• Title/Summary/Keyword: Ground-glass opacity

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Clinical Characteristics of Community-Acquired Viridans Streptococcal Pneumonia

  • Choi, Sun Ha;Cha, Seung-Ick;Choi, Keum-Ju;Lim, Jae-Kwang;Seo, Hyewon;Yoo, Seung-Soo;Lee, Jaehee;Lee, Shin-Yup;Kim, Chang-Ho;Park, Jae-Yong
    • Tuberculosis and Respiratory Diseases
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    • v.78 no.3
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    • pp.196-202
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    • 2015
  • Background: Viridans streptococci (VS) are a large group of streptococcal bacteria that are causative agents of community-acquired respiratory tract infection. However, data regarding their clinical characteristics are limited. The purpose of the present study was to investigate the clinical and radiologic features of community-acquired pneumonia (CAP) with or without parapneumonic effusion caused by VS. Methods: Of 455 consecutive CAP patients with or without parapneumonic effusion, VS were isolated from the blood or pleural fluid in 27 (VS group, 5.9%) patients. Streptococcus pneumoniae was identified as a single etiologic agent in 70 (control group) patients. We compared various clinical parameters between the VS group and the control group. Results: In univariate analysis, the VS group was characterized by more frequent complicated parapneumonic effusion or empyema and bed-ridden status, lower incidences of productive cough, elevated procalcitonin (>0.5 ng/mL), lower age-adjusted Charlson comorbidity index score, and more frequent ground glass opacity (GGO) or consolidation on computed tomography (CT) scans. Multivariate analysis demonstrated that complicated parapneumonic effusion or empyema, productive cough, bed-ridden status, and GGO or consolidation on CT scans were independent predictors of community-acquired respiratory tract infection caused by VS. Conclusion: CAP caused by VS commonly presents as complicated parapneumonic effusion or empyema. It is characterized by less frequent productive cough, more frequent bed-ridden status, and less common CT pulmonary parenchymal lesions. However, its treatment outcome and clinical course are similar to those of pneumococcal pneumonia.

Pandemic Influenza A/H1N1 Viral Pneumonia without Co-Infection in Korea: Chest CT Findings

  • Son, Jun-Seong;Kim, Yee-Hyung;Lee, Young-Kyung;Park, So-Young;Choi, Cheon-Woong;Park, Myung-Jae;Yoo, Jee-Hong;Kang, Hong-Mo;Lee, Jong-Hoo;Park, Bo-Ram
    • Tuberculosis and Respiratory Diseases
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    • v.70 no.5
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    • pp.397-404
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    • 2011
  • Background: To evaluate chest CT findings of pandemic influenza A/H1N1 pneumonia without co-infection. Methods: Among 56 patients diagnosed with pandemic influenza A/H1N1 pneumonia, chest CT was obtained in 22 between October 2009 and Februrary 2010. Since two patients were co-infected with bacteria, the other twenty were evaluated. Predominant parenchymal patterns were categorized into consolidation, ground glass opacity (GGO), and mixed patterns. Distribution of parenchymal abnormalities was assessed. Results: Median age was 46.5 years. The CURB-65 score, which is the scoring system for severity of community acquired pneumonia, had a median of 1. Median duration of symptoms was 3 days. All had abnormal chest x-ray findings. The median number of days after the hospital visit that Chest CT was performed was 1. The reasons for chest CT performance were radiographic findings unusual for pneumonia (n=13) and unexplained dyspnea (n=7). GGO was the most predominant pattern on CT (n=13, 65.0%). Parenchymal abnormalities were observed in both lungs in 13 cases and were more extensive in the lower lung zone than the upper. Central and peripheral distributions were identified in ten and nine cases, respectively. One showed diffuse distribution. Peribronchial wall thickening was found in 16 cases. Centrilobular branching nodules (n=7), interlobular septal thickening (n=4), atelectasis (n=1), pleural effusion (n=5), enlarged hilar and mediastinal lymph nodes (n=6 and n=7) were also noted. Conclusion: Patchy and bilateral GGO along bronchi with predominant involvement of lower lungs are the most common chest CT findings of pandemic influenza A/H1N1 pneumonia.

Acute Respiratory Distress Syndrome after Topotecan Therapy in a Patient with Small Cell Lung Cancer (소세포폐암 환자에서 토포테칸 투약 후 발생한 급성호흡곤란증후군)

  • Tae, Jung Hyun;Lee, Jin Hwa;Kim, Yoon Kyung;Sim, Yun Su;Lee, Kyung Jong;Noh, Young Wook;Park, Jae Jung;Ryu, Yon Ju;Chun, Eun Mi;Chang, Jung Hyun
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.2
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    • pp.142-146
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    • 2008
  • Small cell lung cancer is characterized by an aggressive clinical course and a high tendency for early dissemination in spite of a good chemotherapy response. Topotecan is a topoisomerase I inhibitor, and it is used as second-line treatment for small cell lung cancer. The reported dose-limiting adverse reactions to topotecan are mainly hematologic. Yet pulmonary toxicity associated with topotecan is known to be rare. We report here on a case that showed the development of acute respiratory distress syndrome during the 3rd cycle of topotecan chemotherapy in a patient with small cell lung cancer. He developed dyspnea and respiratory failure, and the chest CT scan revealed diffuse ground-glass opacity that was probably due to chemotherapy-related pulmonary toxicity. He finally died of acute respiratory distress syndrome.

A Case of Pulmonary Alveolar Proteinosis Associated with Pulmonary Tuberculosis (폐결핵과 병발된 폐포단백증 1예)

  • Park, Min Sik;Jung, Sung Chang;Jin, Myoung In;Lee, Jin Bae;Lim, Sang Hyuk;Park, Sung Hun;Chung, Seung Hie;Shin, Tae Rim;Hyun, Dae Sung;Lee, Sang Chae;Yun, Kil Suk;Kwon, Kun Young
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.4
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    • pp.411-418
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    • 2002
  • Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipids, is deposited in the alveoli and bronchioles. The deficiency in the clearance and degradation of the intra-alveolar phospholipoproteinaceous material in PAP most likely represents a dysfunction of the type II pneumocytes. Although the pathogenesis and causative treatment of PAP is unclear a whole lung bronchopulmonary lavage is a relatively safe and effective treatment. Here we experienced a case of pulmonary alveolar proteinosis in a 62 year old female patient who had pulmonary tuberculosis approximately 20 years ago. She complained of aggravated dyspnea and chronic cough, and presented fine inspiratory crackles at both lung fields, diffuse ground glass opacity with some area of consolidation and smooth interlobular septal thickenings in both upper, right middled lobes, and a portion of right lower lobe. Optical microscopy of the lung tissue obtained by and open lung biopsy revealed many granulomas containing acid-fast smear positive bacilli and diffuse homogeneous PAS-positive fluid in the alveolar space. Immunohistochemical stain showed surfactant. A in the alveolar space. Antituberculosis drugs with bronchoalveolar lavage were used to treat the disease. Thereafter she showed improvement in her symptoms and a partial improvement in the chest X-ray and HRCT findings. We present a case of PAP associated with pulmonary tuberculosis.

Respiratory Virus Detection Rate in Patients with Severe or Atypical Community-acquired Pneumonia (중증 또는 비전형적 지역사회획득 폐렴으로 입원한 환자에서 호흡기 바이러스의 검출 빈도)

  • Park, Ji-Won;Jung, Sun-Young;Eun, Hyuk-Soo;Cheon, Shin-Hye;Seong, Seok-Woo;Park, Dong-Il;Park, Myung-Rin;Park, Hee-Sun;Jung, Sung-Soo;Kim, Ju-Ock;Kim, Sun-Young;Lee, Jeong-Eun
    • Tuberculosis and Respiratory Diseases
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    • v.71 no.5
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    • pp.335-340
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    • 2011
  • Background: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality throughout the world in all age groups. Viral causes of CAP are less well characterized than bacterial causes. We analyzed the characteristics of hospitalized patients with CAP who had a viral pathogen detected by multiplex polymerase chain reaction (PCR). Methods: Multiplex real-time PCR was performed for respiratory viruses in samples collected from 520 adults who developed CAP at Chungnam National University Hospital. Clinical, laboratory, and radiological features at presentation as well as other epidemiological data were analyzed. Results: Of 520 patients with CAP, a viral pathogen was detected in 60 (11.5%), and influenza A was the most common. The virus detection rate in patients with CAP was highest in November. Two or more pathogens were detected in 13 (21.7%) patients. Seven patients had severe disease and were administered in the intensive care unit. Most patients (49/60, 81.7%) had comorbidities. However, nine (15%) patients had no comorbidities, and their age was <60 years. The ground glass opacity pattern was the most common radiological feature. Seven (11.7%) patients died from CAP. Conclusion: Viral pathogens are commonly detected in patients with CAP, and a respiratory virus may be associated with the severity and outcome of pneumonia. Careful attention should be paid to the viral etiology in adult patients with CAP.

Severe Acute Fibrinous and Organizing Pneumonia with Acute Respiratory Distress Syndrome

  • Kang, Hyo-Jae;Choi, Sun-Mi;Jeong, Yun-Jeong;Park, Jong-Sun;Lee, Sei-Won;Yoon, Ho-Il;Lee, Jae-Ho;Lee, Choon-Tack;Cho, Young-Jae
    • Tuberculosis and Respiratory Diseases
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    • v.71 no.5
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    • pp.368-372
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    • 2011
  • Acute fibrinous and organizing pneumonia is a newly recognized pattern of acute lung injury. A 49-year-old female presented with a cough and worsening dyspnea on exertion. She had no history of smoking and no specific past medical history except exposure of home humidifier containing sterilizer. A chest computed tomography scan showed patchy consolidation with fibrosis in the right lower lobe and ill-defined centrilobular ground glass opacity in both lungs. The pathological findings were patchy areas of lung parenchyma with fibrin deposits in the alveolar ducts and alveoli, and fibrin balls with hemosiderin deposition in the alveolar spaces. The histological pattern of our case is differentiated from diffuse alveolar damage by the absence of hyaline membranes, and from eosinophilic pneumonia by the lack of eosinophils. In our case, the patient was treated with corticosteroid pulse therapy. However, the clinical course became aggravated and she died within two weeks.

Systemic Lupus Erythematosus Associated with Interstitial Pneumonia and Achalasia (식도 이완 불능증과 간질성 폐렴을 동반한 전신성 홍반성 낭창)

  • Kwon, Hye Lee;Hong, Kyung Wook;Lim, Seung Jin;Park, So Young;Bae, Young Deok;Kim, Kyung Ho;Choi, Jeong Hee;Mo, Eun Kyung;Park, Yong Bum
    • Tuberculosis and Respiratory Diseases
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    • v.65 no.4
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    • pp.323-327
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    • 2008
  • Systemic lupus erythematosus (SLE) is a multisystem disorder where the etiology is not clearly known. Symptomatic chronic interstitial pneumonitis is an uncommon manifestation, with a reported prevalence of 3~13%. Achalasia is rare disease that presents with failure in the relaxation of the esophagus sphincter. A 22-year-old woman was admitted to our hospital because of fever, cough and dyspnea. The patient had a history of pericardial effusion and Raynaud's phenomenon. The results of laboratory tests indicated the presence of lymphopenia and included positive antibody tests for antinuclear antibody and anti Sm antibody. A chest X-ray demonstrated the presence of peribronchial infiltration on both lung fields. A Chest CT image showed interlobar septal thickening, ground-glass opacity and a honeycomb appearance in both lung fields and esophageal dilatation with air fluid level. An esophagogram showed the presence of dilated esophagus ends that represented the non-relaxed lower esophageal sphincter. Manometry demonstrated incomplete sphincter relaxation. The case was diagnosed as systemic lupus erythematosus associated with interstitial pneumonia and achalasia.

Diffuse Pulmonary Alveolar Hemorrhage and Interstitial Pneumonitis after Subcutaneous Injection of Atelocollagen for Cosmetic Purpose : Two Case Reports (미용 목적으로 Atelocollagen 주입 후에 발생한 미만성 폐포출혈과 간질성 폐렴 2례)

  • Ko, Young Chun;Lim, Sung Chul;Park, Kyung Hwa;Kim, Jeong Soon;Kim, Kyu Sik;Kim, Yu Il;Kim, Young Chul;Yoon, Sung Ho;Lee, Seung Il;Park, Kyung Ok
    • Tuberculosis and Respiratory Diseases
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    • v.56 no.3
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    • pp.308-314
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    • 2004
  • Atelocollagen have been used recently in skin and other soft tissue defect regions more than silicone fluid because of the low incidence of an immune reaction and complications. Several cases of acute pneumonitis after a subcutaneous injection of silicone have been reported. The symptoms were dyspnea, fever, chest pain and hemoptysis. Previous reports have explained the pathophysiology of acute pneumonitis to a pulmonary microembolism and cellular inflammation. We experienced two cases of an acute interstitial pneumonitis and pulmonary hemorrhage after a subcutaneous injection of atelocollagen. They were all healthy young women and complained of dyspnea, fever and blood tinged sputum. The chest radiography and computerized tomography showed a bilateral ground glass opacity in both lung fields. One case recovered completely with conservative treatment but the clinical course of the other case was aggravated to the degree that invasive positive pressure ventilation therapy was required. We report a rare case of a diffuse pulmonary alveolar hemorrhage and an interstitial pneumonitis after the subcutaneous injection of atelocollagen for cosmetic purposes.

A Case of Pneumocystis Pneumonia Mimicking Acute Eosinophilic Pneumonia in a Patient with AIDS (후천성면역결핍증후군 환자에게 급성 호산구성 폐렴 양상을 보인 폐포자충 폐렴 1예)

  • Lee, Bo-Ra;Kim, Hyun-Kook;Park, I-Nae;Choi, Sang-Bong;Jung, Hoon;Lee, Hyun-Kyung;Lee, Sung-Soon;Lee, Young-Min;Lee, Hyuk-Pyo;Choi, Soo-Jeon;Yum, Ho-Kee
    • Tuberculosis and Respiratory Diseases
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    • v.68 no.2
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    • pp.97-100
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    • 2010
  • A 73-year-old man was admitted with a sudden onset of dyspnea. He had never smoked. The chest radiograph and computed tomography revealed bilateral ground glass opacity and an enlarging perihilar consolidation with lymphadenopathies. There was a higher percentage of eosinophils (72%) in the bronchoalveolar lavage fluid (BALF) than normal. The patient was diagnosed with acute eosinophilic pneumonia and managed with steroid. Pneumocystis pneumonia (PCP) was diagnosed by an examination of the BALF, and the patient was treated with trimethoprim-sulphamethoxazole. The patient tested positive to the HIV antibody and the peripheral blood CD-4 positive lymphocyte count was only $33/{\mu}L$. The percentage of eosinophils in the BALF can increase in some cases of PCP that is complicated with AIDS. Only a few cases of eosinophilic pneumonia associated with PCP pneumonia have been reported in patients with AIDS but there are no case reports in Korea. This case highlights the need to consider PCP when the percentage of eosinophils in the BALF is elevated.

Surgical Outcomes of Radiographically Noninvasive Lung Adenocarcinoma according to Surgical Strategy: Wedge Resection, Segmentectomy, and Lobectomy

  • Ha, Keong Jun;Yun, Jae Kwang;Lee, Geun Dong;Cho, Won Chul;Choi, Se Hoon;Kim, Hyeong Ryul;Kim, Yong Hee;Kim, Dong Kwan;Park, Seung-Il
    • Journal of Chest Surgery
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    • v.51 no.6
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    • pp.376-383
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    • 2018
  • Background: The aim of this study was to evaluate the outcomes of surgical resection in patients with radiographically noninvasive lung adenocarcinoma according to the surgical strategy. Methods: A retrospective study was conducted of 128 patients who underwent pulmonary resection for ground-glass opacity (GGO)-dominant nodules measuring ${\leq}2cm$ with a consolidation/tumor ratio ${\leq}0.25$ based on computed tomography between 2008 and 2015. The 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate were analyzed. Results: Among the 128 patients, wedge resection, segmentectomy, and lobectomy were performed in 40 (31.2%), 22 (17.2%), and 66 patients (51.6%), respectively. No significant differences were found among the groups in the mean size of tumors (p=0.119), the rate of pure-GGO nodules (p=0.814), the consolidation/tumor ratio (p=0.695), or the rate of invasive adenocarcinoma (p=0.378). Centrally located tumors were more common in the lobectomy group (21.2%) than in the wedge resection (0%) or segmentectomy (0%) groups (p=0.001). There were no significant differences in the 5-year DFS rate (100%, 100%, 92.7%, respectively; p=0.76) or 5-year OS rate (100%, 100%, 100%; p=0.223) among the wedge resection, segmentectomy, and lobectomy groups. Conclusion: For radiographically noninvasive lung adenocarcinoma measuring ${\leq}2cm$ with a consolidation/tumor ratio ${\leq}0.25$, wedge resection and segmentectomy could be comparable surgical options to lobectomy.