• Journal of Chest Surgery
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• v.40 no.5 s.274
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• pp.362-368
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• 2007

Background: Spontaneous pneumothorax patients with blebs or bullae are considered to be good candidates for operation, and various objective diagnostic modalities have been performed for detection of blebs and bullae. This study was performed to compare the efficacy of thoracoscopic examination with using a minimally invasive 2 mm thoracoscope with high-resolution computed tomography (HRCT) for treating primary spontaneous pneumothorax. Material and Method: From June 2001 to March 2002, 34 patients with spontaneous pneumothorax undewent study with 2 mm video-thoracoscopic examination and HRCT. We regarded a blob larger than 5 mm in diameter as significant. Standard thoracoscopic wedge resection was performed in 18 patients with significant blob via a 2 mm video-thoracoscopic examination. 1 patient incurred bleeding, and the remaining 15 patients were treated with pleural drainage. Result: Multiple or single blob lesions were detected by 2 mm video-thoracoscope in 52.9% (18/34) of the patients with primary pneumothorax. For a total of 19 patients who were operated on, the diagnostic accuracy of the 2 mm video-thoracoscopic examination for bullae and blob was 94.7% (18/19), which was superior to that of HRCT (73.7%, 14/19). At a mean follow-up of $30{\pm}3$ months, no recurrence occurred in both the operative group and the non-operative group. Conclusion: 2 mm video-thoracoscopic examination under local anesthesia has higher diagnostic accuracy than HRCT, and it is a useful alternative for determining the operative indications for spontaneous pneumothorax.

• Journal of Chest Surgery
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• v.43 no.6
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• pp.700-704
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• 2010

Background: For staging primary lung cancer, integrated positron emission tomography/computed tomography (PET/CT) imaging is popular. The purpose of this study was to evaluate the accuracy of PET/CT scanning in lymph nodal staging of lung cancer. Material and Method: We studied 48 patients who had received CT, PET/CT and pulmonary resections due to primary non-small cell lung cancer in our hospital between January 2006 and August 2009. Mediastinal lymph nodes were classified as superior mediastinal nodes, aortic nodes, inferior mediastinal nodes, or N1 nodes. We compared the power of CT and PET/CT for diagnosing pulmonary lymph nodes for each of the four types of nodes. Result: PET/CT was more sensitive than CT for all groups except inferior mediastinal nodes. However, the differences were not significant (McNemar's test: superior mediastinal nodes, p=0.109; aortic nodes, p=1.000; inferior mediastinal nodes, p=0.625, N1 nodes, p=0.424). Conclusion: The accuracy of PET/CT is similar to that of CT alone for staging lymph nodes. The two imaging modalities might be used as complementary, cooperative tools. We expect that integrated PET/CT will be found to be significantly mmore sensitive after more trials are done and more data is accumulated.

• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.499-503
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• 2009

Iodinated contrast media (CM) can cause immediate and late reactions. We treated a patient with a recurrent generalized maculopapular rash and a fever that occurred within two days of exposure to iodinated CM, iopromide ($Ultravist^{(R)}$), for chest computed tomography. We performed skin testing including prick tests, intradermal tests, and patch tests. Our findings indicated a late skin reaction to $Ultravist^{(R)}$in addition to cross-reactions to other iodinated CM such as ioversol ($Optiray^{(R)}$), iohexol ($Iobrix^{(R)}$), and iobitridol ($Xenetix^{(R)}$). In this study, we report the case of a patient diagnosed with a late adverse reaction to $Ultravist^{(R)}$in addition to cross-reactions to other iodinated CM.

• Journal of Chest Surgery
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• v.41 no.3
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• pp.386-389
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• 2008

Lung parenchyma is a common organ for metastases of extrathoracic tumors, but endobronchial metastasis is very rare. In this report, we present a case of endobronchial metastases from renal cell carcinoma (RCC), and this was managed by performing operative resection. A 63-year-old man presented with frequent dry cough; he had previously undergone left nephrectomy and postoperative chemotherapy for grade 2 RCC eight years ago. Computed tomography and bronchoscopy showed an endobronchial tumor from the left lower lobe bronchus to the second carina, and this mass was diagnosed as a necrotic tissue with chronic inflammation at biopsy. During the operation, the mass was revealed to be a metastatic renal cell carcinoma on the frozen section diagnosis and there was no mucosal invasion on the resection margin of the left lower lobe bronchus. We performed lobectomy of the left lower lobe with systemic dissection of the mediastinal lymph nodes. The final histopathologic diagnosis of the endobrochial mass was metastatic RCC and any mediastinal lymph node metastasis was not found. The patient was discharged on postoperative day 10 without any postoperative complications.

• Journal of Korean Neurosurgical Society
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• v.57 no.4
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• pp.307-310
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• 2015

We report a case of a paradoxical response of a tuberculoma in the brain mimicking a brain tumor. A 76-year-old woman presented with a 2 week history of headache, dysarthia, and orthopnea. Brain magnetic resonance images (MRI) revealed two rim-enhancing lesions on the pons and occipital lobe, and chest computed tomography showed randomly distributed miliary nodules. The tentative diagnosis was tuberculosis (TB) of the brain and lung. She complained of right hemiparesis and worsening general weakness after taking the anti-TB medication. On the monthly follow-up images, the enhanced lesions were enlarged with increased perfusion and choline/creatinine ratio, suggesting a high grade glioma. A surgical resection was completed to diagnose the occipital lesion, and the tuberculoma was pathologically confirmed by a positive TB-polymerase chain reaction. The anti-TB medication was continued for 13 months. A follow-up MRI showed decreased size of the brain lesions associated with perilesional edema, and the clinical symptoms had improved. Brain tuberculoma could be aggravated mimicking brain malignancy during administration of anti-TB medication. This paradoxical response can be effectively managed by continuing the anti-TB drugs.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.371-377
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• 2017

Background: Lesions in distal target arteries hinder surgical bypass procedures in patients with peripheral arterial occlusive disease. Methods: Between April 2012 and October 2015, 16 patients (18 limbs) with lifestyle-limiting claudication (n=12) or chronic critical limb ischemia (n=6) underwent femoral-above-knee (AK) polytetrafluoroethylene (PTFE) bypass grafts with a bridging stent graft placement between the distal target popliteal artery and the PTFE graft. Ring-supported PTFE grafts were used in all patients with no available vein for graft material. Follow-up evaluations assessed clinical symptoms, the ankle-brachial index, ultrasonographic imaging and/or computed tomography angiography, the primary patency rate, and complications. Results: All procedures were successful. The mean follow-up was 12.6 months (range, 11 to 14 months), and there were no major complications. The median baseline ankle-brachial index of 0.4 (range, 0.2 to 0.55) significantly increased to 0.8 (range, 0.5 to 1.0) at 12 months (p<0.01). The primary patency rate at 12 months was 83.3%. The presenting symptoms resolved within 2 weeks. Conclusion: In AK bypasses with a diffusely diseased distal target popliteal artery or when below-knee (BK) bypass surgery is impossible, this procedure could be clinically effective and safe when used as an alternative to femoral-BK bypass surgery.

• Journal of Chest Surgery
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• v.50 no.6
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• pp.443-447
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• 2017

Background: The inferior vena cava filter (IVCF) is very effective for preventing pulmonary embolism in patients who cannot undergo anticoagulation therapy. However, if a filter is placed in the body permanently, it may lead to other complications. Methods: A retrospective study was performed of 159 patients who underwent retrievable Cook Celect IVCF implantation between January 2007 and April 2015 at a single center. Baseline characteristics, indications, and complications caused by the filter were investigated. Results: The most common underlying disease of patients receiving the filter was cancer (24.3%). Venous thrombolysis or thrombectomy was the most common indication for IVCF insertion in this study (47.2%). The most common complication was inferior vena cava penetration, the risk of which increased the longer the filter remained in the body (p=0.032, Exp(B)=1.004). Conclusion: If the patient is able to retry anticoagulation therapy and the filter is no longer needed, the filter should be removed, even if a long time has elapsed since implantation. If the filter cannot be removed, it is recommended that follow-up computed tomography be performed regularly to monitor the progress of venous thromboembolisms as well as any filter-related complications.

• Tuberculosis and Respiratory Diseases
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• v.59 no.2
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• pp.193-197
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• 2005

The 64-year-old female patient with cough and intermittent hemoptysis of six months duration visited our hospital. On chest computed tomography, a small, ovoid, 1.3cm sized and well enhanced lesion was detected on the distal trachea. Two multiple lobulated lesions on the sigmoid and transverse colon were revealed on the colonoscopy. The histological findings showed small and medium sized lymphocytes infiltration, CD20 and CD79a positive staining and multiple lymphoepithelial lesions on the distal trachea and colon tissues. Herein, a case of primary MALT lymphoma, with involvement of the trachea and colon, which was treated with rituximab (CD20 anti-monoclonal antibody), cyclophosphamide, adriamycin, vincristine and prednisolone (CHOP regimen), is reported.

• Tuberculosis and Respiratory Diseases
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• v.70 no.2
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• pp.165-169
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• 2011

Pheochromocytomas are neuroendocrine tumors of chromaffin cell that originate in the paraganglia of the adrenal medulla. Approximately 10% of pheochromocytomas are found in the extra-adrenal paraganglia and are called paragangliomas. However, cases of middle mediastinal paragangliomas are very rare. In this case, the patient presented with a voice change and a headache. A middle mediastinal soft tissue mass with marked enhancement was detected on computed tomography of the chest. The 24-hour urine catecholamine level was markedly elevated. The middle mediastinal mass was biopsied via mediastinoscopy and the resulting immunohistochemical staining was compatible with a diagnosis of middle mediastinal paraganglioma. The mass was resected surgically and the symptoms were relieved.

• Tuberculosis and Respiratory Diseases
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• v.76 no.5
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• pp.240-244
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• 2014

Pancreaticothoracic fistula is a rare complication of acute or chronic alcoholic pancreatitis. It may present with various symptoms, like dyspnea, abdominal pain, cough, chest pain, fever, back pain, hemoptysis, fatigue, or orthopnea. Pancreaticothoracic fistula can be detected by magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), or computed tomography. MRCP has high sensitivity and fewer side effects, and thus it has recently been recommended as the first choice for the detection of pancreaticothoracic fistula. On the other hand, ERCP enables the detection and treatment of pancreaticothoracic fistula and allows for stent insertion; for this reason it is a commonly used modality in pancreaticothoracic fistula cases. Herein, the authors describe a case of pancreaticothoracic fistula detected by ERCP and MRCP that manifested only respiratory symptoms, namely hemoptysis and pneumothorax without abdominal pain, which commonly accompanies pancreatitis.