대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제64권4호
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  • Pages.351-359
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  • 2011
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  • 1738-2637(pISSN)
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  • 2951-0805(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

한국에서 발생한 신종 인플루엔자(H1N1) 연관 폐렴의 고해상전산화단층촬영의 특징

High-resolution Computed Tomography Findings of H1N1 Influenza-Associated Pneumonia in Korea

  • 이병찬 (화순전남대학교병원 영상의학교실) ;
  • 선현주 (전남대학교 의과대학 영상의학교실) ;
  • 최송 (화순전남대학교병원 영상의학교실) ;
  • 김진웅 (화순전남대학교병원 영상의학교실) ;
  • 임효순 (화순전남대학교병원 영상의학교실) ;
  • 신상수 (전남대학교 의과대학 영상의학교실) ;
  • 김윤현 (전남대학교 의과대학 영상의학교실) ;
  • 박경화 (전남대학교 의과대학 내과학교실)
  • Lee, Byung-Chan (Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University) ;
  • Seon, Hyun-Ju (Department of Radiology, Chonnam National University Hospital, Chonnam National University) ;
  • Choi, Song (Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University) ;
  • Kim, Jin-Woong (Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University) ;
  • Lim, Hyo-Soon (Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University) ;
  • Shin, Sang-Soo (Department of Radiology, Chonnam National University Hospital, Chonnam National University) ;
  • Kim, Yun-Hyeon (Department of Radiology, Chonnam National University Hospital, Chonnam National University) ;
  • Park, Kyung-Hwa (Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University)
  • 발행 : 2011.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: H1N1 인플루엔자 바이러스와 연관된 폐렴의 흉부 고해상전산화단층촬영(HRCT) 소견을 보통의 지역사회 획득 폐렴(community acquired pneumonia, 이하 CAP)과 비교해 감별진단에 도움이 되는 영상소견이 있는지를 알아보고 영상소견에서 예후 예측인자가 있는지를 알아보았다. 대상과 방법: 2009년 9월부터 2010년 1월까지 H1N1 감염으로 진단받고 흉부 HRCT에서 이상소견을 보였던 31명(남:여 = 16:15, 평균 연령 42세)과 연령대와 성별을 적합시킨 CAP 환자 31명의 영상소견을 비교 분석했다. 결과: H1N1 연관 폐렴과 CAP의 흉부 HRCT소견은 주로 폐경화, 젖빛 유리음영과 경화의 혼재, 또는 젖빛 유리음영 순이었으며, 두 군 간에 의미 있는 차이는 없었다. 그러나 H1N1 감염환자는 CAP 환자와 비교해 주로 양측성, 다엽성, 다분절성 폐 침윤을 보였다(p < 0.05). 폐침윤 내에 저음영 또는 공기음영이나 림프절 종대는 CAP환자에서만 보였다(p < 0.05). H1N1 감염 환자 중 8명은 기계적 호흡이 필요했던 중증도 폐렴이었고, 이들 모두에서 병변은 양측성(p=0.015), 다엽성, 다분절성 침범을 보였다. 결론: H1N1 인플루엔자 연관 폐렴의 HRCT 소견은 폐경화, 젖빛 유리음영과 경화의 혼재, 또는 젖빛 유리음영 등으로 나타나며, CAP와 비교했을 때 양측성, 다엽성 또는 다분절성의 침윤을 보이는 경향이 있다. 양측성 폐 병변은 질환의 중증도를 시사했다.

Purpose: To evaluate and compare the high-resolution computed tomography (HRCT) findings of patients with H1N1 influenza-associated pneumonia compared usual community acquired pneumonia (CAP), to determine whether there were any useful common HRCT findings predicting their prognosis. Materials and Methods: HRCT findings of 31 patients (M:F = 16:15, mean age 42 yrs) with Influenza A (H1N1) infection were retrospectively reviewed for abnormal HRCT findings and compared to HRCT findings of CAP in matched patients. Patients were matched according to age and sex, from 2009 to January 2010. Results: The predominant HRCT findings of pneumonia consisted of areas of consolidation and/or ground-glass opacity (GGO) which showed no statistically significant differences when comparing the two groups. However, the abnormalities of H1N1-related pneumonia showed higher bilaterality and multilobar or multisegmental involvement compared with CAP (p < 0.05). Internal low attenuation or air-densities in pulmonary infiltration /or lymphadenopathy was observed only in patients with CAP (p < 0.05). HRCT findings in 8 patients with poor clinical outcome had bilaterality (p=0.015), multilobar, and multisegmental involvement. Conclusion: The predominant HRCT findings of H1N1-related pneumonia were areas of consolidation and/or GGO. In addition, H1N1-related pneumonia showed higher bilaterality or multilobar/multisegmental involvement compared with CAP. The patients who presented bilaterality had a worse clinical outcome.

키워드

참고문헌

  1. Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, Hernandez M, Quinones-Falconi F, Bautista E, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in mexico. N Engl J Med 2009;361:680-689 https://doi.org/10.1056/NEJMoa0904252
  2. Centers for disease control and prevention. Novel H1N1 flu: Background on the situation. [Internet] Atlanta: The Association. [updated 2009 May 25]. Available from: http:// www.Cdc.Gov/h1n1flu/background.Html
  3. WHO. Global alert and response: Pandemic (H1N1) 2009 : Update 100. [Internet] Geneva: World health organization. [cited 2011 Jan 31]. Availabe from: http://www.who.int/csr/don/2010_05_14/en/
  4. WHO. Media centre: H1N1 in post-pandemic period [Internet] Geneva: World health organization. [cited 2011 Jan 31]. Available from: Http://www.who.Int/mediacentre/news/statements/2010/h1n1_vpc_20100810/en/
  5. Kim EA, Lee KS, Primack SL, Yoon HK, Byun HS, Kim TS, et al. Viral pneumonias in adults: radiologic and pathologic findings. Radiographics 2002;22:S137-S149 https://doi.org/10.1148/radiographics.22.suppl_1.g02oc15s137
  6. Agarwal PP, Cinti S, Kazerooni EA. Chest radiographic and CT findings in novel swine-origin influenza A (H1N1) virus (S-OIV) infection. AJR Am J Roentgenol 2009;193:1488-1493 https://doi.org/10.2214/AJR.09.3599
  7. Ajlan AM, Quiney B, Nicolaou S, Muller NL. Swine-origin influenza A (H1N1) viral infection: radiographic and CT findings. AJR Am J Roentgenol 2009;193:1494-1499 https://doi.org/10.2214/AJR.09.3625
  8. Lee EY, McAdam AJ, Chaudry G, Fishman MP, Zurakowski D, Boiselle PM. Swine-origin influenza A (H1N1) viral infection in children: initial chest radiographic findings. Radiology 2010;254:934-941 https://doi.org/10.1148/radiol.09092083
  9. Mollura DJ, Asnis DS, Crupi RS, Conetta R, Feigin DS, Bray M, et al. Imaging findings in a fatal case of pandemic swine-origin influenza A (H1N1). AJR Am J Roentgenol 2009;193:1500-1503 https://doi.org/10.2214/AJR.09.3365
  10. Tanaka N, Matsumoto T, Kuramitsu T, Nakaki H, Ito K, Uchisako H, et al. High resolution CT findings in community-acquired pneumonia. J Comput Assist Tomogr 1996;20:600-608 https://doi.org/10.1097/00004728-199607000-00019
  11. WHO. CDC protocol of realtime rtpcr for influenza A (H1N1) 2009. [Internet] Genova: World health organization. [update 2009 Apr 30]. Available from : http://www.who.int/csr/resources/publications/swineflu/realtimeptpcr/en/
  12. Ramsdell J, Narsavage GL, Fink JB. Management of communityacquired pneumonia in the home: an american college of chest physicians clinical position statement. Chest 2005;127:1752-1763 https://doi.org/10.1378/chest.127.5.1752
  13. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner society: glossary of terms for thoracic imaging. Radiology 2008;246:697-722 https://doi.org/10.1148/radiol.2462070712
  14. Elicker BM, Schwartz BS, Liu C, Chen EC, Miller SA, Chiu CY, et al. Thoracic CT findings of novel influenza A (H1N1) infection in immunocompromised patients. Emerg Radiol 2010;17:299-307 https://doi.org/10.1007/s10140-010-0859-x
  15. Li P, Su DJ, Zhang JF, Xia XD, Sui H, Zhao DH. Pneumonia in novel swine-origin influenza A (H1N1) virus infection: high-resolution CT findings. Eur J Radiol Forthcoming 2010
  16. Soto-Abraham MV, Soriano-Rosas J, Diaz-Quinonez A, Silva-Pereyra J, Vazquez-Hernandez P, Torres-Lopez O, et al. Pathological changes associated with the 2009 H1N1 virus. N Engl J Med 2009;361:2001-2003 https://doi.org/10.1056/NEJMc0907171
  17. Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the united states, april-june 2009. N Engl J Med 2009;361:1935-1944 https://doi.org/10.1056/NEJMoa0906695
  18. Pittet LA, Hall-Stoodley L, Rutkowski MR, Harmsen AG. Influenza virus infection decreases tracheal mucociliary velocity and clearance of streptococcus pneumoniae. Am J Respir Cell Mol Biol 2010;42:450-460 https://doi.org/10.1165/rcmb.2007-0417OC
  19. Dominguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa- Perez L, de la Torre A, et al. Critically ill patients with 2009 influenza A (H1N1) in mexico. JAMA 2009;302:1880-1887 https://doi.org/10.1001/jama.2009.1536
  20. Aviram G, Bar-Shai A, Sosna J, Rogowski O, Rosen G, Weinstein I, et al. H1N1 influenza: initial chest radiographic findings in helping predict patient outcome. Radiology 2010;255:252-259 https://doi.org/10.1148/radiol.10092240
  21. Guo HH, Sweeney RT, Regula D, Leung AN. Best cases from the afip: fatal 2009 influenza A (H1N1) infection, complicated by acute respiratory distress syndrome and pulmonary interstitial emphysema. Radiographics 2010;30:327-333 https://doi.org/10.1148/rg.302095213