Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Perifissural Air Seen in the Pneumomediastinum on MDCT: the Incidence and Clinical Features

MDCT에서 보이는 기종격증의 엽간열주위공기: 그 빈도와 임상적 의의

  • Oh, Soo-Jin (Department of Radiology, Soonchunhyang University Chunan Hospital) ;
  • Kim, Young-Tong (Department of Radiology, Soonchunhyang University Chunan Hospital) ;
  • Jou, Sung-Shick (Department of Radiology, Soonchunhyang University Chunan Hospital) ;
  • Shin, Hyeong-Cheol (Department of Radiology, Soonchunhyang University Chunan Hospital)
  • 오수진 (순천향대학교 천안병원 영상의학과) ;
  • 김영통 (순천향대학교 천안병원 영상의학과) ;
  • 조성식 (순천향대학교 천안병원 영상의학과) ;
  • 신형철 (순천향대학교 천안병원 영상의학과)
  • Received : 2009.11.07
  • Accepted : 2010.05.09
  • Published : 2010.12.01
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Abstract

Purpose: We wanted to evaluate the incidence and clinical features of perifissural air seen in the pneumomediastinum on CT. Materials and Methods: The study included the CT scans of 90 patients with pneumomediastinum (65 males and 25 females) and who had been treated during the recent 3 years. The ages ranged from 2 to 48 years (mean age: 41 years). The patients were divided into 3 groups, I: perifissural air (n=7), II: pneumomediastinum without perifissural air (n=83) and III: pulmonary interstitial emphysema involving the peribronchial or intraparenchymal area (n=9) of the Group II. We analyzed the clinical data and compared it between group I and the other groups. Results: Group I included 7.8% of the total cases. Age was statistically different between Group I and II, but age was not significantly different between Groups I and III (I: 13.7 years, II: 42.9, III: 26.4). A spontaneous cause was the most common (57.2%) in Group I, trauma (33.7%), postoperative occurrence (20.5%) and a spontaneous cause (9.7%) were common in Group II, and trauma (44.4%) and a spontaneous cause (33.3%) were common in Group III. The incidence of a spontaneous cause was statistically different between Groups I and II (p<0.001), but this was not significantly different between Groups I and III. Conclusion: The incidence of perifissural air seen in the pneumomediastinum on CT is 7.8%. Perifissural air is more common in the younger patients with a spontaneous cause.

목적: 기종격증의 MDCT에서 엽간열주위공기의 빈도와 임상특징을 알아보고자 하였다. 대상과 방법: 최근 3년간 CT에서 기종격증을 보인 90명(남: 65, 여: 25, 41세(2-84세))을 대상으로 하였다. 환자를 세군으로 나누었는데, I군은 엽간열주위공기, II군은 엽간열주위공기가 없는 기종격증, III군은 II군 중에서 기관지주위와 폐실질 내 간질성 폐기종으로 분류하였다. I군과 다른 군의 임상 데이터를 비교 분석하였다. 결과: I군의 발생률은 7.8%였다. 발생 연령에 따른 비교에서 I군과 II군 간은 유의성이 있었지만, I군과 III군 간은 유의성이 없었다(I군: 13.7세, II군: 42.9, III군: 26.4). 발생 원인 별로 보면, I군은 자발성이 가장 많았고(57.2%), II군은 외상(33.7%), 수술 후(20.5%), 자발성(9.7%) 순을 보였으며, III군은 외상(44.4%)과 자발성(33.3%)이 있었다. 자발성의 발생빈도에 따른 군간 비교에서 I군이 II군에 비해 더 높게 나왔지만(p < 0.001) I군과 III군간의 비교는 통계학적 유의성이 없었다. 자발성의 빈도에 따른 군간 비교에서 I군과 II군간은 유의성이 있었지만 I군과 III군간은 유의성이 없었다. 결론: 전체 기종격증의 CT에서 약 7.8%에서 관찰되는 엽간열주위공기는 평균 발생 연령이 13.7세로 어린 연령에 자주 생기고 대부분 자발성에 의해 발생한다.

Keywords

References

  1. Wood BP, Anderson VM, Mauk JE, Merritt TA. Pulmonary lymphatic air: locating "pulmonary interstitial emphysema" of the premature infant. AJR Am J Roentgenol 1982;138:809-814 https://doi.org/10.2214/ajr.138.5.809
  2. Macia I, Moya J, Ramos R, Morera R, Escobar I, Saumench J, et al. Spontaneous pneumomediastinum: 41 cases. Eur J Cardiothorac Surg 2007;31:1110-1114 https://doi.org/10.1016/j.ejcts.2007.03.008
  3. deRoux SJ, Prendergast NC. Large sub-pleural air cysts: an extreme form of pulmonary interstitial emphysema. Pediatr Radiol 1998;28:981-983 https://doi.org/10.1007/s002470050514
  4. Campbell RE. Intrapulmonary interstitial emphysema: a complication of hyaline membrane disease. Am J Roentgenol Radium Ther Nucl Med 1970;110:449-456 https://doi.org/10.2214/ajr.110.3.449
  5. Macklin CC. Transport of air along sheaths of pulmonic blood vessels from alveoli to mediastinum: clinical implications. Arch Intern Med 1939;64:913-926 https://doi.org/10.1001/archinte.1939.00190050019003
  6. Wintermark M, Wicky S, Schnyder P, Capasso P. Blunt traumatic pneumomedistinum: using CT to reaveal the Macklin effect. AJR Am J Roentgenol 1999;172:129-130 https://doi.org/10.2214/ajr.172.1.9888752
  7. Albelda SM, Gefter WB, Kelley MA, Epstein DM, Miller WT. Ventilator-induced subpleural air cysts: clinical, radiographic, and pathologic significance. Am Rev Respir Dis 1983;127:360-365
  8. Zylak CM, Standen JR, Barnes GR, Zylak CJ. Pneumomediastinum revisited. Radiographics 2000;20:1043-1057 https://doi.org/10.1148/radiographics.20.4.g00jl131043
  9. Trotman-Dickenson B. Radiology in the intensive care unit (part 2). J Intensive Care Med 2003;18:239-252 https://doi.org/10.1177/0885066603254087
  10. Demura Y, Ishizaki T, Nakanishi M, Ameshima S, Itoh H. Persistent diffuse pulmonary interstitial emphysema mimicking pulmonary emphysema. Thorax 2007;62:652 https://doi.org/10.1136/thx.2006.074724
  11. Bertolini G, Stefanello C, Caldin M. Imaging diagnosis--pulmonary interstitial emphysema in a dog. Vet Radiol Ultrasound 2009;50:80-82 https://doi.org/10.1111/j.1740-8261.2008.01494.x
  12. Oh MH, Kim MY, Shim WS, Oh SS, Shin BK, Cho SJ, et al. A case of localized persistent interstitial pulmonary emphysema. J Korean Med Sci 2001;16:225-258 https://doi.org/10.3346/jkms.2001.16.2.225
  13. Bullaro FM, Bartoletti SC. Spontaneous pneumomediastinum in children: a literature review. Pediatr Emerg Care 2007;23:28-30 https://doi.org/10.1097/01.pec.0000248686.88809.fd
  14. Damore DT, Dayan PS. Medical causes of pneumomediastinum in children. Clin Pediatr (Phila) 2001;40:87-91 https://doi.org/10.1177/000992280104000204