• Journal of Chest Surgery
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• v.36 no.12
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• pp.943-951
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• 2003

We are now detecting an increasing number of solitary pulmonary nodules (SPNs) that are difficult to diagnosis. The purpose of this study was to evaluate the useful radiologic findings for differentiating benign from malignant pulmonary nodules. Material and Method: The high-resolution CT (HRCT) findings of SPNs smaller than 3 cm in largest diameter were evaluated in 134 patients with malignant and benign nodules in regard to internal structures, margin characteristics, and surrounding parenchymal responses. Result: The nodules with the area of ground-glass attenuation (GGA) greater then 50% were noted in adenocarcinoma, inflammatory lesions and some of metastatic tumors, and the lesions greater than 90% were noted only in adenocarcinoma. The area of GGA in non-adenocarcinoma, benign tumors and tuberculomas were less than 50%, and mainly less than 10%. The findings of air bronchogram, spiculation, lobulation, vascular involvement, and pleural indentation were some noted at every types of malignant tumors, but especially high over than 30% in adenocarcinomas. Conclusion: Most peripheral lung adenocarcinomas form a characteristic radiologic findings especially in HRCT. Evaluation of these findings would be helpful in differentiating between lung cancer, especially adenocarcinoma, and other lesions.

• Tuberculosis and Respiratory Diseases
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• v.64 no.5
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• pp.369-373
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• 2008

Tuberous sclerosis (TS) is an autosomal dominant disorder that is characterized by cutaneous lesions, seizures, mental retardation and hamartomas in various organs including the skin, kidney and brain. Pulmonary involvement is extremely rare, and occurs in approximately 0.1 to 1% of TS cases. Recent reports have indicated multiple micronodular pneumocyte hyperplasia (MMPH) as another rare form of pulmonary involvement of tuberous sclerosis. We report a case of a 35 year-old-male patient who had no pulmonary symptoms but showed multinodular pulmonary shadows on his chest CT scan. The patient was finally diagnosed with TS with MMPH of the lung. MMPH does not appear to have any malignant potential but the clinical significance of MMPH in TS patients is unknown.

• Tuberculosis and Respiratory Diseases
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• v.59 no.6
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• pp.690-695
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• 2005

Nitric acid is an oxidizing agent used in metal refining and cleaning, electroplating, and other industrial applications. Its accidental spillage generates oxides of nitrogen, including nitric oxide (NO) and nitrogen dioxide ($NO_2$), which cause chemical pneumonitis when inhaled. The clinical presentation of a nitric acid inhalation injury depends on the duration and intensity of exposure. In mild cases, there may be no symptoms during the first few hours after exposure, or the typical symptoms of pulmonary edema can appear within 3-24 hours. However, in cases of prolonged exposure, progressive pulmonary edema develops instantaneously and patients may not survive for more than 24 hours. We report a case of a 44-year-old male who was presented with acute respiratory distress syndrome after nitric acid inhalation. He complained of cough and dyspnea of a sudden onset after inhaling nitric acid fumes at his workplace over a four-hour period. He required endotracheal intubation and mechanical ventilation due to fulminant respiratory failure. He was managed successfully with mechanical ventilation using positive end expiratory pressure and systemic corticosteroids, and recovered fully without any deterioration in his pulmonary function.

• Journal of Preventive Medicine and Public Health
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• v.29 no.4 s.55
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• pp.853-861
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• 1996

Pneumoconiosis is one of the major problem in the field of occupational health at Korea. Therefore, the efficient diagnosis of pneumoconiosis is a hot issue on the occupational health program. The author executed this study to estimate the diagnostic value of high resolution computed tomography(HRCT) compared with chest radiography for screening of welder's lung. HRCT was introduced very recently for the diagnosis of pneumoconiosis, however, the diagnostic value for screening of welder's lung - principally nonfibrogenic and reversible - has not been evaluated. The subjects were fifty cases of welder's lung or suspected cases who had been collected between 1989 and 1994 from one shipyard and continuously followed-up on the basis of in-plant periodic health check program. We applied both chest radiography and HRCT on the same subjects from May 1 to 30, 1996. The images were evaluated by two careered radiologists independently. The findings of chest radiography were classified into four category by ILO classification, and the findings of HRCT according to the criteria of Bergin et al. The concordance between two radiologists expressed with Kendall's tau-b was 0.72 by chest radiography and 0.44 by HRCT- that is, interobserver variation of HRCT was bigger than that of chest radiography. The concordance between the two different methods was highly variable as 0.44 by radiologist A and 0.06 by radiologist B - that is, interobserver variation was very big. However, HRCT looked more detectable for the minor parenchymal change. These findings suggested that it is not appropriate to use HRCT routinely for screening of welder's lung due to lack of diagnostic criteria, and feasibility, acceptability and economic aspects. Nevertheless, HRCT might be recommendable in the case of equivocal parenchymal features on the chest radiography, unexplained respiratory symptoms, and/or lung function abnormalities suggestive of interstitial fibrosis.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.687-693
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• 2010

Background: It is controversial whether the presence of bullae on the contralateral lung on HRCT plays a role in occurrence of contralateral primary spontaneous pneumothorax. We analyzed the significance of bullae on the contralateral lung and the risk factors associated with contralateral occurrence of primary spontaneous pneumothorax. Material and Method: Three hundred ninety four patients who were undergone Video-Assisted Thoracoscopic Surgery for primary spontaneous pneumothorax between January 2004 and December 2009 were reviewed. The clinical features, HRCT and treatment of these patients were analyzed retrospectively. Result: Twenty eight of 394 patients had contralateral occurrence (7.10%). The average time was $13.06{\pm}9.79$ months. A presence of contralateral bullae of lung on HRCT may not seem to be significant for occurrence of contralateral primary spontaneous pneumothorax (p=0.059). But bullae numbers were much more in contralateral pneumothorax patients (p=0.011). Younger than 20, being underweight (Body Mass Index < $18.5 kg/m^2$) are independent risk factors for contralateral occurrence (odds ratio, 5.075 (1.679~5.339), 2.366 (1.048~5.339) respectively). Conclusion: The presence of bullae on the contralateral lung on HRCT was not significantly influenced the occurrence of contralateral primary spontaneous pneumothorax. However, age, body mass index, and the number of bullae were significant factors for the contralateral pneumothorax. We suggest that those high risk patients may require special attentions and general supportive care to prevent occurrence of contralateral primary spontaneous pneumothorax during the follow-up.

• Tuberculosis and Respiratory Diseases
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• v.53 no.1
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• pp.17-26
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• 2002

Background : The detection and early elimination of the causes for acute respiratory distress syndrome(ARDS) at the initial stage can result in a more favorable prognosis. Miliary tuberculosis as a cause of the ARDS is quite rare. A diagnosis of miliary tuberculosis is difficult due to the diversity of radiological patterns and non-specific clinical finfings, and low sensitivity of sputum examinations for acid-fast bacilli(AFBs). An analysis of the clinical data is the first step in diagnosing these unusual, rare cases. Materials and Methods : In this study the clinical features, laboratory data, radiological findings and diagnostic methods were analyzed in 9 cases with an initial presentation of ARDS due to miliary tuberculosis. The ARDS was defined by the definition of the American-Europian consensus conference 1992. Results : The mean age of the patients was $67{\pm}18$ years (F:M=7:2). The chief complaints were dyspnea(5/9), coughing (3/9) and fever(5/9). On a physical examination, fine or coarse crackles were noted(6/9). The ARDS developed on average 6.7 days after the initial respiratory symptoms. The mean $PaO_2/FiO_2$ of the patients was $133.5{\pm}53.4$, the number of cases with a WBC<5000/$mm^3$ was 4 out of 9 cases. A platelet count<70,000/$mm^3$ was observed in 2 out of 9 cases, and the serum albumin level was $2.6{\pm}0.6$ g/dL. The initial simple chest PA showed ground glass appearances and consolidation in all cases, However, the miliary nodular densities were observed in only 4 out of the 9 cases. HRCT revealed alveolar densities and a consolidation in 5 out of 6 cases, and miliary nodules in 5 out of 6 cases, The diagnosis of tuberculosis was made by a liver biopsy (4/4, 100% sensitivity), a bone marrow biopsy (1/2, 50% sensitivity), and an open lung biopsy (1/1), the sputum AFB was positive in only 2 out of 9 cases. The patient was treated with INH, RFP, EMB, PZA, and steroids. The survival rate was 55.5%. Conclusion : Miliary tuberculosis should be considered as one of the causes for ARDS in areas where there is a high prevalence of tuberculosis. The chief complaints of the patients on admission are dyspnea, fever and coughing without any specific riskfactors. A liver biopsy is particularly useful in ARDS patients with mechanical ventilation to determine the causes of the ARDS if miliary tuberculosis is suspected as being the underlying disease.

• Journal of Preventive Medicine and Public Health
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• v.29 no.3 s.54
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• pp.471-482
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• 1996

Early recognition of coalescence in pneumoconiotic lesions is important because such coalescence is associated with the respiratory symptoms and deterioration of lung function. This complicated form of pneumoconiosis also has worse prognosis than does simple pneumoconiosis. High resolution computerized tomography(HRCT) provides significant additional information on the stage of the pneumoconiosis because it easily detects coalescence of nodules and emphysema that may not be apparent on the simple radiograph. The purpose of this study is to clarify the role of HRCT in detection of large opacity and the relationship of change between the coalescence of nodules or emphysema and lung function in dust exposed workers. 1. There was good correlation between the HRCT grade of pneumoconiosis and ILO category of profusion. 5(9.09%) in 55 study population had confluent nodule extending eve, two o, more cuts on HRCT. HRCT could identify the pneumoconiotic nodules which was not found by simple radiogrphy in 6 workers with category 0/0. 2. No significant difference was observed coalescence of nodules and emphysema by dust type. 3. There was no significant difference in pulmonary function according to ILO and HRCT classification. 4. HRCT could detect the significant reduction in $FEV_1,\;FEV_1/FVC$, PEFR, $FEF_{25},\;FEF_{50},\;and\;FEF_{75}$ and remarkable increase in RV and TLC in study persons with emphysema compared with non-emphysema group. 5. Emphysema was found more often in nodules-coalescence group than small opacity group by HRCT. We found that HRCT could easily detect areas of coalescence and complicated emphysema compared to plain chest X-ray. Also our data suggest that it is primarily the degree of emphysema rather than the degree of pneumoconiosis that determines the level of pulmonary function.

• Tuberculosis and Respiratory Diseases
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• v.60 no.3
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• pp.297-303
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• 2006

Background : Pulmonary tuberculosis is frequently accompanied with complications such as bronchiectasis, cavities, fibrosis and a deterioration of the lung function. However, there is little information available on the pathogenesis of these complications in pulmonary tuberculosis. Among the many factors involving in tissue remodeling, transforming growth factor-${\beta}1$ ($TGF-{\beta}1$) is a potent stimulus of the extracellular matrix fomation and a mediator of potential relevance for airway wall remodeling. Therefore, this study examined the relationship between the radiological changes and the $TGF-{\beta}1$ level in patients with pulmonary tuberculosis. Methods : Serum and bronchoalveolar lavage fluid (BALF) were collected from total of 35 patients before treating them for active pulmonary tuberculosis, and the $TGF-{\beta}1$ levels were measured using an enzyme-linked immunosorbent assay (ELISA). The BALF levels were recalculated as the epithelial lining fluid (ELF) levels using the albumin method. pulmonary function test (PFT) and high resolution computed tomography (HRCT) were performed before and after treatment. Results : There was a strong correlation between the serum $TGF-{\beta}1$ level and the presence of cavities (r=0.404, p=0.006), even though the BAL $TGF-{\beta}1$ level showed a weak correlation with complications. In addition, there was no correlation between the $TGF-{\beta}1$ levels before treatment and the changes in the PFT and HRCT during treatment. Conclusion : There is a correlation between the serum $TGF-{\beta}1$ level and cavity formation in pulmonary tuberculosis before treatment. However, further study will be needed to confirm this.

• Tuberculosis and Respiratory Diseases
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• v.64 no.3
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• pp.210-214
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• 2008

Chemical pneumonitis is an occupational lung disease that's caused by the inhalation of chemical substances. Its severity depends on the characteristics of the substances, the exposure time and the susceptibility of the patients. Hydrogen sulfide is not only emitted naturally, but it also frequently found in industrial settings where it is either used as a reactant or it is a by-product of manufacturing or industrial processes. Inhalation of hydrogen sulfide causes various respiratory reactions from cough to acute respiratory failure, depending on the severity. Two pharmaceutical factory workers were admitted after being rescued from a waste water disposal site that contained hydrogen sulfide. In spite that they recovered their consciousness, they had excessive cough and mild dyspnea. The simple chest radiographs and high resolution computed tomography showed diffuse interstitial infiltrates, and hypoxemia was present. They were diagnosed as suffering from chemical pneumonitis caused by hydrogen sulfide. After conservative management that included oxygen therapy, their symptoms, hypoxemia and radiographic abnormalities were improved.

• Tuberculosis and Respiratory Diseases
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• v.44 no.1
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• pp.124-135
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• 1997

Background : Diffuse panbronchiolitis(DPB) is a disease characterized clinically by chronic cough, expectoration and dyspnea; and histologically by chronic inflammation localized mainly in the region of the respiratory bronchiole. It is prevalent in Japanese, but is known to be rare in Americans and Europians. Only a few cases in Chinese, Italians, North Americans and Koreans have been reported. It is diagnosed by characteristic clinical, radiological and pathologic features. High-resolution CT(HRCT) is known to be valuable in the study of the disease process and response to therapy in DPB. To our knowledge, there has been no correlation of its appearance on HRCT with the severity of the disease process, and radioaerosol scan(RAS) of the lung has not previously been used for the diagnosis of DPB. Method : During recent two years we have found 12 cases of DPB in Kangnam St. Mary's Hospital, Catholic University Medical College. We analysed the clinical characteristics, compared HRCT classifications with clinical stages of DPB, and determined characteristic RAS manifestations of DPB. Results : 1. The ages ranged from 31 to 83 years old(mean 54.5 years old), and male female ratio was 4:8. 75%(9/12) of patients had paranasal sinusitis, and only one patient was a smoker. 2. The patients were assigned to one of three clinical stages of DPB on the basis of clinical findings, sputum bacterology and arterial blood gas analysis. of 12 cases, 5 were in the first stage, 4 were in the second stage, and 3 were in the third stage. In most of the patients, pulmonary function tests showed marked obstructive and slight restrictive impairments. Sputum culture yielded P.aeruginosa in 3 cases of our 12 cases, K.pneumoniae in 2 cases, H.influenzae in 2 cases, and S.aureus in 2 cases. 3. Of 12 patients, none had stage I characteristics as classified on HRCT scans, 4 had slage II findings, 5 had stage III findings, and 3 had stage IV characteristics. 4. We peformed RAS in 7 of 12 patients With DPB. In 71.4% (5/7) of the patients, RAS showed mottled aerosol deposits characteristically in the transitional and intermediary airways with peripheral airspace defects, which contrasted sharply with central aerosol deposition of COPD. 5. There were significant correlations between HRCT stages and clinical stages(r= 0.614, P < 0.05), between HRCT types and Pa02(r= -0.614, P < 0.05), and between HRCT types and ESR(r= 0.618, P < 0.01). Conclusion : The HRCT classifications correspond well to the clinical stage. Therfore in the examination of patients with DPB, HRCT is useful in the evaluation of both the location and severity of the lesions. Also, RAS apears to be a convenient, noninvasive and useful diagnostic method of DPB.