• Journal of the Korean Society of Radiology
• /
• v.82 no.4
• /
• pp.903-913
• /
• 2021

Purpose To identify the imaging features indicative of sarcoid-like reactions in patients with intrathoracic lymphadenopathy after complete remission of malignancies. Materials and Methods This study enrolled five patients with histopathologically confirmed sarcoid-like reactions that developed after cancer remission. The clinical features and findings of CT and ¹⁸F-fluorodeoxyglucose (FDG) PET/CT were assessed. Results The underlying malignancies included breast, nasopharyngeal, colon, and endometrial cancer and lymphoma. The time intervals between complete remission of malignancy and the diagnosis of sarcoid-like reaction ranged from 6 to 78 months. CT findings of sarcoid-like reaction included bilateral hilar and mediastinal lymphadenopathies (n = 5), pulmonary nodules (1-15 mm) with peribronchovascular, fissural, or subpleural distribution, and interlobular interstitial thickening in the lungs (n = 4). ¹⁸F-FDG PET/CT revealed hypermetabolic uptake in the mediastinal and hilar lymph nodes and both lungs in the absence of extrathoracic uptake (n = 3). The sarcoid-like reactions resolved in all patients after corticosteroid treatment. Conclusion In patients with complete remission of malignancies, newly developed bilateral hilar and mediastinal lymphadenopathies with or without pulmonary nodules of perilymphatic distribution, in the absence of recurrence at the primary tumor site and extrathoracic metastasis, may suggest a sarcoid-like reaction. Such cases warrant histologic evaluation of the lymph nodes to prevent unnecessary systemic chemotherapy.

• Journal of Chest Surgery
• /
• v.36 no.6
• /
• pp.411-417
• /
• 2003

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, neoadjuvant therapy been used in an attempt to increase the long term survival but has not been shown as a clear advantage. We reviewed the recurrence and survival after complete resection of esophageal cancer without neoadjuvant therapy. Material and Method: From December 1994 to December 2001, 182 consecutive patients who underwent intrathoracic esophagectomy, transthoracic esophagogastrostomy and two-field lymph node dissection for esophageal canter without neoadjuvant therapy were studied retrospectively. Result: There were 167 men and 15 women. The median age was 65 years (range, 40 to 90 years). The tumor was located in the upper third part of the esophagus in 7 patients (3.8%), middle third in 86 (47.3%), and lower third in 89 (48.9%). The postsurgical stage were as follows: stage 0 in 2 patients (1.1%), stage I in 32 (17.6%), stageIIA in 47 (25.8%), stage IIB in 25 (13.7%), stage III in 54 (29.7%), stage IVA in 10 (5.5%), and stage IVB in 12 (6.6%). The in-hospital mortality rate was 3.8% (7 patients) and complications occurred in 65 patients (35%), Follow-up was complete in 95.6%. The recurrence occurred in 56 patients (30.8%) and the overall 5-year disease free rate was 55%. The overall 5-year survival rate was 57%; it was 80% for patients in stage I, 65% in stage IIA, 58% in stage IIB, 48% in stage III, and 40% in stage IVB. The overall 5-year survival rate of patients with postoperative adjuvant therapy was 59% compared to 34% in patients without postoperative adjuvant therapy (p<0.05). Conclusion: The most effective therapy for esophageal cancer may be complete resection. More aggressive surgical therapy and adjuvant therapy may improve the long-term survival, even for advanced stage esophageal cancer.

• Tuberculosis and Respiratory Diseases
• /
• v.44 no.1
• /
• pp.59-68
• /
• 1997

Background : Tuberculous chest wall abscess is a rare complication of tuberculosis. However, there have been few reports about the variable extents and shapes of tuberculous chest wall abscesses. We analyzed the extent and shape of tuberculous chest wall abscess-es and grouped them according to combined pleuroparenchymal lesions by CT scans. Materials and Methods : CT findings were evaluated in 20 patients of tuberculous chest wall abscesses. We classified 29 abscesses in 20 patients into three types according to pleuroparnechymal lesions. Type 1 was defined when there was no active pleuroparenchymal lesion, Type 2, when intrathoracic tuberculosis was contacted with chest wall abscess, Type 3, when ipsilateral subpleural nodules were not contacted with chest wall abscess. Results : The type 1 included 6 abcesses in 6 patients. They showed rib and/or costal cartilage destruction in their center. They were relatively large and round. The type 2 included 13 abscesses in 10 patients. The abscesses in contact with pleural lesion or mediastinal lesion were mainly located in the outer muscle layer, and they were relatively large in size. However, the abscesses in contact with parenchymal lesion were mainly located in extrapleural space. They were relatively small and they were longest along the long axis of ribs. The type 3 included 10 abscesses in 6 patients. They were located mainly in the extrapleural space. Conclusion : Tuberculous chest wall abscess-es showed variable extents and shapes according 10 pleuroparenchymal lesions. CT is a good diagnostic modality to visualize the extent of tuberculous chest wall abscess and combined pleuroparenchymal lesion.

• Journal of Chest Surgery
• /
• v.43 no.6
• /
• pp.681-686
• /
• 2010

Background: A chest computed-tomography has become more prevalent so that it is more common to detect small sized pulmonary nodules that have not been found in previous simple chest x-ray. If those detected nodules are undersized or located in pulmonary parenchyma, it is difficult to accomplish a biopsy since it is vulnerable to explore them either grossly or digitally. Thus, in our hospital, a thoracoscopic pulmonary wedge resection was performed after locating a lesion by means of hook wire with CT-guided. Material and Method: 31 patients (17 males and 14 female patients) from December in 2006 to June in 2010 became our subjects; their 34 pulmonary nodules were subjected to the thoracoscopic pulmonary wedge resection after locating a lesion by means of hook wire with CT-guided. Also we analyzed a possibility of hook wire dislocation, a frequency of conversion to open thoracotomy, time consumed to operation after location of a lesion, operation time, post operation complication, and histological diagnosis of the lesion. Result: 12 of 34 cases were ground glass lesion, whereas 22 cases of them were solitary pulmonary lesion. The median value of the lesion was 8mm in size (range: 3 to 23 mm), while the median value was 12.5 mm in depth (range: 1 to 34 mm). The median value of time consumed from location of the lesion to anesthetic induction was 86.5 minutes (41~473 minutes); furthermore the mean value of operation time was 103 minutes (25~345 minutes). Intrathoracic wire dislocation was found in one case, but a target lesion was successfully excised. Open thoracotomy was performed in four cases due to pleural adhesion. However, there was no case of conversion to open thoracotomy due to failure to detect a target lesion. In histological diagnosis, metastatic cancer were found in 15 cases, which were the most common, primary lung cancer were in 9 cases, non-specific inflammation were in 3 cases, tuberculosis inflammation were in 2 cases, lymph nodes were in 2 cases, active tuberculosis were in 1 case, atypical adenomatous hyperplasia was in 1 case and normal lung parenchymal finding was in 1 case, respectively. Conclusion: In our hospital, in order to accomplish a precise histological diagnosis of ground-glass lesion and pulmonary nodules in lung parenchyma, location of pulmonary nodules were exactly located with hook wire under chest computed-tomography, which was followed by lung biopsy. We concluded that this was an accurate, minimally invasive and valuable method to minimize the complications and increase of cost of medical service provided.

• Journal of Chest Surgery
• /
• v.35 no.4
• /
• pp.290-295
• /
• 2002

Backgroud: Pneumonectomy carries the possibility of numerous dangerous complications as well as the vast effect the operation itself has on the cardiopulmonary function. Most of operations are done with the insertion of the chest tubes upon completion, but because of the high incidence of pyothorax as its complications, we have tried to analyze and compare the cases without inserting the chest tubes. Material and Method: During a 5 year period from January, 1996 to December 2000, 100 cases, which were operated at the Hanyang University Hospital, were selected using the patient's charts. The age, gender, indication of operation, associated diseases, and operation site(left or right) were classified accordingly and the postoperative complications and mortality were statistically analyzed using the $\chi$ 2-test. After resecting the lung, the intrathoracic pressure was set at -15 ~ -20cm $H_2O$ using the nelaton catheter, and the thoracotomy site was then closed. The gradual collection of the fluid and blood in the thorax of the operated side, as well as the mediastinum location, were observed carefully for 4~5 days postoperatively with the aid of the simple chest x-rays. Result: Of the 100 cases, 16 cases of pulmonary tuberculosis(16%), 81 cases of lung tumor(81%), 2 cases of bronchiectasis(2%), and 1 case of aspergilloma associated bronchiectasis were noted. There were 8 mortality cases(8%), and of the 34 cases(34%), 44 complications were noted. The age, sex, and operation site(left or right) were not statistically significant with the complications. 7 of the 16 cases of pulmonary tuberculosis(44%) and 27 of the 81 cases of lung tumor(33%) had complications, but they were found not to be statistically significant. The increase of the complication rate in the pulmonary tuberculosis patients was 3.86. The evidence of postoperative bleeding was observed in 6 cases with the 3 cases being the pulmonary tuberculosis patients and the 3 cases were others. This shows that the increase in postoperative bleeding in the pulmonary tuberculosis is statistically significant(p=0.019). Of the 100 cases, there were 8 mortality cases(8%), with 5 cases from the 81 cases of the lung tumor group(6.1%), 3 cases from the 16 cases of pulmonary tuberculoses group(18.7%).

• Journal of Chest Surgery
• /
• v.30 no.10
• /
• pp.991-1000
• /
• 1997

Closed thoracostomy with UWSD* which is the most utilized procedure in chest surgery applies general thoracic disorders, trauma and after-thoracic surgery. The University hospital was involved on operating 2341 cases of closed thoracostomy with UWSD except chest tubing after-thoracic surgery for a full six years from January, 1991 to December, 1996. The rate of men and women out of the total 2341 cases was 3.5 : 1, the distribution by age showed that men were 36.6 $\pm21.0$ years old, women were $47.0\pm20.2$ years old and so that the total were 40.0 $\pm$ 20.5 years old. As for indication, spontaneous, secondary and traumatic pneumothorax were the most common, in addition to hemothorax hemopneumothorax, hydrothorax, hydropneumothorax, empyema, chylothorax. The most indwelling period of chest tubing is between eight and fourteen days for 974 cases and the average is 13.7 $\pm$ 6.3 days, The average drainage amount immediately after thoracostomy was 537 $\pm$ 88m1, and in 694 cases(46.0%), the drain amount was 201 ~ 500 ml. The rate of right and left tubing was 52.4 47.6, in 2071 cases(88.5%), the thoracostomy was the first chance and 2210 cases(94.4%) were treated with a single tube drainage. Almost all the patients complained of tube site pain, besides tube site infection, intercostal neuralgia, loss of tube function by the pleural adhesion, intrathoracic infection, incomplete reexpansion of defective lung, hemorrhage caused by the rupture of a blood vessel, subcutaneous emphysema, lung parenchymal rupture, diaphragmatic and intraabdominal trauma, reexpansionary pulmonary edema of one side lung and cellulitis were relapsed. 84.6% of all patients recovered with only clo ed thoracostomy and the rest of patient needed additional some necessary managements and so on to have successful results. There were two deaths(0.1%), caused by reexpansionary pulmonary edema, the cellulitis were complicated by thoracostomy with UWSD on an empyema patients to come to death(due to sepsis). t UWSD = under water seal drainage

• Journal of Chest Surgery
• /
• v.32 no.6
• /
• pp.556-560
• /
• 1999

Background: The cause of spontaneous pneumothorax is not yet but it is certain that intrathoracic air comes from ruptured bulla. Video-assisted thoracoscopic surgery(VATS) or open thoracotomy is recommended for thoracic incision in recurrent pneumothorax. However, recurrent rate after bullectomy with the VATS is very high compared to mini-thoracotomy, 3% to 20% and below 2%, respectively. Material and Method: This retrospective analysis was performed on 16 re-operated cases among 446 surgically treated pneumothorax of the 737 cases of spontaneous pneumothorax diagnosed at Yongdong Severance Hospital from Nov. 1992 to June 1997. Result: Among the 446 surgically-treated patients in 737 case of spontaneous pneumothorax, 16 patients underwent re-operation, showing a 3.5% re-operation rate. Male-to-female ratio was 15 to 1 and mean age at initial attack was 20.2 years(ranging from 15 to 50). Mean hospital stay was 6.34 days(ranging from 2 to 20 days) and mean chest tube indwelling period was 4.2 days(ranging from 1-10 days). Median follow-up was 46 months(range 10-66 months). Three different surgical methods were applied : video-assisted thoracoscopic surgery(VAST) in 281 cases, of whom 2 underwent local anesthesia; subaxillary mini-thoracotomy in 159 cases and limited lateral thoracotomy in the remaining 6 cases. Three different re-operative surgical methods were applied ; video-assisted thoracoscopic surgery (VAST) in 6 cases, subaxillary mini-thoracotomy in 9 cases, and limited lateral thoracotomy in the remaining 1 case. The underlying etiological factors of the recurrent pneumothorax after bullectomy were o erlooking type(9) and new growing type(7). Mean recurrent period from previous operation was 1 month for overlooking type and 18 months for new growing type. Conclusion: The underlying etiological factors of recurrent pneumothorax lead to re-operation were new-growing and over-looking type. We need additional treatments besides resecting blebs of prevent the recurrence rate and more gentle handling with forceps due to less damage to the pleura.

• Journal of Chest Surgery
• /
• v.43 no.3
• /
• pp.285-291
• /
• 2010

Background: Thoracic trauma is one of the leading causes of morbidity and mortality in developing countries. A rib fracture that is secondary to blunt thoracic trauma is an important indicator of the severity of the trauma. The purpose of study was to determine the morbidity and mortality rates and the management of rib fractures. Material and Method: We performed a retrospective study that involved all the blunt trauma patients with rib fractures, excluding those that were transferred to other hospital within 3 days, that were seen at our hospital between May 2002 and December 2008. Of the 474 admitted patients, 454 met the inclusion criteria. There were 356 male and 98 females, and their overall mean age was 53 years (range: 5~90 years). The outcome parameters included the mechanism of injury, the number of fractured ribs, the length of stay in the ICU, the Injury Severity Score (ISS), the length of the hospital stay, the pulmonary complications and the mortality. Result: The mechanism of trauma included traffic accidents in 189 (41.7%) cases, slipping down in 103 (22.7%) cases, falls in 85 (18.7%) cases, cultivator accidents in 30 (6.6%) cases, industrial accidents in 32 (7.0%) cases and assault in 15 (3.3%) cases. Intrathoracic injury was noted such as hemothorax in 269 (59.3%) cases, pneumothorax in 144 (31.7%) cases, pulmonary contusion in 95 (20.9%) cases, subcutaneous emphysema in 29 (6.4%) cases and great vessel injury in 5 (0.1%) cases. Conservative treatment was administered to most of the patients. Tube thoracostomy was administered in 234 (51.5%) cases, whereas thoracotomy was performed in 18 (4.0%) cases. The mean duration of thoracostomy was $5.2{\pm}6.2$ days. Most of the cases with rib fracture were treated in wards and their mean duration of hospital stay was $22.5{\pm}20$ days. The mean Injury Severity Score (ISS) was $14.8{\pm}10.9$ (range: 3~75). The mortality rate was calculated to be 4.8% (n=22). The main factors correlated with an adverse outcome were the number of ribs fractured, the duration of thoracostomy and pulmonary disease. Industrial insurance affected the length of hospitalization. Pulmonary contusion and the Injury Severity Score (ISS) affected the mortality. Conclusion: Rib fractures are a indicator of severe injury. Because of the complication and associated injuries, we believe these patients should be admitted for evaluation and treatment. Recent studies on the impact of rib fractures after blunt trauma have shown that patients as young as 40 years of age demonstrate increased morbidity and mortality with similar injuries as compared to that of older patients. The ISS and pulmonary contusion influenced the mortality rate. Patients with isolated rib fractures should be hospitalized if the number of fractured ribs is one or more.

• Tuberculosis and Respiratory Diseases
• /
• v.40 no.5
• /
• pp.575-583
• /
• 1993

Background: Mediastinal masses are not uncommon, and an overall incidence of one case per 100,000 population per year in individuals of all ages and with no difference in sex incidence may be a reasonable estimation. At least half of all mediastinal masses are asymptomatic and this proportion has increased in recent decades with wider use of screening chest roentgenography. Symptoms in patients with mediastinal mass lesions are usually due to compression or invasion of nearby intrathoracic structures. Most mediastinal mass lesions have characteristic predilectional locations. The basic focus of diagnostic evaluation is an orderly preparation for obtaining a tissue diagnosis but even lesions discovered to be benign must generally be removed. Seldom is this status known for certain preoperatively. In additaion, benign tumors may continue to enlarge, thus compromising vital organs; they may rupture, hemorrhage, become infected or have the possibility of various malignant degeneration. Therefore, all mediastinal masses must be surgically removed whether they are malignant or benign. Methods: We reviewed the medical records of 344 cases previously confirmed as mediastinal tumors or cysts from January, 1960 to August, 1992 and investigated the clinical findings. Results: Neurogenic tumors were the most common(24.7%) and thymomas were distinctively increased recently. Overall ratio between males and females was 1.1:1 and age distribution was relatively even among all age groups. Predilectional sites were posterior for neurogenic tumors, and anterior for teratodermoid tumors, thymomas and lymphomas. Dyspnea was the most common symptom in the patients of the mediastinal tumors and asymptomatic patients were 19.5%, Benign mediastinal mass lesions were 66.0% and malignant, 34.0%, Complete or partial resection was done in 42.4%. Conclusion: We could find the increasing incidence and the tendency of aggressive resection as possible in the mediastinal tumors. We expect the discovery of more mediastinal tumors with wider use of regular check-up and development of diagnostic methods.

• Radiation Oncology Journal
• /
• v.14 no.4
• /
• pp.299-306
• /
• 1996

Purpose : Respiratory symptoms related with malignant airway disease have been the main causes of lowered qualify of life and also sometimes may be life-threatening if not properly managed. The authors report the short-term experiences of endobronchial brachytherapy for symptomatic malignant airway obstruction using high dose rate after-loading brachytherapy unit. Materials and Methdos : Twenty-five Patients with symptomatic malignant airway obstruction were treated with endobronchial brachytherapy between the period of December 1994 and March 1996 at Department of Radiation Oncology of Samsung Medical Center Twenty-one ($84\%$) were patients with non-small cell lung cancer, three with tracheal malignancies, and one with recurrence of esophageal cancer. Twenty Patients were given elective external beam radiation therapy, while six were given endobronchial laser evaporation therapy on emergency bases in addition to endobronchial brachytherapy. Three procedures for each patient were planned and total of 70 procedures were completed. Results : Improvement rates of major respiratory symptoms after endobronchial brachytherapy procedures were $88\%$(22/25). $96\%$(22/23), $100\%$ (15/15), and $100\%$(9/9) for cough, dyspnea, hemoptysis and obstructive pneumonia, respectively. ECOG performance scores were improved in $56\%$ of total patients group, while there was no case with worsened ECOG score. Fifteen patients died and the median interval from the start of treatment to death was 4 months (range: $1\~17$ months), while that of ten survivors was 9 months (range $5\~19$ months). There were five patients with controlled intrathoracic disease, who have survived over one rear. All deaths were associated with uncontrolled local and/or distant disease. Four Patients died of massive fatal hemoptysis, three of who received emergency endobronchial laser evaporation therapy before the start of endobronchial brachytherapy. Conclusion : Endobronchial brachytherapy has been confirmed as an excellent palliative treatment modality improving respiratory symptoms as well as patients' general performance status. Based on the current observations, use of endobronchial brachytherapy in curative setting as a boost technique may be warranted.