• Pediatric Infection and Vaccine
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• 제28권2호
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• pp.124-131
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• 2021

Cryptococcus neoformans는 주로 면역이 저하된 환자에서 기회 감염을 일으키는 진균이다. 그러나 면역이 정상인 환자에서도 다양한 감염을 일으킬 수 있다. 림프절을 침범한 폐 크립토코쿠스증은 정상 면역을 가진 사람에서는 상대적으로 드물게 발생한다. 고열과 지속적인 기침을 주소로 병원에 온 17세 여자 청소년이 가슴X선 영상검사 및 컴퓨터단층촬영에서 전방 종격동에서 우측 쇄골하 부위까지 침범된 종괴를 보여 초음파 유도하 총생검 검사로 크립토코쿠스증을 진단하였다. 각종 면역 검사에서는 이상 소견이 발견되지 않았다. 환자는 2주간 암포테리신 B와 플루시토신으로 치료 후 8개월간 플루코나졸로 치료하였고 완쾌되었다. 본 증례를 통해 크립토코쿠스증의 특징을 이해하고 정상 면역 환자에게서도 크립토코쿠스증이 발생할 수 있음을 염두에 두고 진단을 내리는 것이 바람직하겠다.

• Journal of Chest Surgery
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• 제22권5호
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• pp.731-738
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• 1989

The development of chylothorax and chylopericardium are serious and often life-threatening clinical entity. The ideal treatment of these problems is not well established to date. We reviewed our experiences with chylothorax or chylopericardium in 16 patients [17 cases] from July 1979 to May 1989. Ages ranged from 20 days to 41 years. The etiologies were traumatic in 10, congenital or idiopathic in 5, and tuberculous lymphadenopathy in one. In 8 patients, the chylothorax or chylopericardium occurred as a complication of cardiothoracic surgery. Eleven patients were treated nonoperatively with either repeated thoracenteses or chest tube drainage. Five patients underwent operative treatment: transthoracic thoracic duct ligation [three patients], thoracic duct ligation combined with decortication [one], and oversewn the defect of mediastinal pleura[one]. Duration of preoperative therapy ranged from 18 to 38 days. One of eleven [9.1 %] patients treated nonoperatively died. Of the surgically treated group, there were no deaths. All patients except one dead cured or improved either treated nonoperatively or operatively. Our experience suggests that surgical management of the chylothorax or chylopericardium is not always required, and each patient must be judged individually according to disease process.

• Tuberculosis and Respiratory Diseases
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• 제68권4호
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• pp.231-235
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• 2010

Lymphadenopathy in the thoracic cavity is frequently caused by inflammatory diseases. In very rare cases, the node-bronchial fistula has been reported to be the cause of complications of pulmonary tuberculosis. A male patient with necrotizing pneumonia and mediastinal lymph node enlargements identified by chest computed tomography was also found to have a node-bronchial fistula caused by lung cancer. The patient was treated for tuberculosis with pneumonia for one week before a definitive diagnosis was made. A further investigation revealed him to have non-small cell lung cancer (NSCLC, adenocarcinoma) and multiple mediastinal lymphadenopathies accompanied with the node-bronchial fistula. We report this specific case that had been previously treated for tuberculosis but was later revealed to be NSCLC accompanied with a node-bronchial fistula.

• 대한영상의학회지
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• 제82권4호
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• pp.903-913
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• 2021

목적 악성 종양의 완전 관해 후 발생한 흉강 내 림프절병증 환자에서 사르코이드증 유사 반응을 시사할 수 있는 영상의학적 특징을 알아보고자 한다. 대상과 방법 이 연구는 악성 종양의 완전 관해 상태에서 발생한 조직병리학적으로 확인된 사르코이드증 유사 반응을 보인 5명의 환자의 임상적 특징과 CT 및 ¹⁸F-fluorodeoxyglucose(이하 FDG) PET/CT 소견을 분석하였다. 결과 기저 악성 종양으로는 유방암, 비인두암, 자궁내막암 및 림프종이 포함되며. 악성 종양의 완전 관해와 사르코이드증 유사 반응 진단 사이의 시간 간격은 6~78개월이었다. CT 소견으로는 양측 폐문 및 종격동 림프절병증(n = 5), 기관지혈관주위, 엽간열주위 또는 흉막하 폐결절(1~15 mm) 및 소엽내 간질비후가 포함되었다(n = 4). ¹⁸F-FDG PET/CT는 흉강 외 FDG 흡수 없이 양측 폐문 및 종격동 림프절의 대사항진을 나타냈다(n = 3). 모든 환자에서 코르티코스테로이드 치료 후 사르코이드증 유사 반응이 호전되었다. 결론 악성 종양의 완전 관해를 달성한 환자에서, 원발성 종양의 재발과 흉강 외 원격 전이 없는 상태에서 새로 발견된 양측 폐문 및 종격동 림프절병증은 림프관주위 폐결절의 유무에 관계없이 사르코이드증 유사 반응의 가능성을 시사할 수 있으며 불필요한 전신 화학요법을 예방하기 위해 림프절의 조직병리학적 확인이 필요하다.

• Tuberculosis and Respiratory Diseases
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• 제41권6호
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• pp.616-623
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• 1994

연구목적: 수술전 전산화 단층촬영상 임파절종대의 소견이 없는 $T_{1-3}N_0M_0$비소세포폐암 환자들을 대상으로 수술전 후 병기의 차이를 비교하여 이들에 있어 수술전 관혈적인 병기판정의 필요성에 대하여 검토하였다. 방법: 경북대학교병원에서 비소세포폐암으로 개흉절제술을 받았던 환자들 가운데 수술전 병기가 $T_{1-3}N_0M_0$인 41명을 대상으로 수술전과 수술후의 병기의 차이를 비교하였다. 결과: 1) 수술전 병기는 I기의 경우 $T_1N_0M_0$ 3예, $T_2N_0M_0$ 32예로 모두 35예였고 IIIa기 ($T_3N_0M_0$)는 6예였다. 종양의 위치는 중심형 폐암 24예, 말초형 폐암 17예였는데 IIIa기는 모두 중심형 폐암이었다. 2) 수술후 병기는 I기의 경우 $T_1N_0M_0$ 2예, $T_2N_0M_0$ 25예로 모두 27예였고 II기의 경우 $T_1N_1M_0$ 1예, $T_2N_1M_0$ 3예로 모두 4예였으며 IIIa기는 $T_3N_0M_0$ 1예, $T_3N_1M_0$ 2예, $T_3N_2M_0$ 4예, $T_2N_2M_0$ 2예로 모두 9예였고 IIIb기($T_4N_1M_0$)는 1예였다. 3) 수술후 T의 변화가 있은 경우는 $T_2$ 32예 가운데 2예는 $T_3$로 $T_3$ 6예중 1예는 $T_4$로 판명되었다. 4) 수술후 $N_1$으로 판명된 경우는 7예였고 $N_2$로 판명된 경우는 6예였다. 5) 수술전 T에 따른 임파절전이는 $T_{1-2}$인 경우는 35예 중 8예($N_1$ 5예, $N_2$ 3예)였고 $T_3$인 경우는 6예중 5예($N_1$ 2예, $N_2$ 3예)로 $T_{1-2}$에 비해 $T_3$에서 임파절 전이빈도가 높았고 $N_2/N_1$비도 높았다 그러나 수술전 $T_{1-2}$경우 종양의 위치에 따른 임파절전이의 차이는 없었다. 6) 41예의 대상환자중 $N_2$ 6예와 $T_4$ 1예를 제외한 34예에서 완전 절제가 가능하였다. 결론: 이상의 결과로 전산화 단층촬영상 임파절종대가 없는 비소세포암의 수술전 병기판정시 수술전 $T_3$에서는 종격동경 검사 등의 관혈적인 병기판정방법이 필요하리라 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제80권1호
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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.

• Tuberculosis and Respiratory Diseases
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• 제68권5호
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• pp.267-272
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• 2010

Background: Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. Methods: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis. Results: A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. Conclusion: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.

• Tuberculosis and Respiratory Diseases
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• 제69권4호
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• pp.293-297
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• 2010

A 60-year-old man was diagnosed with stage IV squamous cell carcinoma of lung and treated with weekly doses of docetaxel and cisplatin. Tumor mass and mediastinal lymphadenopathy disappeared after 4.5 cycles of chemotherapy. At one week post final chemotherapy, the patients developed sudden shortness of breath. New, multifocal infiltrations developed on both lungs without definitive evidence of infection. Despite administration of broad spectrum antibiotics, the lung lesion did not improve, so bronchoalveolar lavage and computed tomography-guided lung biopsy were performed. The proportion of lymphocytes was increased markedly and histopathology revealed squamous cell carcinoma combined with bronchiolitis obliterans organizing pneumonia. After high dose corticosteroid therapy, dyspnea and the newly developed consolidation had decreased slightly. However, dyspnea and hypoxemia increased again because of aggravated lung cancer since chemotherapy had stopped. Chemotherapy couldn't be restarted due to the poor performance status of the patient. Later, patient died of respiratory failure from poor general condition and progression of lung cancer.

• Tuberculosis and Respiratory Diseases
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• 제43권1호
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• pp.113-116
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• 1996

A previously healthy 59-year old male patient was admitted due to cough and abnormal chest x-ray. Cough started 5 months ago and persisted. Two months before admission, abnormality in chest PA was detected. He had no symptom other than cough. He was nonsmoker and physical examination revealed no abnormal finding. His chest X-ray showed ill-defined $2{\times}1\;cm$ ovoid infiltration in left middle lung field. On chest computed tomography, it was located in the subpleural region of posterobasal segment of left lower lobe. Mediastinal lymphadenopathy was absent. Blood test and sputum examination were not diagnostic. Fluoroscopy-guided percutaneous needle biopsy revealed pulmonary cryptococcosis. After central nervous system involvement was excluded by spinal tap, oral ketoconazole therapy was started. The lesion decreased in size after 8 weeks of therapy and almost disappeared on follow-up chest X-ray 4 months later.

• Tuberculosis and Respiratory Diseases
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• 제71권5호
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• pp.355-358
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• 2011

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a useful, safe diagnostic modality for evaluating mediastinal and hilar lymphadenopathy. We report a 51-year-old male who presented with a left renal mass and multiple pleural masses without lung parenchymal lesions. The pleural masses were thought to be metastatic tumors or malignant mesothelioma. The patient underwent two percutaneous needle biopsies of the pleural mass, but the specimens were insufficient for a histopathological diagnosis. Because one pleural mass was adjacent to the right main bronchus, we decided to perform EBUS-TBNA for the pleural mass. As a result, sufficient core tissue was obtained with no complications, and the histopathological findings were consistent with metastatic papillary renal cell carcinoma. To our knowledge, this is the first case of using EBUS-TBNA for a pleural mass.