• Journal of the Korean Society of Radiology
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• v.82 no.2
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• pp.440-446
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• 2021

The levoatriocardinal vein is an uncommon pulmonary venous abnormality that connects the left atrium or pulmonary vein with the systemic vein. It is distinct from partial anomalous pulmonary venous return in that the former forms a connection with the left atrium through the normal pulmonary vein whereas the latter involves pulmonary venous drainage to the systemic vein. Herein, we describe a case of the levoatriocardinal vein initially misdiagnosed as a pulmonary arteriovenous malformation using chest radiography and chest CT. The levoatriocardinal vein combined with pulmonary venous varix was confirmed using pulmonary angiography. To the best of our knowledge, this unusual coexistence of the levoatriocardinal vein and pulmonary venous varix has not been reported in English literature.

• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.432-440
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• 2000

Background : The prevalence of pulmonary tuberculosis among the elderly is increasing in Korea and in the developed countries due to the increased elderly population and their predispositions to chronic disease, poverty and decreased immunity. To define the characteristics of pulmonary tuberculosis in the elderly, we evaluated the clinical spectrum of pulmonary tuberculosis. Method : We analyzed 92 patients retrospectively that were diagnosed as active pulmonary tuberculosis over the age of 65. The analysis involved patient's profiles, clinical manifestations, coexisting diseases, diagnostic methods, anti-TB medications and their side effects, and treatment outcomes. Results : The results were as follows : - 1) The ratio of male to female was 2.1:1(62:30 cases) 2) Chief complaints were a cough (47.8%), dyspnea (40.2%), sputum (38.0%), chest pain (12.0%), anorexia (10.9%), and fever (9.8%). 3) 38 (41.3%) of cases had a past history of pulmonary tuberculosis. 4) The coexisting diseases were : -COPD, 25 cases (27.2%); pneumonia, 17 cases (18.5%); DM. 13 cases (14.1%); and malignancy, 10 cases (10.9%). 5) The positivity of Mantoux test (5 TU, PPD-S) was 82.7%. 6) Pulmonary tuberculosis was diagnosed using the following methods : sputum AFB (Acid Fast Bacillus) smear 42.4%, sputum TB (M. Tuberculosis) culture 15.2%, sputum TB PCR (Polymerase Chain Reaction) 10.9%, bronchial washing AFB smear 2.1%, chest radiology only 25.0%. 7) Locations of radiologic lesions were RULF, 50 cases; RLLF, 50 cases, mostly, then LLLF ; 26 cases were leastly involved. 8) The coexisting tuberculosis were endobronchial TB(8.7%), TB pleurisy(7.6%) miliary TB(5.4%), intestinal TB(2.2%), renal TB(1.1%) 9) The proportion of treatment regimen with 1st line drug and 2nd line drug were 92.3% and 7.6%, respectively. 10) The outcome of treatment were as follows : cured 31.5%, expired 13.0%, no return 47.8%, follow-up now 7.6%. Conclusion : The pulmonary tuberculosis in the elderly has atypical patterns with chronic coexisting diseases. Therefore, the possibility of pulmonary tuberculosis should be considered in elderly patients with pulmonary symptoms.

• Pediatric Infection and Vaccine
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• v.31 no.1
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• pp.37-45
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• 2024

Purpose: This study aimed to examine the clinical features and determinants of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMP) and to assess the differences in the time to fever resolution between doxycycline (DXC), tosufloxacin (TFX) and corticosteroid (CST) as second-line treatment. Methods: We retrospectively analyzed the medical records of patients under the age of 18 who were admitted to Nowon Eulji University Hospital between July 2018 and February 2020, diagnosed with mycoplasma pneumonia. Macrolide resistance was confirmed by detecting point mutations in the 23S rRNA gene. MUMP was clinically defined by persistent fever (≥38.0℃) lasting for 72 hours or more after the initiation of macrolide treatment. In cases of MUMP, patients were treated with an addition of CST, or the initial macrolide was replaced either DXC or TFX. Results: Out of 157 cases of mycoplasma pneumonia, 83 cases (52.9%) did not respond to macrolides. Patients with MUMP exhibited significantly higher C-reactive protein (CRP) levels (3.2±3.0 vs. 2.4±2.2 mg/dL, P=0.047), more frequent lobar/segmental infiltrations or pleural effusions (56.6% vs. 27.0%, P<0.001; 6.0% vs. 0.0%, P=0.032), and a higher prevalence of 23S rRNA gene mutations (96.4% vs. 64.6%, P<0.001) when compared to those with macrolide-susceptible M. pneumoniae pneumonia. In terms of second-line treatment, 15 patients (18.1%) responded to CST, 30 (36.1%) to DXC, and 38 (45.8%) to TFX. The time to defervescence (TTD) after initiation second-line treatment was significantly shorter in the CST group compared to the DXC (10.3±12.7 vs. 19.4±17.2 hours, P=0.003) and TFX groups (10.3±12.7 vs. 25.0±20.1 hours, P=0.043), with no significant difference observed between the DXC and TFX groups (19.4±17.2 vs. 25.0±20.1 hours, P=0.262). Conclusions: High CRP levels, the presence of positive 23S rRNA gene mutation, lobar or segmental lung infiltration, and pleural effusion observed in chest X-ray findings were significant factors associated with macrolide unresponsiveness. In this study, CST demonstrated a shorter TTD compared to DXC or TFX. Further, larger-scale prospective studies are needed to determine the optimal second-line treatment for MUMP.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1982.05a
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• pp.5.2-5
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• 1982

With the improvement of living standard and socioenvironmental change, esophageal stricture due to acetic acid, Hcl, insecticides and lye has led to decrease remarkably. Esophageal stricture has decreased because of immediate treatment and adequate management. However there are still sporadic incidents of esophageal stricture due to inadequate treatment and uncooperation of patients. The authors recently have experienced seven severe cases of esophageal stricture. All six patients were treated with 18-51 French Sippy esophageal dilating bougie. One patient was transfered to thoracic surgery department due to complete esophageal obstruction. Case 1. A 23 year old housewife who ingested Hcl for suicide. After Witzel's operation, she visited to dilate esophageal first constriction stircture due to swallowing difficulty postoperation 2 months later. We were treated successfully. Case 2. A case of esophageal stricuture in the second and third physiologic constriction part. The patient was 51 years old man who ingested lye accidently, and was dilated by bougination. Case 3. The patient was 43 year-old man who ingested acetic acid as a mistake and was treated inadequately at hopsital. Inspite of treatment, esophageal stricture developed at the third physiologic part. We are trying to dilate the esophagues now. Case 4. The patient was 55 year-old woman who had ingested Hcl for the purpose of suicidal attempt. 2 months later gastroduodenal anastomoisis due to pyloric region stenosis, the first physiologic constriction stricture was dilated successfully. Case 5. The patient was 41 year-old woman who ingested Hcl for suicide 4 months ago. There was indwelled orogastric tube for 1 month but esophageal stricture developed at the first and 3rd constriction part. She was treated by using a bougination. Case 6. An athlete 21 year old man, ingested acetic acid 2 spoonful per 3 days by purpose in order to soften the bone for last 14 months. There was complete esophageal obsturction in esophagogram and transferred to the thoracic surgery department. Case 7. A 3 year-old girl was ingested lye at a accident. She had a bougination for 16 months under the general anesthesia for dilation due to whole irregular esophageal stricture. She developed lower esophageal perforation, but healed eventually.

• Tuberculosis and Respiratory Diseases
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• v.46 no.5
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• pp.709-717
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• 1999

Background & Method : Bronchiolitis obliterans organizing pneumonia(BOOP) is a specific clinicopathologic condition characterized by chronic inflammatory interstitial infiltrates. Cryptogenic form of BOOP presents subacute clinical course of flu-like illness, such as cough, fever, dyspnea with exertion and other constitutional symptoms. Pathologically it shows the presence of granulation tissue filling the lumen of terminal and respiratory bronchioles, extending into distal airspaces. Recently, we reviewed 24 cases of idiopathic type of BOOP, 5 cases of our hospital and another 19 cases on Korean literatures, and compared with reviewed data from foreign literatures. Results : Mean age was 54 years old and there was female preponderance in domestic reports. Their common presenting symptoms were dyspnea and cough, and mean duration of illness was 41 days. On chest examination, inspiratory crackle was a common finding. The laboratory findings were nonspecific except hypoxemia. Lung function studies revealed restrictive defect or combined obstructive and restrictive pattern in most patients. Bilateral patchy and nonsegmental alveolar opacities constituted characterized radiographic finding, highlighted on high resolution computed tomogram. It showed a favorable prognosis with an excellent responsiveness to corticosteroid therapy. The clinical features and laboratory findings were similar between domestic and foreign cases except female preponderance in Korean cases. Conclusion : If the clinical course is atypical or pregressive under proper treatment, clinicians should reevaluate clinical features and radiographic findings under the consideration of BOOP. Tissue confirmation would be recommended for the definitive diagnosis of BOOP.

• Proceedings of the Korean Society of Computer Information Conference
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• 2017.01a
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• pp.235-238
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• 2017

This study was to develop a portable digital radiography (PDR) system with a function measuring the X-ray source-with-detector angle (SDA) and to evaluate the imaging performance for the diagnosis of chest imaging. The SDA device consisted of an Arduino, an accelerometer and gyro sensor, and a Bluetooth module. According to different angle degrees, five anatomical landmarks on chest images were assessed using a 5-point scale. Mean signal-to-noise ratio and contrast-to-noise ratio were 182.47 and 141.43. Spatial resolution (10% MTF) and entrance surface dose were 3.17 lp/mm ($157{\mu}m$) and 0.266mGy. The angle values of SDA device were not significant difference as compared to those of the digital angle meter. In chest imaging, SNR and CNR values were not significantly different according to different angle degrees (repeated-measures ANOVA, p>0.05). The visibility scores of the border of heart, 5th rib and scapula showed significant differences according to different angles (rmANOVA, p<0.05), whereas the scores of the clavicle and 1st rib were not significant. It is noticeable that the increase in SDA degree was consistent with the increase of visibility score. Our PDR with SDA device would be useful to be applicable to clinical radiography setting according to the standard radiography guideline at various fields.

• Journal of Biomedical Engineering Research
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• v.39 no.1
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• pp.48-54
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• 2018

In this study, We developed a Ancillary device for child radiography for X-ray of children under 5 years old and verified its effectiveness. Chest X-rays of children younger than 5 years of age were performed by Supine method at the position of Table detector, Short - Source to Image Receptor Distance(SID). Existing Supine and Short -SID imaging methods cause many problems, such as errors in image reading and excessive radiation exposure dose to patients, but the use of an Ancillary device for child radiography(ADCR) solves these problems. A total of 160 children were divided into the Upright group using ADCR and Supine group without ADCR. The chest X-ray image was visually evaluated by two radiologists with reference to the European Commission's List of Quality Criteria for Diagnostic Radiographic Images in Pediatrics. The total score of the qualitative evaluation was 5.15% higher in the chest upright method using ADCR than in the chest supine method without ADCR, and the chest upright method score was higher than that of the chest supine method in items 1 to 7. whether infants have deep inspiration or not, 4.87% higher for item 1, whether infants rotate or not and the degree of tilting, 0% higher for the item 2, the reproduction of image from just above apices of lungs to T12/L1, 0% for the item 3, reproduction of the vascular pattern in central 2/3 of the lungs, 6.92% higher for the item 4, reproduction of the trachea and the proximal bronchi, 12.9% higher for the item 5, visually sharp reproduction of the diaphragm and costo-phrenic angles, 10% higher for the item 6, reproduction of the spine and paraspinal structures and visualisation of the retrocardiac lung and the mediastinum, and 3.65% higher for the item 7. Items 2 and 3 showed no statistically significant differences(P > 0.05), and items 1, 4, 5, 6, and 7 showed statistically significant differences(P < 0.05). In conclusion, Upright method using ADCR in pediatric chest X-ray is considered as a good alternative to existing Supine method.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.710-715
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• 2010

Background: Video-assisted thoracic surgery (VATS) became common in the treatment of spontaneous pneumothorax (SP). Therefor we've reviewed the recurrence rate after VATS and analysed the factors affecting recurrent pneumothorax after VATS on this study. Material and Method: This retrospective analysis was performed on 321 patients of SP who had undergone VATS from Jan. 2001 to Dec. 2008. The two groups were divided as follow: group A, non-recurrent group (298 patients: 93%); and group B, recurrent group (26 patients: 7%); the two groups were analysed retrospectively. Result: The average age of the study groups were $20.9{\pm}4.3$ years old in recurrent group vs. $25.9{\pm}11.7$ years old in non-recurrent group with statistical significance (p < 0.05). There were no statistical significance in male to female ratio, height/weight ratio, location of pneumothorax, smoking history, operative time, duration of drain, hospital stay, indication of opertion and incidence rate. Average length of duration in recurrence was 12.9 months. There was 22 (95.7%) recurrent patients after VATS within 4 year period among recurrent group. Treatment methods in 23 of recurrent patients were, 8 (VATS), 2 (Axillary thoracotomy) with 15% or more in amount of pneumothorax and 7 (7 Fr. chest tube), 6 (nasal 02) with 15% or less in amount of pneumothorax. Among 10 cases of reoperation, there were 3 cases of over looking type and 7 cases of new growing type. There was no additional recurrence after these procedures were given. Conclusion: There was higher recurrence rate in younger age after VATS thus for those under 20 yrs old, detailed and possible preoperative warning for recurrence is warranted. Most recurrence occured within 4 year period, thus for this reason, regular interval based follow up with chest x-ray study is suggested during this period.

• Tuberculosis and Respiratory Diseases
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• v.65 no.1
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• pp.7-14
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• 2008

Background: Residual pleural thickening (RPT) is the most frequent complication of tuberculous pleurisy (TP), and this can happen despite of administering adequate anti-tuberculous (TB) therapy. Yet there was no definite relation between RPT and other variables. The aim of this study was to examine matrix metalloproteinases (MMPs) and the inhibitors of metalloproteinases (TIMPs) and to identify the factors that can predict the occurrence of RPT. Methods: The patients with newly-detected pleural effusions were prospectively enrolled in this study from January 2004 to June 2005. The levels of MMP-1, -2, -8 and -9, and TIMP-1 and -2 were determined in the serum and pleural fluid by ELISA. The residual pleural thickness was measured at the completion of treatment and at the point of the final follow-up with the chest X-ray films. Results: The study included 39 patients with pleural fluid (PF). Twenty-three had tuberculous effusion, 7 had parapneumonic effusion, 7 had malignant effusion and 2 had transudates. For the 17 patients who completed the anti-TB treatment among the 23 patients with TP, 7 (41%) had RPT and 10 (59%) did not. The level of PF TIMP-1 in the patients with RPT ($41,405.9{\pm}9,737.3ng/mL$) was significantly higher than that of those patients without RPT ($29,134.9{\pm}8,801.8$) at the completion of treatment (p=0.032). In 13 patients who were followed-up until a mean of $8{\pm}5$ months after treatment, 2 (15%) had RPT and 11 (85%) did not. The level of PF TIMP-2 in the patients with RPT ($34.4{\pm}6.5ng/mL$) was lower than that of those patients without RPT ($44.4{\pm}15.5$) at the point of the final follow-up (p=0.038). Conclusion: The residual pleural thickening in TP might be related to the TIMP-1 and TIMP-2 levels in the pleural fluid.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.795-804
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• 1998

Background: Chronic eosinophilic pneumonia(CEP) is interstitial lung disease characterized by multiple infiltration on radiographic study, accumulation of eosinophils in the alveolar space and interstitium of the lung, chronic persistent symptoms and possible relapse. Acute eosinophilic pneumonia(AEP) is a recently described illness, characterized by rapid clinical course, acute respiratory insufficiency and no relapse. Method : To better characterize acute and chronic eosinophilic pneumonia, we studied the clinical and laboratory features of 16 patients(AEP : 7 patients, CEP : 9 patients), which were clinico-pathohistologically diagnosed and not to be associated with organic disorders producing peripheral blood eosinophilia. Results: The mean age was higher for patients with CEP than for patients with AEP ($55.4{\pm}15.1$ vs. $24.6{\pm}7.9$ years, p<0.05). High fever(above $38^{\circ}C$) was presented in all patients of AEP and in one patient(11%) of CEP. All patients of AEP and eight patients (89%) of CEP showed bilateral pulmonary infiltrates, and 6 patients(86%) of AEP and 2 patients(22%) of CEP showed pleural effusion in chest radiograph. The mean white blood cell count of AEP and CEP were $17,186/mm^3$ and $12,867/mm^3$, respectively. The mean peripheral blood eosinophil count of AEP and CEP were $939/mm^3$ and $2,104/mm^3$, respectively. The mean eosinophil fraction of BAL fluid of AEP and CEP were 32.4% (range: 18~47%) and 35.8% (range: 15.3~88.2%), respectively. The mean $PaO_2$ was lower for patients with AEP than for patients with CEP ($44.1{\pm}15.5$ vs. $62.7{\pm}6.9$mmHg, p<0.05). All patients of AEP and CEP were initially treated with antibiotics. All patients of CEP and one patients of AEP were finally required systemic steroid therapy. 6 patients of AEP were improved without steroid therapy. Relapse was observed in 3 patients(33%) of CEP. Conclusion : Compair with of chronic eosinophilic pneumonia, acute eosinophilic pneumonia was characterized by relatively young age, acute onset, high fever, severe hypoxemia, diffuse pulmonary infiltrates with pleural effusion, steroid therapy is effective but spontaneous improvement with conservative therapy was frequent.