• Tuberculosis and Respiratory Diseases
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• v.42 no.2
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• pp.226-230
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• 1995

Effusions arising from acute pancreatitis are usually small, left sided and self limiting. The incidence of pleural effusions in acute pancreatitis is reported between 3% and 17%. In chronic pancreatitis, as a consequence of fistula and pancreatitic pseudocyst formation or by spontaneous rupture of a pancreatic psudocyst directly into thoracic cavity, extremely large effusions may be seen. When the underlying pacreatic disease is asymptomatic, the diagnosis is made by measuring the amylase content of the pleural fluid. We experience a case of left sided pleural effusions caused by pancreatico-pleural fistula associated with pancreatic pseudocyst. The diagnosis was made by measuring of pleural fluid amylase level(80000U/L). Abdominal CT scan revealed pancreatic pseudocyct and pancreatitis with extension to left pleural space through esophageal hiatus and extension to left subdiaphragmatic space. Left pleural effusions were decreased after fasting, total parenteral nutrition and percutaneous pleural fluid catheter drainage. We reported a case of pleural effusions and pacreatico-pleural fistula asssociated with asymptomatic pancreatic disease with review of literatures.

• Tuberculosis and Respiratory Diseases
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• v.58 no.4
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• pp.404-409
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• 2005

An 86 year old woman was admitted complaining of dyspnea and right pleuritic pain with a 5 week durations. A physical examination, chest X-ray, and diagnostic thoracentesis upon admission revealed findings consistent with severe pneumonia and empyema on the right lung. Despite the insertion of a chest tube and negative suction via Emersion pump, the continuous air leakage was sustained, and a bronchopleural fistula (BPF) was found on the chest-CT. A flexible bronchoscopic occlusion with an Endobronchial Watanabe Spigot (EWS) was performed after 56 days of admission. An 5 mm diameter EWS was successfully inserted into the anterior segmental bronchus of the right upper lobe by flexible bronchoscope. There was no aAir leakage detected after this procedure. The patient was discharged 30 days after the EWS occlusion.

• Tuberculosis and Respiratory Diseases
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• v.47 no.4
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• pp.543-548
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• 1999

Bronchopleural fistula(BPF) occurs as a postoperative complication in 2 to 5 percent of pulmonary resection. The detection of BPF is generally difficult and various diagnostic methods have been utilized to identify the site of the fistula in order to treat it adequately. Closure of these BPF can be surgical intervention or bronchoscopic application of various sealing agents. We report an experience with use of bronchoscopic instillation of n-butyl-2-cyanoacrylate($Histoacryl^{(R)}$) for closure of a postpneumonectomy BPF.

• Tuberculosis and Respiratory Diseases
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• v.51 no.1
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• pp.70-75
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• 2001

Aspergillosis refers to an infection with any species from the genus Aspergillus. Pleural aspergillosis is an uncommon disease with less than 30 cases having been reported in the literature since 1958. The etiologic factors for this aspergillosis are preexisting pulmonary tuberculosis, bronchopleural fistula, pleural drainage, and a lung resection. Surgical removal of the aspergillus-infected pleura is the main treatment for managing this disease. We have experienced two cases of pleural aspergillosis as a complication of a preexisting chronic empyema. The chest radiographs showed a pyopneumothorax with cavitation and the chest computed tomographic scans revealed a loculated pyopneumothorax with cavity formation suggesting a bronchopleural fistula. A grossly purulent fluid was extracted by thoracentesis, and Aspergillus fumigatus was grown from a fungus culture of the fluid. A decortication, wedge resection with a pleurectomy and a pleuropneumonectomy were performed. The postoperative course was satisfactory and the patients have been in good condition up to now. Pleural aspergillosis is a very rare and potentially life-threatening disease. However, good result without significant complication were obtained by treatment with systemic antifungal agents and surgical removal.

• Tuberculosis and Respiratory Diseases
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• v.53 no.2
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• pp.221-226
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• 2002

A 58-year-old man was admitted after suffering dyspnea and pleuritic chest pain on his right side for one week. A chest X-ray revealed necrotizing pneumonia and a lung abscess on right upper lobe. Despite of antibiotics and supportive care, a complicated parapneumonic effusion developed on his right side. Closed thoracostomy was performed for drainage. However, after the thoracostomy, a bronchopleural fistula (BPF) occurred with a continuous air leak. After 30 days intensive therapy, the underlying necrotizing pneumonia and lung abscess resolved, but the BPF continued. Bronchoscopic treatment was performed because the patient was a poor candidate for surgery. After localizing the BPF with a systemic occlusion of the segmental bronchi, small strips of Gelfoam were placed in the suction channel of the flexible bronchoscopy, and either flushed with a saline solution or inserted with forceps until the cessation of air leak. The patient was discharged 10 days after the bronchoscopic treatment.

• Tuberculosis and Respiratory Diseases
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• v.64 no.1
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• pp.48-51
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• 2008

Chronic expanding hematoma of the thorax is a specific subtype of the chronic empyema. It presents as a slowly expanding intrathoracic mass which result in dyspnea or recurrent hemoptysis. The symptoms develop months or years after tuberculous pleurisy, trauma or surgery. Usually, it shows three common findings: a giant mass lesion in the thorax, some surrounding calcifications, the absence of signs or symptoms of infection. We report a case of chronic expanding hematoma of the thorax, initially presenting as massive hemoptysis through bronchopleural fistula which resulted in radiologic findings of new air-fluid level within the previous pleural lesion filled with unknown materials.

• Tuberculosis and Respiratory Diseases
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• v.65 no.3
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• pp.216-221
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• 2008

A chronic expanding hematoma (CEH) in the thorax is a rare and specific condition of chronic empyema. CEHs in the thorax are often associated with tuberculosis and/or previous surgical procedures. While the incidental detection of a pleural mass and dyspnea are common clinical manifestations, a few cases present with hemoptysis. We encountered a case of CEH in the thorax. This case is unique in that it developed without a prior history of tuberculosis or surgery and presented with massive hemoptysis accompanied by bronchopleural fistula. We report the third case of CEH in the thorax in Korea with a summary of the clinical characteristics of previous cases.

• Tuberculosis and Respiratory Diseases
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• v.61 no.5
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• pp.484-489
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• 2006

A primary pulmonary leiomyosarcoma is a very rare pulmonary malignancy that arises from smooth muscle of either the bronchial or arterial walls. Common symptoms of the tumor are cough, dyspnea, chest pain and hemoptysis. The diagnosis of a primary pulmonary sarcoma can be established only after extensive clinical and radiologic examinations have failed to identify an alternative primary source. The only effective treatment for the tumor is a complete surgical resection when feasible. The type of resection is dictated by the local anatomic extent of the tumor. We report a case of a 21-year-old male with a primary endobronchial leiomyosarcoma who presented with massive hemoptysis. A necrotic ulcerative endobronchial lesion was observed in the orifice of left lower lobe bronchus on a bronchoscopic examination. He was treated with a complete sleeve resection of the left lower lobe. Three months later, local recurrence of the tumor was noticed on the follow up bronchoscopy and a then left pneumonectomy was then performed. Fifteen months later, the patient died from empyema with a bronchopleural fistula that was associated with tumor recurrence at the stump of the pneumonectomy.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1308-1317
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• 1997

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.