.001) were shown to linearly increase with age. On the contrary, tachypnea (P<0.001), dyspnea (P=0.016), and interstitial lung disease (P=0.008) were shown to have a decreasing linear association with age. The length of hospital stay was significantly increased in patients with inter￢stitial lung disease (P=0.042), those with pneumothorax (P=0.044), and those without chest pain (P=0.013). Conclusion: According to age groups, there were significant differences in causes and clinical manifestations. In particular, pneumo￢mediastinum that developed in younger patients with interstitial lung disease showed unfavorable outcomes, such as dyspnea, pneumothorax, and increased length of hospital stay. Therefore, precise evaluation of predisposing causes and careful manage￢ment are needed for children with pneumomediastinum.(Allergy Asthma Respir Dis 2015;3:145-150)

소아 객혈의 원인: 나이와 객혈의 양과의 연관성

곽혜원 ( Hae Won Kwak ),김형영 ( Hyung Young Kim ),손승국 ( Seung Kook Son ),김혜영 ( Hye Young Kim ),박희주 ( Hee Ju Park ) 대한천식알레르기학회 2016 Allergy Asthma & Respiratory Disease Vol.4 No.2

Purpose: Studies on hemoptysis is rare because hemoptysis is an uncommon symptom in children. The aim of this study was to identify the causes of hemoptysis in children. Methods: Medical chart review of patients with hemoptysis was retrospectively conducted at 2 tertiary hospitals from November 2008 to December 2014. Patients were divided into 3 groups according to age. The amount of hemoptysis was categorized as mild (<20 mL/day), moderate (20-99 mL/day), and massive (≥100 mL/day). Results: A total of 59 patients were identified, and their mean age was 11.0±5.6 years. Among the causes of hemoptysis, respiratory tract infection was most common. Other causes included vasculitis syndrome, neoplasm in the airway, idiopathic pulmonary hemosiderosis, cardiac disease, and bronchiectasis. According to age, a significant difference was identified between the age groups in children with pneumonia (<6 years vs. 12-18 years, P=0.001). Differences were verified between the age groups in children with tuberculosis (<6 years vs. 12-18 years and 6-11 years vs. 12-18 years, P=0.023). According to amounts of hemoptysis, no significant difference was identified regardless of the causes. Conclusion: This study showed that the causes of hemoptysis in children were heterogeneous and the respiratory tract infection was most common. In children with hemoptysis, the age of onset and the amount of hemoptysis are needed to be considered for more precise diagnosis and more proper management of the underlying cause of hemoptysis. (Allergy Asthma Respir Dis 2016;4:114-118)

전산화 단층 촬영을 통해 발견된 소아 기관기관지(Tracheal Bronchus)의 임상적 고찰

김용석 ( Yong Seok Kim ),엄태민 ( Tae Min Um ),손승국 ( Seung Kook Son ),김혜영 ( Hye Young Kim ),김용우 ( Yong Woo Kim ),박희주 ( Hee Ju Park ) 대한소아알레르기호흡기학회(구 대한소아알레르기 및 호흡기학회) 2012 소아알레르기 및 호흡기학회지 Vol.22 No.4

목 적 : 기관기관지는 기관분기부 상부의 기관의 측벽에서 기원하는 이소성 기관지로, 대개 무증상으로 우연히 발견되며, 다른 기형과 동반되는 경우가 많다. 본 연구에서는 기관기관지의 임상 양상에 대해서 알아보고자 한다. 방 법 : 2000년 1월부터 2011년 12월까지 흉부 전산화단층 촬영 스캔을 실시하여 기관기관지로 진단된 19례를 대상으로 이들의 증상, 방사선학적 소견, 동반 기형의 유무 등 임상 양상을 후향적으로 조사하였다. 결 과 : 기관기관지로 진단될 때 나이는 2일부터 14세까지(평균 51개월)였으며, 남아가 12명(63.2%), 여아가 7명(36.8%)이었다. 우측 기관기관지가 18명(94.7%), 좌측 기관기관지가 1명(5.3%)으로 대부분 우측에서 기원하였고, 기관지의 수에 따라 전위형이 14명(73.7%), 과다형이 5명(26.3%)으로 전위형이 많았다. 증상은 없는 경우가 13명(68.4%)이었고, 기침 5명(26.3%), 반복적 천명이 4명(21.1%)에서 관찰되었다. 동반기형은 17명(89.5%)에서 확인되었고, 선천 심혈관계 기형이 16명(84.2%), 기관-식도루 3명(15.8%), 다운증후군 2명(10.5%)이었다. 결 론 : 기관기관지 환자에서 호흡기계 증상은 심하지 않았으나, 다른 동반 기형들이 많이 발견되었다. 따라서 반복되는 천명과 같은 증상이 있는 경우 기관기관지 여부를 확인하고, 기관기관지로 진단된 경우에는 동반 기형 여부 등에 대한 평가가 필요하겠다. 본 연구는 연구 대상에 심혈관계 기형을 가진 환자의 빈도(84.2%)가 높아 한계를 가진다. Purpose : Tracheal bronchus is an aberrant bronchus arising from tracheal wall above the carina. Most cases of tracheal bronchus are asymptomatic, so they are diagnosed incidentally. Tracheal bronchus may be associated with other anomalies. The aim of this study is to evaluate the clinical characteristics of tracheal bronchus. Methods : This study was conducted on 19 children who were diagnosed as tracheal bronchus by the chest computed tomography from January 2000 to December 2011. Based on the medical record, clinical features, such as symptoms, radiologic findings, combined anomalies were evaluated retrospectively. Results : The age at diagnosis was ranged from 2 day to 14 years (mean, 51 months). Among the 19 children, twelve children (63.2%) were boys and seven children (36.8%) were girls. Eighteen children (94.7%) had right-side tracheal bronchus and one child (5.3%) had left-side tracheal bronchus. Displaced type were fourteen children (73.7%), supernumerary type were five children (26.3%). Thirteen children (68.4%) had no respiratory symptoms, but five children (26.3%) had persistent cough and four children (21.1%) had recurrent wheezing. Combined congenital abnormalities were present in seventeen children (89.5%), including congenital cardiovascular anomaly (n=14, 73.7%), trachea-esophageal fistula (n=3, 15.8%), Down syndrome (n=2, 10.5%). Conclusion : The patients with tracheal bronchus had not severe respiratory symptoms, but had many combined anomalies. So, it is necessary to consider the presence of tracheal bronchus in children with respiratory symptom, like recurrent wheezing, and to evaluate clinical significance, like combined anomaly, in tracheal bronchus patients. The limitation of this study is that the study group includes many cardiovascular disease patients (84.2%). [Pediatr Allergy Respir Dis(Korea) 2012;22:411-416]