DOI QR코드

DOI QR Code

성인의 흡인 관련 폐질환: 영상의학적 이해

A Radiologic Overview of Aspiration-Induced Lung Disease in Adults

  • 강은영 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 용환석 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 김채리 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 이기열 (고려대학교 의과대학 안산병원 영상의학과) ;
  • 황성호 (고려대학교 의과대학 안암병원 영상의학과) ;
  • 오유환 (고려대학교 의과대학 안암병원 영상의학과)
  • Kang, Eun-Young (Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University) ;
  • Yong, Hwan Seok (Department of Radiology, Korea University Guro Hospital, College of Medicine, Korea University) ;
  • Kim, Cherry (Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University) ;
  • Lee, Ki Yeol (Department of Radiology, Korea University Ansan Hospital, College of Medicine, Korea University) ;
  • Hwang, Sung Ho (Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University) ;
  • Oh, Yu-Whan (Department of Radiology, Korea University Anam Hospital, College of Medicine, Korea University)
  • 투고 : 2018.04.27
  • 심사 : 2018.06.19
  • 발행 : 2018.10.01

초록

흡인은 우발적으로 하부 호흡기로 이물질이 유입되는 것으로 정의한다. 흡인은 흔히 발생하며, 건강한 성인에게도 발생할 수 있다. 흡인으로 인한 폐질환의 유형은 흡인한 물질의 성분과 양, 만성도, 흡인한 물질에 대한 숙주의 반응에 따라 달라진다. 성인에서 흡인은 다양한 임상 증상과 함께 다양한 폐 질환을 유발할 수 있다. 영상의학적으로 진단할 수 있는 흡인관련 폐질환 중 기도가 주 병소인 질환으로는 기관기관지 이물과 미만성흡인세기관지염이 있다. 폐실질이 주 병소인 질환으로는 급성 질환인 감염성흡인폐렴, 비감염성흡인폐렴, 익사 직전 폐와 만성 질환인 만성외인성지질폐렴과 만성간질폐질환이 있다. 흡인 관련 폐질환의 진단은 종종 어려울 수 있으며, 정확한 진단과 적절한 치료를 위해 영상의학소견에 대한 지식은 필수이다.

Aspiration is defined as accidental entrance of foreign matter into the lower respiratory tract, and is a common event and can occur in healthy individuals. The type of aspiration-induced lung diseases depends on the quantity and nature of the aspirated material, the chronicity, and the host responses. Aspiration into the airways and lungs can cause a wide spectrum of lung diseases with various manifestations in adults. Diseases with predominantly airway manifestation include foreign body aspiration and diffuse aspiration bronchiolitis. Diseases with predominantly lung parenchymal manifestation include acute diseases such as aspiration pneumonia, aspiration pneumonitis, and near drowning, and chronic diseases such as chronic exogenous lipoid pneumonia and chronic interstitial lung disease. Definitive diagnosis of aspiration-induced lung diseases is challenging to make. Awareness of radiologic findings associated with these diseases is essential for accurate diagnosis and management of these diverse aspiration-induced lung diseases.

키워드

참고문헌

  1. Hu X, Lee JS, Pianosi PT, Ryu JH. Aspiration-related pulmonary syndromes. Chest 2015;147:815-823
  2. Marik PE. Pulmonary aspiration syndromes. Curr Opin Pulm Med 2011;17:148-154
  3. DiBardino DM, Wunderink RG. Aspiration pneumonia: a review of modern trends. J Crit Care 2015;30:40-48
  4. Boyd M, Chatterjee A, Chiles C, Chin R Jr. Tracheobronchial foreign body aspiration in adults. South Med J 2009;102: 171-174
  5. Sehgal IS, Dhooria S, Ram B, Singh N, Aggarwal AN, Gupta D, et al. Foreign body inhalation in the adult population: experience of 25998 bronchoscopies and systematic review of the literature. Respir Care 2015;60:1438-1448
  6. Franquet T, Gimenez A, Roson N, Torrubia S, Sabate JM, Perez C. Aspiration diseases: findings, pitfalls, and differential diagnosis. Radiographics 2000;20:673-685
  7. Matsuse T, Oka T, Kida K, Fukuchi Y. Importance of diffuse aspiration bronchiolitis caused by chronic occult aspiration in the elderly. Chest 1996;110:1289-1293
  8. Prather AD, Smith TR, Poletto DM, Tavora F, Chung JH, Nallamshetty L, et al. Aspiration-related lung diseases. J Thorac Imaging 2014;29:304-309
  9. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med 2001;344:665-671
  10. Teramoto S, Fukuchi Y, Sasaki H, Sato K, Sekizawa K, Matsuse T. High incidence of aspiration pneumonia in community-and hospital-acquired pneumonia in hospitalized patients: a multicenter, prospective study in Japan. J Am Geriatr Soc 2008;56:577-579
  11. Komiya K, Ishii H, Umeki K, Mizunoe S, Okada F, Johkoh T, et al. Impact of aspiration pneumonia in patients with community-acquired pneumonia and healthcare-associated pneumonia: a multicenter retrospective cohort study. Respirology 2013;18:514-521
  12. Komiya K, Ishii H, Umeki K, Kawamura T, Okada F, Okabe E, et al. Computed tomography findings of aspiration pneumonia in 53 patients. Geriatr Gerontol Int 2013;13:580-585
  13. Yi MS, Kim KI, Jeong YJ, Park HK, Lee MK. CT findings in hydrocarbon pneumonitis after diesel fuel siphonage. AJR Am J Roentgenol 2009;193:1118-1121
  14. Gentina T, Tillie-Leblond I, Birolleau S, Saidi F, Saelens T, Boudoux L, et al. Fire-eater's lung: seventeen cases and a review of the literature. Medicine (Baltimore) 2001;80:291-297
  15. Kadakal F, Uysal MA, Gulhan NB, Turan NG, Bayramog lu S, Yilmaz V. Fire-eater's pneumonia characterized by pneumatocele formation and spontaneous resolution. Diagn Interv Radiol 2010;16:201-203
  16. Gregorakos L, Markou N, Psalida V, Kanakaki M, Alexopoulou A, Sotiriou E, et al. Near-drowning: clinical course of lung injury in adults. Lung 2009;187:93-97
  17. Rossi SE, Erasmus JJ, Volpacchio M, Franquet T, Castiglioni T, McAdams HP. "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 2003;23:1509-1519
  18. Lee JS, Im JG, Song KS, Seo JB, Lim TH. Exogenous lipoid pneumonia: high-resolution CT findings. Eur Radiol 1999; 9:287-291
  19. Tobin RW, Pope CE II, Pellegrini CA, Emond MJ, Sillery J, Raghu G. Increased prevalence of gastroesophageal reflux in patients with idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 1998;158:1804-1808
  20. Lee JS, Song JW, Wolters PJ, Elicker BM, King TE Jr, Kim DS, et al. Bronchoalveolar lavage pepsin in acute exacerbation of idiopathic pulmonary fibrosis. Eur Respir J 2012;39:352-358
  21. Christmann RB, Wells AU, Capelozzi VL, Silver RM. Gastroesophageal reflux incites interstitial lung disease in systemic sclerosis: clinical, radiologic, histopathologic, and treatment evidence. Semin Arthritis Rheum 2010;40:241-249