Tuberculosis and Respiratory Diseases
- Volume 50 Issue 1
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- Pages.106-116
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- 2001
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- 1738-3536(pISSN)
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- 2005-6184(eISSN)
Clinical Study of Pulmonary Thromboembolism
폐혈전색전증의 임상적 연구
- Bak, Sang-Myeon (Department of Internal Medicine, College of Medicine, Korea University) ;
- Lee, Sang-Hwa (Department of Internal Medicine, College of Medicine, Korea University) ;
- Lee, Sin-Hyung (Department of Internal Medicine, College of Medicine, Korea University) ;
- Sin, Cheol (Department of Internal Medicine, College of Medicine, Korea University) ;
- Cho, Jae-Youn (Department of Internal Medicine, College of Medicine, Korea University) ;
- Shim, Jae-Jeong (Department of Internal Medicine, College of Medicine, Korea University) ;
- In, Kwang-Ho (Department of Internal Medicine, College of Medicine, Korea University) ;
- Kang, Kyung-Ho (Department of Internal Medicine, College of Medicine, Korea University) ;
- Yoo, Se-Hwa (Department of Internal Medicine, College of Medicine, Korea University)
- 박상면 (고려대학교 의과대학 내과학교실) ;
- 이상화 (고려대학교 의과대학 내과학교실) ;
- 이신형 (고려대학교 의과대학 내과학교실) ;
- 신철 (고려대학교 의과대학 내과학교실) ;
- 조재연 (고려대학교 의과대학 내과학교실) ;
- 심재정 (고려대학교 의과대학 내과학교실) ;
- 인광호 (고려대학교 의과대학 내과학교실) ;
- 강경호 (고려대학교 의과대학 내과학교실) ;
- 유세화 (고려대학교 의과대학 내과학교실)
- Published : 2001.01.30
Abstract
Background : Pulmonary thromboembolism is relatively frequent and potentially fatal. However, it is commonly misdiagnosed. The incidence of pulmonary thromboembolism is not decreasing despite advances in diagnosis and effective prophylatic measures. Its potential for significant sequela necessitates a prompt diagnosis and treatment. Unfortunately, there are many difficulties and problems regarding accurate diagnosis. There is a low prevalence of deep vein thrombosis and pulmonary thromboembolism in Korea and only few reports on this subject are available. Method : The clinical features of 36 patients, who were diagnosed with pulmonary thromboembolism at the Korea University medical center, were reviewed. Results : 1) There was no significant difference in prevalence between men an women, and the mean age was 50.9 years in men 59.2 years in women. 2) The frequent causes of pulmonary thromboembolism were malignancies (22.2%), surgery (22.2%), and heart disease(8.2%). Specific causes were not identified in 33.3%. 3) The most common symptom was dyspnea(72.2%), and the most common sign was tachypnea(61.1%). 4) The EKG findings were normal in 28.6%, an S1Q3T3 pulmonale pattern in 25.7%, ST or QRS changes in others. 5) The chest X-ray findings indicated pulmonary infiltration in 37.5%, cardiomegaly in 15.6%, pleural effusion in 12.5%, and normal in 27.8%. The perfusion lung scan showed a high probability in 66.7%, and intermediate or low probability in 33.3%. 6) The pulmonary arterial pressure(PAP) in the high probability groups was 57.9mmHg with a higher mortality rate(35%). Conclusion : Pulmonary thromboembolism is not uncommon in Korea and its clinical features do not differ greatly from thase reported in the literature. When pulmonary thromboemblism of unknown causes are diagnosed, a search for an occult malignancy is recommended. Rapid diagnosis and treatment are achieved when thromboemblism is suspected.
연구배경 : 폐혈전색전증은 드물지 않은 질환이지만 치명적이며 많은 경우 진단되지 못하기도 한다. 폐혈전색전증이 증가되는 추세이나 연구는 많지 않은 실정이다. 저자는 폐혈전색전증으로 진단된 증례들을 통하여 임상상을 알아보고자 했다. 방법 : 1989년 1월부터 1995년 5월까지 임상적으로 폐혈관 색전증이 의심되었던 환자 중 폐관류 주사나 폐동맥 촬영술, 흉부 전산화 단층촬영술을 통해 확진 된 36명을 대상으로 조사하였다. 결과 : 1) 남녀의 성비는 같았고 평균 연령은 남자가 50.9세, 여자가 59.2세 이고 60세 이상 고령자는 38.9% 차지하였다. 2) 원인 질환으로 악성종양이 22.2%를 차지하였고 수술이 22.2%, 심장질환이 8.2% 등이었고 원인질환이 없는 경우가 33.3%이었다. 3) 가장 흔한 임상 징후는 호흡곤란(7.2%) 이었고 증상은 빈호흡이 61.1%로 가장 많았다. 증상이 없던 경우도 44.4%나 되었다. 4) 심전도는 정상소견을 보인 28.6%외에 대부분 ST 또는 QRS 변화를 관찰할 수 있었고 25.7%에서는 급성 폐성심의 양상을 관찰하였다. 동맥혈 검사상 77.8%에서