• Tuberculosis and Respiratory Diseases
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• v.56 no.6
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• pp.646-656
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• 2004

Background : The aim of this study was to elucidate the mediastinal lymphatic drainage of nonsmall- cell lung cancer (NSCLC). Methods : We retrospectively analyzed the frequency of enlarged mediastinal lymph node (LN) in 256 NSCLC patients with N2 or N3 diseases on CT scan, especially with respect to the location of primary tumor. Results : In 57 patients with right upper lobe (RUL) tumors, right lower paratracheal LN (89.5%) was the most commonly enlarged, followed by subcarinal LN (54.4%). In 61 patients with left upper lobe (LUL) tumors, left lower paratracheal (70.5%) and subaortic LNs (52.5%) were commonly enlarged. Subcarinal LN enlargement without ipsilateral superior mediastinal LN enlargement was rarely found in both upper lobe tumors; RUL 8.8%, LUL 6.6%. In patients with right or left lower lobe (RLL or LLL) tumors, the most commonly enlarged LN was subcarinal; 88.2%, 65.7%, respectively. In RLL tumors with both subcarinal and superior mediastinal LN enlargements, the frequency of ipsilateral superior mediastinal LN involvement was similar to that of bilateral superior mediastinal involvement. In LLL tumors with both subcarinal and superior mediastinal LN enlargements, bilateral superior mediastinal involvement was more frequent than ipsilateral superior mediastinal involvement. Conclusion : The results of this study suggest that both upper lobe tumors are mainly drained directly to ipsilateral superior mediastinal LNs, and that both lower lobe lesions are drained to superior mediastinal LN via subcarinal LNs.

• Pediatric Infection and Vaccine
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• v.18 no.1
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• pp.80-84
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• 2011

Empyema necessitatis refers to empyema that extends into the extrapleural space through a defect in the pleural surface. Tuberculous empyema necessitatis is a rare complication of tuberculosis. We experienced a 21-month-old boy with tuberculous empyema necessitatis with osteomyelitis in the right $7^{th}$ rib. He presented with a mass on the right lateral chest wall, which was soft and nontender, enlarging for one month. He also had mild fever. The plain radiograph of his chest revealed soft tissue swelling and calcified lymph node on the left axilla, and his PPD skin test was positive. CT scan of the chest showed empyema necessitatis at the right lower chest and upper abdominal walls with osteomyelitis of the right $7^{th}$ rib. He did not have concurrent pulmonary tuberculosis. Surgery was performed for diagnosis and treatment. In histopathologic findings, chronic granulomatous inflammation with caseation necrosis was shown and was positive for acid fast bacilli stain. In addition, M. tuberculosis complex was found as etiology by polymerase chain reaction. The patient has been treated with anti-tuberculous medication without any specific complication.

• Tuberculosis and Respiratory Diseases
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• v.59 no.2
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• pp.209-212
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• 2005

Sarcoidosis, a multisystemic granulomatous disorder of unknown causes, which presents with bilateral hilar adenopathy, pulmonary infiltration, and cutaneous, ocular, bones, and nervous and reticuloendothelial systems involvement, commonly involves young adults of both sexes. Herein, the case of a 70-year-old male, with progressive hoarseness of two weeks' duration and mild dyspnea, is reported. A fiberoptic bronchoscopy, performed to investigate the hoarseness, revealed paralysis of the left vocal cord, but with no other local abnormality. Two nodules, as pathologic findings, showed noncaseating epithelioid cell granulomas. We note a rare case of sarcoidosis, with vocal cord palsy, in Korea.

• Tuberculosis and Respiratory Diseases
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• v.42 no.1
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• pp.105-109
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• 1995

Pulmonary involvement of salmonella infection is very rare and only one case of salmonella empyema had been reported in Korea. A 53-year-old woman presented to Kyung Hee Medical Center with 2-months history of left chest pain and mild fever. 3 months prior to admission, the patient was taken to laparoscopic laser cholecystectomy due to gall stone in other hospital. Chest X-ray taken on admission day showed pneumonic infiltration at left lower lung field with pleural effusion. Salmonella Group B was identified from the cultures of stool, blood, and pleural fluid. After consecutive therapy with two weeks of ceftriaxone and three weeks of ciprofloxacin combined with repeated pleural aspirations, the patient was recovered and discharged. But she was readmitted two months later due to fever and generalized malaise. The result of blood culture showed growth of Salminella Group B. The excisional biopsy of right supraclavicular lymph node disclosed necrotizing lymphadenitis. She was recovered clinically and no more bacteremia occurred after two weeks of ciprofloxacin therapy. We present very rare case of empyema due to salmonella infection and review the pertinent literature.

• Tuberculosis and Respiratory Diseases
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• v.44 no.6
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• pp.1440-1446
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• 1997

The radiologically detectable pulmonary involvement of NHL at diagnosis is about 4%. The commonest intrathoracic manifestations of secondary pulmonary lymphoma are mediastinal or hilar lymph node enlargement And the most frequent manifestations of pulmonary parenchymal lymphoma are lymphomatous nodules. But, when patients with newly diagnosed lymphoma exhibit rapidly progressive parenchymal lesions, an infection, such as pneumonia, is usually suspected. We present a report of a patient who developed rapidly progressive pulmonary involvement with T cell lymphoma, which was considered to be pneumonia because of high fever and rapidly progressive radiologic findings.

• Tuberculosis and Respiratory Diseases
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• v.80 no.1
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• pp.45-51
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• 2017

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic method for mediastinal and hilar lymphadenopathy. This study aimed to investigate the incidence of fever following EBUS-TBNA. Methods: A total of 684 patients who underwent EBUS-TBNA from May 2010 to July 2012 at Seoul National University Hospital were retrospectively reviewed. The patients were evaluated for fever by a physician every 6-8 hours during the first 24 hours following EBUS-TBNA. Fever was defined as an increase in axillary body temperature over $37.8^{\circ}C$. Results: Fever after EBUS-TBNA developed in 110 of 552 patients (20%). The median onset time and duration of fever was 7 hours (range, 0.5-32 hours) after EBUS-TBNA and 7 hours (range, 1-52 hours), respectively, and the median peak body temperature was $38.3^{\circ}C$ (range, $137.8-39.9^{\circ}C$). In most patients, fever subsided within 24 hours; however, six cases (1.1%) developed fever lasting longer than 24 hours. Infectious complications developed in three cases (0.54%) (pneumonia, 2; mediastinal abscess, 1), and all three patients had diabetes mellitus. The number or location of sampled lymph nodes and necrosis of lymph node were not associated with fever after EBUS-TBNA. Multiple logistic regression analysis did not reveal any risk factors for developing fever after EBUS-TBNA. Conclusion: Fever is relatively common after EBUS-TBNA, but is transient in most patients. However, clinicians should be aware of the possibility of infectious complications among patients with diabetes mellitus.

• Clinical and Experimental Pediatrics
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• v.45 no.4
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• pp.454-458
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• 2002

Purpose : Bacillus Calmette-$Gu\acute{e}rin$(BCG) lymphadenitis is one of the most common complications of BCG vaccination. The involved lymph nodes usually subside spontaneously, but they may become enlarged and form an abscess. Treatment of these infants is controversial. The Pan American Health Organization recommends local isoniazid or rifampicin instillation for patients with suppurative BCG lymphadenitis. Methods : The study group comprised 37 patients who presented with BCG lymphadenitis over the last three years. BCG lymphadenitis was diagnosed if the affected patient developed an ipsilateral axillary or supraclavicular lymphadenitis, with no other identifiable cause for the lymphadenitis. We used rifampicin instillation therapy for patients with suppurative BCG lymphadenitis. Results : Lymphadenitis regressed spontaneously in three patients. Thirty four patients showed a progression to abscess formation. Among 34 patients with suppurative lymphadenitis, drainage developed spontaneously during the follow-up period in nine patients before therapy. Twenty five patients received needle aspiration and local rifampicin instillation therapy. Reaspiration was performed in seven patients. One of these patients still has large lymph nodes after the second attempt. Conclusion : Needle aspiration and local rifampicin instillation therapy into the node is a safe and effective form of treatment for suppurative BCG lymphadenitis.

• Tuberculosis and Respiratory Diseases
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• v.73 no.6
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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.

• Tuberculosis and Respiratory Diseases
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• v.41 no.2
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• pp.144-151
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• 1994

Background: Miliary tuberculosis almost always results from the discharge of infected caseous material into the blood stream, usually from a well hidden lymph node in the presentation of this disease in the past four decades, and although it is seen less frequent1y today than previously, its presentation and manifestation may require greater suspicion and diligence by the physician. We investigated the clinical characteristics, predisposing factors and accompanying diseases of miliary tuberculosis and tried to acquire the early diagnosis and treatment of this disease. Methods: A retrospective clinical study was done on 40 cases of miliary tuberculosis admitted to Hanyang University Hospital from Mar. 1989 to Dec.1992. The study investigated age and sex distribution, seasonal distribution, duration of symptoms before admission, pre-disposing factors, clinical symptoms, biochemical findings, chest X-ray findings, extrapulmonary tuberculosis associated with miliary tuberculosis, prognosis and mortality rate. Results: 1) The patients were most common in the age group between 20 and 29(23%) and the ratio of male to female was 1.4:1(male 23 : female 17). 2) Sputum smears for tubercle bacilli were positive in 5 cases(13%). 3) The most common clinical symptoms were fever with chilling(47.5%), coughing(47.5%), second most common symptom was dyspnea(32.5%), and the physical findings on admission were tachycardia(30%), weight loss(27.5%), meningeal signs(17.5%) in order. 4) The predisposing factors were heavy alcohol drinking(6 cases), steroid use(3 cases), pregnancy(2 cases) etc. 5) The chest X-ray findings on admission were miliary shadow only(40%), in addition pneumonic infiltration, pleurisy, and calcification in order. 6) The extrapulmonary tuberculosis associated with miliary tuberculosis were tuberculous meningitis(30%), bone and joint tuberculosis(17.5%), intestinal tuberculosis(15%) in order. 7) Biochemical findings were increased SGOT/SGPT(32.5%), increased alkaline phosphatase(32.5%), hypoalbuminemia(15%), hyponatremia(15%) etc. 8) About 4-6 weeks later after treatment(INH, RFP, PZA, EMB), 26 cases(65%) were improved on clinical symptoms or chest X-ray, 12 cases(30%) were stationary or aggravated, and 2 cases(5%) were died. Conclusion: For the early diagnosis and treatment of miliary tuberculosis, we must see its presentation and manifestation with greater interest and suspicion and investigate its predisposing factors and accompanying diseases.

• Journal of Chest Surgery
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• v.8 no.2
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• pp.109-118
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• 1975

This is a report on four cases of the lobar emphysema due to proximal bronchial obstruction in the Department of Thoracic Surgery, Hanyang University Hospital, during the period of three and half years from 1972 to 1975. First case, a two years old male child was referred to our Department with the lobar emphysema of the lower lobe of the right lung with pneumonia. This emphysema was developed after aspiration of a piece of peanut. Bronchoscopy revealed that the bronchus of the right lower lobe was obstructed with the foreign body, however removal of the peanut through bronchoscope was not attempted because of corruption and softening of the peanut. The removal of the peanut by bronchotomy was performed after subsiding of acute phase of pulmonary infection. Postoperative course was uneventful and the emphysema was disappeared. Second case, a twenty months old female baby was referred to our Department with lobar emphysema of the lower lobe of the left lung. The emphysema was suddenly developed with coughing and dyspneic symptoms and the diagnosis was made roentgenologically. She gave a history of reccurrent infections of the respiratory tract after birth. Bronchoscopy showed an obstruction of the left main bronchus with the growing of fibrinous tissue on the bronchial mucosa. The protruded tissue in the left main bronchus taken out about O.8ml with biopsy forceps for histological examination. After this procedure, the emphysema of the left lung was disappeared. Histological finding was reported to be a chronic inflammatory granulation tissue. Third case, a two and half years old male child was referred to our Department with roentgenological lobar emphysema. Two weeks prior to admission he had an episode of sudden onset of coughing attack with dyspnea. Bronchoscopy revealed that the bronchus of the left lower lobe was obstructed with a mass which was strongly suspected of a neoplastic tissue. At operation, there was found a perforation of enlarged tuberculous lymph node in the bronchus of the left lower lobe and protrusion of granulation tissue into the bronchus. Ruptured orifice on themembranous wall of the left lower lobe bronchus was closed with interrupted suture after the" removal of a perforated tuberculous lymph node. Postoperative course was uneventful and antituberculous chemotherapy was given. Fourth case, a 47 years old man was admitted to our Department with the complaint of severe dyspnea of few months duration. Twenty years ago, he had a history of lung tuberculosis and was treated for many years. X-ray examination including tomography and bronchography revealed that the upper lobe of the right lung was destroyed with cavities, the lower lobe was completely shrunk, and the right middle lobe was strongly overdistended with narrowing bronchial trees. Differential bronchospirometry and lung scanning confirmed that the respiratory function of the affected lung was impaired almost totally. The value of the right lung was calculated on 6% of oxygen uptake, 1% of Minute volume, and 32% of vital capacity. The right pneumonectomy was performed under the careful consideration of anesthetic and surgical procedures. Postoperative course was uneventful and the respiratory function was improved nearly to the normal level.evel.