Tuberculosis and Respiratory Diseases
- 제44권6호
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- Pages.1308-1317
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- 1997
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- 1738-3536(pISSN)
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- 2005-6184(eISSN)
폐국균종의 임상적 고찰
Clinical Characteristics of Pulmonary Aspergilloma
- 강태경 (경북대학교 의과대학 내과학교실) ;
- 김창호 (경북대학교 의과대학 내과학교실) ;
- 박재용 (경북대학교 의과대학 내과학교실) ;
- 정태훈 (경북대학교 의과대학 내과학교실) ;
- 손정호 (계명대학교 의과대학 내과학교실) ;
- 이준호 (계명대학교 의과대학 내과학교실) ;
- 한승범 (계명대학교 의과대학 내과학교실) ;
- 전영준 (계명대학교 의과대학 내과학교실) ;
- 김기범 (영남대학교 의과대학 내과학교실) ;
- 정진홍 (영남대학교 의과대학 내과학교실) ;
- 이관호 (영남대학교 의과대학 내과학교실) ;
- 이현우 (영남대학교 의과대학 내과학교실) ;
- 신현수 (대구효성카톨릭대학교 의과대학 내과학교실) ;
- 이상채 (대구효성카톨릭대학교 의과대학 내과학교실) ;
- 권삼 (동국대학교 의과대학 내과학교실)
- Kang, Tae-Kyung (Department of Internal Medicine, College of Medicine, Kyungpook National University) ;
- Kim, Chang-Ho (Department of Internal Medicine, College of Medicine, Kyungpook National University) ;
- Park, Jae-Yong (Department of Internal Medicine, College of Medicine, Kyungpook National University) ;
- Jung, Tae-Hoon (Department of Internal Medicine, College of Medicine, Kyungpook National University) ;
- Sohn, Jeong-Ho (Department of Internal Medicine, School of Medicine, Keimyung University) ;
- Lee, Jun-Ho (Department of Internal Medicine, School of Medicine, Keimyung University) ;
- Han, Seong-Beom (Department of Internal Medicine, School of Medicine, Keimyung University) ;
- Jeon, Young-Jun (Department of Internal Medicine, School of Medicine, Keimyung University) ;
- Kim, Ki-Beom (Department of Internal Medicine, School of Medicine, Yeungnam University) ;
- Chung, Jin-Hong (Department of Internal Medicine, School of Medicine, Yeungnam University) ;
- Lee, Kwan-Ho (Department of Internal Medicine, School of Medicine, Yeungnam University) ;
- Lee, Hyun-Woo (Department of Internal Medicine, School of Medicine, Yeungnam University) ;
- Shin, Hyeon-Soo (Department of Internal Medicine, School of Medicine, Catholic University of Taegu-Hgosung) ;
- Lee, Sang-Chae (Department of Internal Medicine, School of Medicine, Catholic University of Taegu-Hgosung) ;
- Kweon, Sam (Department of Internal Medicine, Medical School, Dongguk University)
- 발행 : 1997.12.31
초록
연구배경 : 폐국균종은 대부분 기존에 존재하는 공동성 폐병소에 이차적인 감염을 일으켜 주위조직의 침윤없이 집락을 형성하고 국소성장으로 균구을 보이는 질환으로 공동성 폐결핵환자의 약 15%에서 합병되는 것으로 알려져 있다. 지금까지의 국내보고는 주로 증례나 소수예에 대한 보고가 대부분이었기에 저자들은 대구 4개 대학병원에서 폐국균종으로 진단된 91예를 대상으로 임상적 특성을 알아보고자 하였다. 방 법 : 1986년 6월부터 1996년 5월까지 10년간 대구지역의 4개 대학병원에서 단순흉부촬영, 전산화단층촬영, 국균에 대한 혈청침강반응검사 및 생검을 통해 폐국균종으로 진단받은 91예를 대상으로 임상적 특성에 대한 후향적조사를 실시하였다. 총 91예중 10예(11.0%)는 임상적으로, 81예(89.0%)는 조직학적인 방법에 의하여 진단하였다. 결 과 : 1) 대상환자의 평균연령은
Background : Pulmonary aspergillomas usually arise from colonization and proliferation of Aspergillus in preexisting cavitary lung disease of any cause. About 15% of patients with tuberculous pulmonary cavities were found to have aspergilloma. We analyzed the clinical features and course of 91 patients with pulmonary aspergilloma. Method : During the ten-year period from June 1986 to May 1996, 91 patients whose condition was diagnosed as pulmonary aspergilloma at 4 university hospitals in Taegu city were reviewed. All patients fulfilled one of the following criteria : 1) histologic evidence of aspergilloma within abnormal air space in tissue sections, or 2) a positive Aspergillus serum precipitin test with the radiologic finding of a fungus ball. The histological diagno-sis was established in 81 patients(89.0%) and clinical diagnosis in 10 patients(11.0%). Results : 1) The age range was 22 to 65 years, with an average of 45 years. A male and female ratio was 1.7 : 1 (57 men and 34 women). 2) Hemoptysis was far the most frequent symptom(89%), followed by cough, dyspnea, weakness, weight loss, fever, chest pain. 3) In all but 14 cases(15.4%) there had been associated conditions. Pulmonary tuberculosis was far the most frequent underlying condition found(74.7%), followed by bronchiectasis (6.6%), cavitary neoplasm(2.2%), pulmonary sequestration(1.1%). 4) The involved area was usually in the upper lobes; the right upper lobe was involved in 39(42.9%), the left upper lobe in 31(34.1%), the left lower lobe in 13(14.3%), the right lower lobe in 7(7.7%), and the right middle lobe in 1(1.1%). 5) On standard chest roent geno gram the classic "bell-like" image of a fungus ball was found in 62.6% of the subjects. On CT scan, 88.1% of the subjects in which they were done. 6) The surgical therapy was undertaken in 76 patients, and medical therapy in 15 patients, including 4 patients with intracavitary instillation of amphotericin B. 7) The surgical modality was lobectomy in 55 patients(72.4%), segmentectomy in 16 patients(21.1%), pneumonectomy in 4 patients(5.3%), wedge resection in 1 patient(1.3%). The mortality rate was 3.9% (3 patients) ; 2 patients died of sepsis and 1 died of hemoptysis. The postoperative complications were encountered in 6 patients (7.9%), including each one patient with respiratory failure, bleeding, bronchopleural fistula, empyema, and vocal cord paralysis. 8) In the follow-up cases, each 2 patients of 71 patients with surgical treatment and 10 patients with medical treatment had recurrent hemoptysis. Conclusion : During follow-up of the chronic pulmonary disease with abnormal air space, if the standard chest roentgenograms are insufficient to detect a fungus ball, computed tomographic scan and serum precipitin test are likely to aid the diagnosis of patients with suspected pulmonary aspergilloma. A reasonable recommendation for management of a patient with aspergilloma would be to reserve surgical resection for those patients who have had severe, recurrent hemoptysis. And a well controlled cooperative study to the medical treatment such as intracavitary antifungal therapy is further needed.