대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제78권2호
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  • Pages.81-87
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  • 2018
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  • 1738-2637(pISSN)
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  • 2951-0805(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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객혈 환자의 영상진단검사: 한국형 권고안

Korean Clinical Imaging Guideline for Hemoptysis

  • 강미진 (인제대학교 상계백병원 영상의학과) ;
  • 김진환 (충남대학교 의학전문대학원 충남대학교병원 영상의학과) ;
  • 김윤경 (가천대학교 길병원 영상의학과) ;
  • 이현주 (울산대학교 의과대학 서울아산병원 영상의학과, 영상의학연구소) ;
  • 신경민 (경북대학교 의과대학 영상의학교실) ;
  • 김정임 (경희대학교 의과대학 강동경희대학교병원 영상의학과) ;
  • 이현주 (서울대학교병원 영상의학과) ;
  • 도경현 (울산대학교 의과대학 서울아산병원 영상의학과, 영상의학연구소) ;
  • 용환석 (고려대학교 의과대학 구로병원 영상의학과) ;
  • 최솔지 (한국보건의료연구원 보건의료근거연구본부) ;
  • 최미영 (한국보건의료연구원 보건의료근거연구본부) ;
  • 정정임 (가톨릭대학교 의과대학 서울성모병원 영상의학과)
  • Kang, Mi-Jin (Department of Radiolgoy, InJe University Sanggye Paik Hospital) ;
  • Kim, Jin Hwan (Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine) ;
  • Kim, Yoon Kyung (Department of Radiology, Gachon University Gil Medical Center) ;
  • Lee, Hyun Joo (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Kyung Min (Department of Radiology, Kyungpook National University Chilgok Hospital) ;
  • Kim, Jung Im (Department of Radiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine) ;
  • Lee, Hyun Ju (Department of Radiology, Seoul National University Hospital) ;
  • Do, Kyung Hyun (Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Yong, Hwan Seok (Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine) ;
  • Choi, Sol Ji (Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency) ;
  • Choi, Miyoung (Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency) ;
  • Jung, Jung Im (Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2017.06.29
  • 심사 : 2017.08.07
  • 발행 : 2018.02.01
⟨ 이전 논문 다음 논문 ⟩

초록

2014년 미국영상전문의학회(American College of Radiology)에서 객혈로 내원한 환자에 대하여 객혈의 중등도 및 폐암의 위험도 정도에 따른 진단 및 치료에 대한 권고안을 발표하였다. 그러나 한국에서는 과거 결핵으로 인한 폐의 섬유화가 많고, 현재의 활동성 결핵에 의한 객혈이 있는 경우도 많아 미국의 권고안을 그대로 사용하기는 어려운 실정이다. 따라서 대한영상의학회 및 대한흉부영상의학회에서는 한국의 실정에 맞는 권고안을 개발하기로 결정하였고, 개발위원회, 실무위원회 및 자문위원단이 의견을 모아 한국의 질병 상황에 적합한 권고안을 개발하였다. 권고안 개발 절차는 개발위원회에서 개발한 근거기반 임상영상 가이드라인 수용개작 방법론에 근거하여 이루어졌다. 객혈이 있는 성인 환자에서 객혈의 원인을 진단하기 위한 영상의학적 검사에 대한 권고 내용은 다음과 같다. 객혈이 있는 모든 환자에 대한 초기 검사로 흉부 X선 검사를 권고한다. 객혈이 있는 환자가 2가지 폐암의 위험인자(40세 이상, 30갑년 이상 흡연)가 있거나, 중등증 객혈(24시간 이내 30 mL 이상의 객혈) 또는 반복적 객혈이 있을 경우에는 조영증강 흉부 CT를 권고한다. 대량 객혈(24시간 이내 400 mL 이상의 객혈)이 있으나 심폐기능이 유지되어 있는 경우에도 조영증강 흉부 CT를 권고한다.

In 2014, the American College of Radiology announced a guideline for appropriate diagnostic approach and treatment in patients with hemoptysis, according to severity of hemoptysis and risk of lung cancer. However, in Korea many patients have pulmonary fibrosis due to previous tuberculosis or have active tuberculosis. Therefore, application of this guideline is not appropriate. The Korean Society of Radiology and Korean Society of Thoracic Radiology proposed a guideline more closely matching the real state of diagnostic approach and treatment of patients with hemoptysis in Korea. The guideline was prepared in consensus by a development committee, working party, and an advisory committee. The process of the guideline proposal was based on methodology for developing evidence-based clinical imaging guidelines: joint recommendations by the Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency. The clinical imaging guideline for adult patients with hemoptysis is as follows. Chest radiography is an initial imaging modality to evaluate hemoptysis. Contrast enhanced chest CT is recommended in patients with two lung cancer risks (> 40 years old and > 30 packs per year smoking history), moderate hemoptysis (> 30 cc/24 hours) or recurrent hemoptysis. Contrast enhanced chest CT is also recommended for patients with massive hemoptysis (> 400 mL/24 hours) without cardiopulmonary compromise.

키워드

과제정보

연구 과제 주관 기관 : National Evidence-based Collaborating Agency, Korean Society of Radiology

참고문헌

  1. ACR Appropriateness $Criteria^{(R)}$ hemoptysis. Available at: https://acsearch.acr.org/docs/69449/Narrative/. Published Aug, 2010. Accessed Jan 31, 2017
  2. Choi SJ, Jeong WK, Jo AJ, Choi JA, Kim MJ, Lee M, et al. Methodology for developing evidence-based clinical imaging guidelines: joint recommendations by Korean Society of Radiology and National Evidence-Based Healthcare Collaborating Agency. Korean J Radiol 2017;18:208-216 https://doi.org/10.3348/kjr.2017.18.1.208
  3. Tsoumakidou M, Chrysofakis G, Tsiligianni I, Maltezakis G, Siafakas NM, Tzanakis N. A prospective analysis of 184 hemoptysis cases: diagnostic impact of chest X-ray, computed tomography, bronchoscopy. Respiration 2006;73:808-814 https://doi.org/10.1159/000091189
  4. Fidan A, Ozdogan S, Oruc O, Salepci B, Ocal Z, Caglayan B. Hemoptysis: a retrospective analysis of 108 cases. Respir Med 2002;96:677-680 https://doi.org/10.1053/rmed.2002.1359
  5. Bruzzi JF, Remy-Jardin M, Delhaye D, Teisseire A, Khalil C, Remy J. Multi-detector row CT of hemoptysis. Radiographics 2006;26:3-22 https://doi.org/10.1148/rg.261045726
  6. Lee SJ, Rho JY, Yoo SM, Kim MD, Lee JH, Kim EK, et al. Use-fulness of multi-detector computed tomography before bronchoscopy and/or bronchial arterial embolization for hemoptysis. Tuberc Respir Dis 2010;68:80-86 https://doi.org/10.4046/trd.2010.68.2.80
  7. Revel MP, Fournier LS, Hennebicque AS, Cuenod CA, Meyer G, Reynaud P, et al. Can CT replace bronchoscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis? AJR Am J Roentgenol 2002;179:1217-1224 https://doi.org/10.2214/ajr.179.5.1791217
  8. Delage A, Tillie-Leblond I, Cavestri B, Wallaert B, Marquette CH. Cryptogenic hemoptysis in chronic obstructive pulmonary disease: characteristics and outcome. Respiration 2010;80:387-392 https://doi.org/10.1159/000264921
  9. Menchini L, Remy-Jardin M, Faivre JB, Copin MC, Ramon P, Matran R, et al. Cryptogenic haemoptysis in smokers: angiography and results of embolisation in 35 patients. Eur Respir J 2009;34:1031-1039 https://doi.org/10.1183/09031936.00018709
  10. Poe RH, Israel RH, Marin MG, Ortiz CR, Dale RC, Wahl GW, et al. Utility of fiberoptic bronchoscopy in patients with hemoptysis and a nonlocalizing chest roentgenogram. Chest 1988;93:70-75 https://doi.org/10.1378/chest.93.1.70
  11. Herth F, Ernst A, Becker HD. Long-term outcome and lung cancer incidence in patients with hemoptysis of unknown origin. Chest 2001;120:1592-1594 https://doi.org/10.1378/chest.120.5.1592
  12. Thirumaran M, Sundar R, Sutcliffe IM, Currie DC. Is investigation of patients with haemoptysis and normal chest radiograph justified? Thorax 2009;64:854-856 https://doi.org/10.1136/thx.2008.108795
  13. McGuinness G, Beacher JR, Harkin TJ, Garay SM, Rom WN, Naidich DP. Hemoptysis: prospective high-resolution CT/bronchoscopic correlation. Chest 1994;105:1155-1162 https://doi.org/10.1378/chest.105.4.1155
  14. Kim HB. Bronchial artery embolization. In Korean Society of Interventional Radiology, ed. Interventional radiology, 2nd ed. Seoul: Ilchokak 2014:321-325
  15. Millar AB, Boothroyd AE, Edwards D, Hetzel MR. The role of computed tomography (CT) in the investigation of unexplained haemoptysis. Respir Med 1992;86:39-44 https://doi.org/10.1016/S0954-6111(06)80146-0
  16. Khalil A, Fartoukh M, Parrot A, Bazelly B, Marsault C, Carette MF. Impact of MDCT angiography on the management of patients with hemoptysis. AJR Am J Roentgenol 2010;195:772-778 https://doi.org/10.2214/AJR.09.4161
  17. Hsiao EI, Kirsch CM, Kagawa FT, Wehner JH, Jensen WA, Baxter RB. Utility of fiberoptic bronchoscopy before bronchial artery embolization for massive hemoptysis. AJR Am J Roentgenol 2001;177:861-867 https://doi.org/10.2214/ajr.177.4.1770861