• Tuberculosis and Respiratory Diseases
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• 제66권5호
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• pp.385-389
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• 2009

저자들은 성인에서 객혈을 동반한 폐의 선천성 낭성 선 종양 기형과 전암 병변인 비정형 샘 증식증의 동반 발병을 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제27권11호
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• pp.930-937
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• 1994

Pulmonary sequestration, congenital cystic adenomatoid malformation[CCAM], infantile lobar emphysema[ILE], and bronchogenic cysts are four congenital lesions that show abnormal cystic areas within the lung field in early life. They share similar embryologic and clinical characteristics, Therefore they are sometimes difficult to make differential diagnosis each other, and all require surgical treatment. From 1984 to 1993, 20 patients underwent surgical corrections under these diagnostic categories[10 bronchogenic cyst, 4 pulmonary sequestration, 4 CCAM, and 2 ILE] in the department of thoracic & cardiovascular surgery, Inje University, Pusan Paik Hospital. There were 9 females and 11 males, Ages ranged from 26 days after birth to 69 years. Among them 5 cases of bronchogenic cyst were found out incidentally, but remained all 15 cases were noted as symptomatic cases. Recurrent pulmonary infections, respiratory distress and cough with cystic lesions in chest film were the main characteristics of them. Computed tomography and aortography were available for diagnostic conformation. For all the cases surgical resection were performed: 1 pneumonectomy, 2 bilobectomy, 9 lobectomy, 7 cyst resection and 1 mass[extralobar pulmonary sequestration] resection. All surgical treatments were well tolerated with no physical limitation. There was no operative mortality, and only one postoperative complication[empyema thoracis]. All patients were followed up ranging from 4 months to 9 years. A clinical awareness of these related lesions is important for prompt diagnosis and effective surgical treatment.

• Journal of Chest Surgery
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• 제23권4호
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• pp.698-706
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• 1990

Congenital Cystic Lung Disease is a spectrum of closed related anomalies that arise during an early stage of embryonic lung bud maturation-namely bronchogenic cyst, congenital lobar emphysema, pulmonary sequestration and congenital cystic adenomatoid malformation. And they show similar surgical strategies. So they are called as the term bronchopulmonary-foregut malformations, firstly proposed by Gerle[1968]. From Aug. 1979 to Aug 1989, 47 patients were operated upon on Dept. of Thoracic & Cardiovascular Surgery at the CUMC. There were 21 females and 26 males ranging in age from age of 21 day to age of 56 year [15 cases under 15 years old]. 30 patients had bronchogenic cysts - 23 of intrapulmonary type, 7 of mediastinal type in location. Affected lobes and locations were as follows: 11 in upper lobe, 3 in middle lobe, 11 in lower lobe and anterosuperior, middle, and posterior mediastinal type were 3, 2, 2 respectively. There were 9 pulmonary sequestrations[all intralobar type] with the distribution of 5 in right lower lobe and 4 in left lower lobe. And associated anomalies were presented with arterial supply originating from thoracic aorta[8 cases], abdominal aorta[1 case] and with venous drainage into azygos vein[1 case]. They all were operated upon lower lobectomy [8 case], pneumonectomy[1 case] in case of pulmonary hypoplasia Congenital lobar emphysema and congenital cystic adenomatoid malformation had 4 cases respectively. Their affected lobes were as follows: the former were 3 in upper lobes, 1 in middle lobe and the latter were 3 in upper lobe, 1 in lower lobe. They were treated with lobectomy and segmentectomy. Diagnosis was aided by chest X - ray, bronchography, aortography, DSA and CT scan, They all were confirmed by pathologic exams. There were no hospital death but few minor morbidities such as, atelectasis-pneumonia[2], wound infection[2], prolonged chest tube placement[2]. We experienced surgical treatments of 47 cases for 10 years and reported them with literature review.

• Journal of Chest Surgery
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• 제17권1호
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• pp.118-124
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• 1984

Congenital Cystic Adenomatiod Malformation (C.C.A.M.) is rare, but one of the most common congenital pulmonary anomalies that cause acute respiratory distress in the newborn infants. It is characterized and differentiated from the diffuse pulmonary cystic disease pathologically, i.e. adenomatoid appearance due to marked proliferation of the terminal respiratory components. An 2/12 year old male patient was suffered from respiratory distress and cyanosis on crying since birth, but no specific therapy was given. With progression of symptoms, he came to Korea University Hospital for further evaluation and then transfered to Dept. of Chest Surgery for operative correction under the impression of Congenital Obstructive Emphysema suggested by a pediatrician. On gestational and family history, there was nothing to be concerned such as congenital anomaly. Physical examinations showed; moderate nourishment and development (Wt. 5.5kg), cyanosis on crying, both intercostal and lower sternal retraction on inspiration, Lt. chest building with tympany, Rt. shifting of cardiac dullness, decreased breathing sound with expiratory wheezing on entire Lt. lung field, decreased breathing sound on Rt. upper lung filed, and tachycardia. The remainders were nonspecific. Laboratory findings were normal except WBC $14000/mm^3$ (lymphocyte 70%), Hgb 9.8m%, Hct 28%, negative Mantaux test, and sinus tachycardia and counter-clockwise rotation on EKG. Preoperative simple Chest PA revealed marked hyperlucent entire Lt. lung, herniation of Lt. upper lobe to Rt., collapsed Rt. upper lobe, tracheal deviation and mediastinal shifting to Rt., and no pleural reaction. At operation, after Lt. posterolateral thoracotomy, 4th rib was resected. Operative findings were severe emphysematous changes limited to both lingular segmentectomy was done. The resected specimen showed slight solidity, measuring $8{\times}4.5{\times}2cm$ in size, and small multiple cystic spaces filled with air. Microscopically, entire tissue structures were glandular in appearance, cyst were lined by ciliated columnar epithelium, and occasional cartilages were noted around the cystic spaces. Bronchial elements were dilated but normal pattern on histologically. The patient had a good postoperative courses clinically and radiologically, and discharged on POD 10th without event. The authors report a case of Cogenital Cystic Adenomatoid Malformation (C.C.A.M.)

• Journal of Chest Surgery
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• 제23권2호
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• pp.407-415
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• 1990

A total of 69 patients were treated for congenital lung cysts at Seoul National University Hospital during the period between 1960 and Aug, 1989. They were 37 patients of bronchogenic cyst, 18 patients of pulmonary sequestration, 7 patients of congenital cystic adenomatoid malformation [C.C.A.M.], and 7 patients of congenital lobar emphysema. In cases of bronchogenic cyst, involved age was variable from 7 months to 53 years and most cases were asymptomatic. They were located 14 cases in the right lung, 6 cases in the left lung and 17 cases in the mediastinum. Their sizes were also variable from 2.5 to 12 cm and most of them except 3 cases were solitary cysts. There were 6 cases that had bronchial communication. In cases of pulmonary sequestration, aged from 3 months to 29years, all were intrapulmonary type. 15 cases of them were found in the left lower field and 3 cases in the right lower field. Anomalous vessels were confirmed in 16 cases by aortography and/or surgical exploration. In cases of congenital cystic adenomatoid malformation, aged from 7 days to 6 years, 3 cases of infants were admitted due to severe dyspnea and cyanosis but the remaining 4 cases were admitted due to large cyst or abscess on chest roentgenogram. 3 cases were located in the right lung and 4 cases in the left lung. In cases of congenital lobar emphysema, aged from 14 days to 11 years, 6 cases were located in the right lung and one case was located in the left lung. All of them were male and had shown some degree of dyspnea from birth There were 2 cases of mortality, one in C.C.A.M and one in congenital lobar emphysema. But the remaining cases were well treated and recovered with the surgical resections.

• Journal of Chest Surgery
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• 제17권2호
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• pp.326-330
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• 1984

Congenital Cystic Adenomatoid Malformation [C.C.A.M], one of lung bud anomalies, is an unusual lesion, only about 200 cases baring been reported by 1980, and characterized by marked proliferation of terminal respiratory structures. Recently we experienced two infants with C.C.A,M., whose clinical courses were quite different. On case 1, the patient was 25-day-old female, and suffered from progressive respiratory distress for 10 days duration. A right middle lobectomy was performed, with a satisfactory postoperative course. On case II, the patient was 7omonth-old male, and admitted for evaluation of known pulmonary anomaly, which was detected for the first time during hospitalization for treatment of pneumonia at 1 month of his age. He underwent a lingular segmentectomy, but died of respiratory insufficiency on postop 10th day. We believe that awareness of the presence of C.C.A.M. is important in making the differential diagnosis of progressive respiratory disease or of recurrent pulmonary infection in infants.

• Journal of Chest Surgery
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• 제43권4호
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• pp.450-453
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• 2010

선천성 낭종성 선종양 기형은 폐격리증과 같은 다른 동반된 기형 없이는 혈액공급을 폐동맥에서 받는 것으로 알고 있었으나, 저자들의 증례에서는 다른 기형이 동반되지 않은 단순 선천성 낭종성 선종양 기형이 영양동맥을 가지고 있었다. 술 전 영양동맥이 발견되지 않았어도 선천성 낭성 폐질환에서 영양혈관의 가능성에 유의하여야 할 것이다.

• Journal of Chest Surgery
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• 제21권6호
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• pp.1095-1098
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• 1988

Congenital cystic adenomatoid malformation[CCAM] is a rare disease that cause respiratory distress in the newborn and infants, but is one of the two causes along with lobar emphysema. This malformation has the pathologic characteristics which can be differentiated from other forms of diffuse cystic disease, i.e. CCAM is marked proliferation of the terminal bronchioles and that can enlarge rapidly by air trapping in cystic areas. The CCAM has a clinical importance because of rapid worsening respiratory distress, with tachypnea, subcostal retraction and cyanosis. This is a strict surgical condition and after operation[lobar, segmental resection or pneumonectomy] the symptoms relieved obviously. We experienced 6 cases of CCAM from July, 1980 to September, 1987 at the Department of Cardiovascular and Thoracic Surgery, Severance Hospital, College of Medicine, Yonsei University. The male patients were two and female patients were four. The age distribution was from premature to 10 year old. One of them was 27 weeks gestational premature female who was borne dead. The other 5 patients were performed on thoractomy[1 case pneumonectomy and 5 cases lobectomy]. The postoperative courses were good and no complications were seen.

• Journal of Chest Surgery
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• 제22권2호
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• pp.272-289
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• 1989

Benign lung tumors compose a heterogeneous group of solid growths that present variations in clinical features, depending on whether the origin is within the bronchus on lung parenchyma or from visceral pleura. Benign tumors of the lung are relatively uncommon, and series are to be found in the literature and the classification of benign tumors of the lung continues to be controversial because of disagreement concerning the origin and prognosis of many common lesions. We adopt Liebows original classification but excluded bronchial adenoma which no longer considered as benign tumor and added pulmonary A-V fistula and congenital cystic adenomatoid malformation. We analyzed 61 cases of benign tumors which were composed of 16 original Korean cases and 45 cases which were reported on journal of Thoracic & Cardiovascular Surgery. The results were. [1] Incidence; Of 61 cases, chondromatous hamartoma was 2 cases [41 %], congenital cystic adenomatoid malformation 10 cases [16.4 %], pulmonary A-V fistula 5 cases [8.1 %], sclerosing hemangioma 4 cases [6.5 %], teratoma, plasma cell granuloma & mesothelioma were 3 cases [4.9%], Castlemans disease 2 cases [3.3%], and mucous gland adenoma, paraganglioma, and leiomyoma 1 case [1.6 %]. [2] Age & Sex distribution; Male 30 cases and female 31 cases. Mean age was 31.4 years old. [3] Main symptom; was coughing, 32.8%, and no symptom, 24.6%. [4] Sixty eight percentage of chest film showed mass density, and 4 cases showed calcification, 2 cases had lobulation. [5] Size of mass was large and multiple mass was 2 cases. Endobronchial tumors were 9 cases, 14.9 %. [6] Three cases of endobronchial tumor were preoperatively diagnosed by bronchoscopy and 2 cases of pulmonary A-V fistula were diagnosed by pulmonary arteriography. [7] Seven cases, 11.5%, had associating diseases such as bronchogenic cyst, thymic cyst, Schwannoma, situs inversus, bronchiectasis and bronchogenic carcinoma. [8] Minor resection such as excision 8i: wedge resection were 15 cases, 26.2 %, and 6 cases, 75.4 %, of lobectomy were performed including 5 cases of pneumonectomy 5 cases had. [9] Postoperative complications; One case, 1.6 %, expired due to respiratory insufficiency. Two cases had re-operation due to bleeding and hemoptysis.

• Journal of Chest Surgery
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• 제21권6호
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• pp.1084-1094
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• 1988

Conservative management of 3 iatrogenic perforations of intrathoracic esophagus was reviewed. The primary disorders were achalasia in 2 patients and congenital tracheoesophageal fistula in 1 patient. Perforation occurred after treatment of the primary disorders in the distal esophagus in 2 patients and mid-thoracic esophagus in 1 patient. All the perforations appeared late after the previous treatments and the inflammation spread to mediastinum and pleural cavity in all the 3 patients. Conservative management of esophageal perforation was carried out with intraluminal drainage from the perforated site of esophagus[insertion of Levin`s tube and continuous suction], pleural drainage and feeding of liquid diet through gastrostomy tube with Fowler`s position. The patients revealed spontaneous closure of perforated sites about 3 to 4 weeks after this conservative management without open thoracotomy. This result suggests that this conservative management may be accepted as therapeutic method in the thoracic esophageal perforations regardless of cause and time of the perforation.