• Tuberculosis and Respiratory Diseases
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• 제45권5호
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• pp.1031-1038
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• 1998

목 적: 악성 종양과 연관된 흉막삼출에서 혈액상을 보이는 빈도를 확인하고 혈액상 여부와 세포진 검사나 흉막조직 검사의 양성률 그리고 흉막액 CEA 양성률과의 연관 관계를 확인해 보고자 하였다. 또한 일반적으로 흉막액 CEA의 증가는 세포진 양성률과 밀접한 연관관계를 보인다고 하는데, 이에 대한 의미를 재조명하고자 하였다. 방 법: 1995년 3월부터 1996년 12월까지 연세대학교 의과 대학 세브란스 병원에서 악성 종양으로 진단된 환자중 흉막삼출이 발생한 98예를 대상으로 흉막액의 통상검사(pH, cell count, glucose, protein, LDH)와 함께 흉막액의 외견, 적혈구 수, CEA, 그리고 세포 조직학적 검사를 시행하였다. 결 과: 악성 종양과 연관된 흉막삼출의 44.9%에서 혈액상이었고 55.1%에서 장액상으로 나타났다. 흉막액의 적혈구 수가 $100,000/mm^3$ 이상 증가된 경우 흉막액 세포진 검사의 양성률은 42.8%였으며 흉막액의 적혈구수와 흉막액 세포진 검사의 양성률 그리고 CEA 양성률 등의 상호간에 연관관계는 없었다. 세포조직검사장 확진된 악성 흉막삼출의 경우 흉막액 CEA는 72.7%에서 10ng/ml 이상으로 증가된 소견을 보였고, 흉막액 CEA가 10ng/ml 이상으로 증가된 경우 새포조직검사의 양성률은 58.2%였다. 종양 진단후 흉막액이 발현되기까지의 기간과 흉막액 세포진 검사의 양성률, 흉막액 CEA의 양성률, 그리고 흉막액 적혈구수 등의 상호간에 연관관계를 발견할 수 없었다. 결 론: 소견을 악성 종양과 연관된 흉막삼출의 44.9%에서 혈액상보였으며 흉막액내 적혈구 수의 증가와 세포조직학적 검사의 양성률이나 CEA의 양성률간에 유의한 상관관계는 없었다. 흉막액 CEA의 측정은 세포조직학적인 양성률과 일치하지는 않았지만 일부 비종양성 흉막삼출에 의한 증가를 임상적으로 배제하면 흉막생검, 세포진 검사와 함께, 악성 흉막삼출의 진단적 접근에서 보조적인 역할을 감당할 수 있을 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제76권5호
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• pp.199-210
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• 2014

Pleural effusion is not a rare disease in Korea. The diagnosis of pleural effusion is very difficult, even though the patients often complain of typical symptoms indicating of pleural diseases. Pleural effusion is characterized by the pleural cavity filled with transudative or exudative pleural fluids, and it is developed by various etiologies. The presence of pleural effusion can be confirmed by radiological studies including simple chest radiography, ultrasonography, or computed tomography. Identifying the causes of pleural effusions by pleural fluid analysis is essential for proper treatments. This review article provides information on the diagnostic approaches of pleural effusions and further suggested ways to confirm their various etiologies, by using the most recent journals for references.

• Tuberculosis and Respiratory Diseases
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• 제76권4호
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• pp.160-162
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• 2014

Increasing incidence of pleural infection has been reported worldwide in recent decades. The pathogens responsible for pleural infection are changing and differ from those in community acquired pneumonia. The main treatments for pleural infection are antibiotics and drainage of infected pleural fluid. The efficacy of intrapleural fibrinolytics remains unclear, although a recent randomized control study showed that the novel combination of tissue plasminogen activator and deoxyribonuclease had improved clinical outcomes. Surgical drainage is a critical treatment in patient with progression of sepsis and failure in tube drainage.

• Tuberculosis and Respiratory Diseases
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• 제73권6호
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• pp.320-324
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• 2012

A 55-year-old woman was admitted for an elevated serum carbohydrate antigen-125 (CA-125) level, and a left pleural effusion, which were detected at a routine health examination. Computed tomography of the chest was performed upon admission, revealing extensive bilateral paratracheal and mediastinal lymph node enlargement with a massive left-sided pleural effusion. Subsequent analysis of the pleural fluid demonstrated consistency with an exudate, no evidence of malignant cells, and a normal adenosine deaminase. However, the pleural fluid and serum CA-125 levels were 2,846.8 U/mL and 229.5 U/mL, respectively. A positron emission tomography did not reveal any primary focus of malignancy. Finally, a surgical mediastinoscopic biopsy of several mediastinal lymph nodes was performed, revealing non-necrotizing granulomas, consistent with sarcoidosis. After a month of treatment of prednisolone, the left pleural effusion had resolved, and after 2 months the serum CA-125 level was normalized.

• Journal of Yeungnam Medical Science
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• 제36권1호
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• pp.8-15
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• 2019

Connective tissue diseases (CTDs) can affect all compartments of the lungs, including airways, alveoli, interstitium, vessels, and pleura. CTD-associated lung diseases (CTD-LDs) may present as diffuse lung disease or as focal lesions, and there is significant heterogeneity between the individual CTDs in their clinical and pathological manifestations. CTD-LDs may presage the clinical diagnosis a primary CTD, or it may develop in the context of an established CTD diagnosis. CTD-LDs reveal acute, chronic or mixed pattern of lung and pleural manifestations. Histopathological findings of diverse morphological changes can be present in CTD-LDs airway lesions (chronic bronchitis/bronchiolitis, follicular bronchiolitis, etc.), interstitial lung diseases (nonspecific interstitial pneumonia/fibrosis, usual interstitial pneumonia, lymphocytic interstitial pneumonia, diffuse alveolar damage, and organizing pneumonia), pleural changes (acute fibrinous or chronic fibrous pleuritis), and vascular changes (vasculitis, capillaritis, pulmonary hemorrhage, etc.). CTD patients can be exposed to various infectious diseases when taking immunosuppressive drugs. Histopathological patterns of CTD-LDs are generally nonspecific, and other diseases that can cause similar lesions in the lungs must be considered before the diagnosis of CTD-LDs. A multidisciplinary team involving pathologists, clinicians, and radiologists can adequately make a proper diagnosis of CTD-LDs.

• Tuberculosis and Respiratory Diseases
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• 제75권4호
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• pp.161-164
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• 2013

Eosinophilic pleural effusion (EPE) is defined as a pleural effusion that contains at least 10% eosinophils. EPE occurs due to a variety of causes such as blood or air in the pleural space, infection, malignancy, or an autoimmune disease. Undifferentiated connective tissue disease (UCTD) associated with eosinophilic pleural effusion is a rare condition generally characterized by the presence of the signs and symptoms but not fulfilling the existing classification criteria. We report a case involving a 67-year-old man with UCTD and EPE, who has been successfully treated with a single intrapleural corticosteroid injection.

• Tuberculosis and Respiratory Diseases
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• 제58권6호
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• pp.543-553
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• 2005

Radiological analysis of chest lesions detected on chest radiographs or CT scans begins with their classification into parenchymal, pleural, or extrapleural lesions according to their presumed origin. The mediastinum is divided anatomically into the anterior, middle, and posterior mediastinal compartments, and localizing a mediastinal mass to one of these divisions can facilitate their differential diagnosis. A differential diagnosis of a mediastinal mass is usually based on a number of findings, including its location; the structure from which it is arising; whether it is single, multifocal (involving several different areas or lymph node groups), or diffuse; its size and shape; its attenuation (fatty, fluid, soft-tissue, or a combination of these); the presence of calcification along with its characteristics and amount; and its opacification following the administration of contrast agents.

• Tuberculosis and Respiratory Diseases
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• 제42권2호
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• pp.226-230
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• 1995

만성 췌장질환에 의한 흉막삼출은 췌장염 증상없이 대량으로 발생하기도 한다. 이런 경우 흉막액내 아밀라제의 현저한 증가는 췌장질환의 발견에 도움이 되며 대부분 보존적 췌장염 치료로 호전된다. 저자들은 췌장염 증상없이 흉막저류가 발생한 환자에서 흉막액내 아밀라제 증가를 발견하여 복부 및 흉부 전산화 단층촬영으로 췌장가낭종과 췌장-흉막루를 진단하고 보존적 치료로 호전되었기에 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제47권1호
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• pp.50-56
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• 1999

연구배경: 양성 질환과 악성 질환의 감별 전단으로 혈청에서의 cyfra 21-1 에 관한 연구는 많이 되고 있으나, 흉수내 cyfra 21-1 의 진단적 의의에 관한 연구는 거의 없는 실정이다. 저자들은 흉수의 원인의 감별 진단으로 흉수의 cyfra 21-1 이 진단적 의의가 있는지를 알아보기 위하여 흉수내 cyfra 21-1 을 측정하였으며 혈청내 cyfra 21-1과도 비교하여 흉수내 cyfra 21-1의 진단적 의의를 알아보았다. 연구방법: 1994년 8월부터 1996년 6월까지 삼출성 흉막염으로 내원하였던 환자 92례를 대상으로 흉수와 혈청의 cyfra 21-1을 측정하였다. 흉수의 원인은 생화학적 검사, 세포학적 검사, 그리고 기관지 내시경 등응로 확진 되었으며, 흉수의 원인 질환에 따라 흉수와 혈청 cyfra 21-1 을 비교하였으며 각각의 민감도와 특이도는 ROC 곡선으로 분석하였다. 결과: 혈청 cyfra 21-1은 폐암군에서 가장 높았으며 양성질환군 및 전이암군과 비교할 때 양성 질환군과는 통계학적 의의가 있었으나, 전이암군과는 통계학적 의의가 없었다. 폐암군의 흉수 cyfra 21-1은 혈청보다 높았고, 각 질병군을 비교하였을 때 혈청에서와 같은 통계학적 결과를 보였다. 혈청과 흉수의 cyfra 21-1의 상관관계는 양성 질환군의 경우 통계학적 의의가 없었으나(r=-0.044, p=0.866), 악성 질환군은 유의한 상관 관계가 있었다(r=0.837, p=0.001). 전체 악성질환군인 경우 혈청 cyfra 21-1의 cut off 치를 2.7ng/mL로 하였을 때 민감도와 특이도는 각각 72.7%, 72.4%였으며, 폐암군은 cut off 치를 2.39ng/mL로 하였을 때 민감도와 특이도는 각각 73.9%, 72.4%로 두 군사이의 cut off 치, 민감도, 특이도는 차이가 없었다. 흉수 cyfra 21-1은 전체 악성 질환군의 경우 cut off 치가 10.74ng/mL 일 때 민감도 및 특이도는 각각 78.7%, 69.6% 이었으며, 폐암군은 cut off 치가 22.25 ng/mL 일 때 민감도 및 특이도는 각각 81.8%, 78.7%였다. 결론: 흉수의 cyfra 21-1 치는 양성 질환보다 악성 질환에 의한 흉막염에서 유의하게 높았으며 특히 원발성 폐암에 의한 악성 흉막염에서 민감도와 특이도가 높아 원발성 폐암에 의한 흉수의 감별진단에 cyfra 21-1을 유용하게 이용할 수 있을 것으로 생각한다.

• 대한핵의학회지
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• 제24권2호
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• pp.279-285
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• 1990

Simultaneous presence of ascites and pleural effusion has been documented in patients with cirrhosis of the liver, renal disease, Meigs' syndrome and in patients undergoing peritoneal dialysis. Mechanisms proposed in the formation of pleural effusion in most of the above diseases are lymphatic drainage and diaphragmatic defect. But sometimes, hepatic hydrothoraxes in the absence of clinical ascites and pleural effusion secondary to pulmonary or cardiac disease are noted. It is not always possible to differentiate between pleural effusion caused by transdiaphragmatic migration of ascites and by other causes based soly on biochemical analysis. Authors performed radionuclide scintigraphy after intraperitoneal administration of $^{99m}Tc-labeled$ colloid in 23 patients with both ascites and pleural effusion in order to discriminate causative mechanisms responsible for pleural effusion. Scintigraphy demonstrated the transdiaphragmatic flow of fluid from the peritoneum to pleural cavities in 13 patients correctly. In contrast, in 5 patients with pleural effusion secondary to pulmonary, pleural and cardiac diseases, radiotracers fail to traverse the diaphragm and localize in the pleural space. Ascites draining to mediastinal lymph nodes and blocked passage of lymphatic drainage were also clarified, additionaly. Conclusively, radionuclide peritoneal scintigraphy is an accurate, rapid and easy diagnostic tool in patients with both ascites and pleural effusion. It enables the causes of pleural effusion to be elucidated, as well as providing valuable information required when determining the appropriate therapy.