• Journal of Chest Surgery
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• 제34권11호
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• pp.883-886
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• 2001

종격동 섬유화는 대부분 특발성으로 여러 종격동 구조물, 측 상대정맥, 폐동정맥 등에 병발하여 섬유조직의 포착과 미란, 협착 등으로 증상이 나타난다. 그 중 상대정맥에 가장 흔하게 병 발하지만, 식도에 병발한 특발성 섬유화는 아주 드물게 보고되고 있다. 이러한 특발성 종격동 섬유화로 인한 식도협착은 알 수 없는 염증성 섬유의 증식이지만 그것에 대한 치료방법은 아직 뚜렷이 정해진 바는 없다. 본 보고는 이러한 환자를 부분적 식도해리 및 근절개술로 성공적으로 치료하였다.

• Tuberculosis and Respiratory Diseases
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• 제44권4호
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• pp.935-941
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• 1997

저자들은 흉통을 주소로 내원한 53세 남자 환자에서 특발성 종격동 섬유증 1예를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제51권4호
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• pp.373-378
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• 2001

저자들은 애성을 주소로 내원한 60세 남자 환자에서 prednisolone과 tranilast의 투여로 호전된 특발성 종격동 섬유화증 1예를 경험하였기에 문현고찰과 함께 보고하는 바이다.

• Journal of Chest Surgery
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• 제36권2호
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• pp.113-117
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• 2003

특발성 종격동 섬유증은 매우 드문 질환으로 특별한 원인 없이 종격동에 섬유화가 진행되는 질환이다. 본 증례는 요통을 주소로 내원한 41세 남자환자와 쉰 목소리를 주소로 내원한 65세 남자환자에서 종격동에 종괴가 관찰되었고 진단적 목적의 흉강경을 이용한 조직 생검을 시행하여 조직 소견상 특발성 종격동 섬유증으로 진단된 2 례를 보고하였다. 수술 소견은 2 례 모두에서 종괴가 매우 단단하였고 주위조직과 단단히 유착되어 있었으며 주위조직과 명확한 경계가 없이 섬유화가 심하였다. 현미경 소견에서 염증세포의 침윤과 함께 다량의 교원질 및 섬유 아세포를 관찰할 수 있었나. 수술 후 약물치료는 시행하지 않았고 5개월과 7개월 추적관찰 중에 합병증은 없었으며 종격동 섬유화의 진행도 보이지 않았다.

• Journal of Chest Surgery
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• 제12권2호
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• pp.140-144
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• 1979

This is a report of a case of superior vena caval syndrome due to idiopathic mediastinal fibrosis, which was surgically treated. The patient was 35-year-old Korean male who progressively complained shortness of breath about for 40 days prior to operation. Phlebogram of SVC showed indentation of SVC at the site of cavoatrial junction. The operation was performed under impression of bronchogenic cancer of right hilum. After thoracotomy, it was found a irregular mass in the mediastinum at the level of cavoatrial junction, which was developed to surrounding with SVC, pericardium, trachea and bronchus and they fixed together to immobile. Bypass graft between SVC and right atrial appendage was performed using a pericardial roll tube This is a report of a case of superior vena caval syndrome due to idiopathic mediastinal fibrosis, which was surgically treated. The patient was 35-year-old Korean male who progressively complained shortness of breath about for 40 days prior to operation. Phlebogram of SVC showed indentation of SVC at the site of cavoatrial junction. The operation was performed under impression of bronchogenic cancer of right hilum. After thoracotomy, it was found a irregular mass in the mediastinum at the level of cavoatrial junction, which was developed to surrounding with SVC, pericardium, trachea and bronchus and they fixed together to immobile. Bypass graft between SVC and right atrial appendage was performed using a pericardial roll tube [$1.3{\times}5$ cm]. After that SVC was decompressed very well. SVC pressure was markedly reduced from 32 cm $H_2O$ in preoperative to 21 cm $H_2O$in postoperative. Mediastinal fibrosis was confirmed by histopathological examination postoperatively. The postoperative course was uneventful.

• Journal of Chest Surgery
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• 제36권9호
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• pp.703-706
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• 2003

전폐절제술 후 증후군은 우전폐절제술 후 혹은 우동맥궁을 가진 환자의 좌전폐절제술 후 심한 종격동의 이동과 회전에 의하여 기도가 폐쇄되어 심한 호흡곤란을 일으키는 질환이다. 그러나, 전폐절제술이 아니더라도 종격동의 이동과 회전에 의해 기도가 폐쇄될 수 있다. 삼성서울병원 흉부외과에서는 폐결핵성 파괴폐에 의해 유발된 전폐절제술후양(postpeumonectomy-like syndrome) 증후군을 전폐절제술과 함께 조직확장기(tissue expander)를 삽입하여 종격동 정복(mediastinal repositionng)을 시행한 예를 경험하였기에 보고하는 바이다.

• Journal of Chest Surgery
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• 제22권5호
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• pp.839-844
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• 1989

There appears to be significant problems remained in the treatment of tuberculous empyema with BPF in spite of several surgical methods: decortication, thoracoplasty, and pleuropneumonectomy. We presented one case of tuberculous empyema with BPF. The patient was 42-year-old male and his chief complaint was hemoptysis. In past history, he was treated with left closed thoracostomy and antituberculous medication for two months, 16 years ago. Chest X-ray, tomogram and C. T, revealed a huge mass with central necrosis in the lower 2/3 of left thoracic cavity and shifting of the mediastinal structure to the right. Needle aspiration cytology was undifferentiated large cell carcinoma. Left thoracotomy was made under the impression of lung cancer and pleuropneumonectomy was done. Operative findings; thick walled empyema sac filled with hematoma and BPF, the mediastinum was fixated due to fibrosis and calcification of the pleura and the mediastinum. Postoperative biopsy was consistent with tuberculosis. In the postoperative course, there was massive hemorrhage and so reoperation was done. But there was no active bleeding focuses in the thoracic cavity at the time of reoperation. Massive transfusion, coagulant therapy and intermittent clamping and declamping of the chest tube were carried out. Especially, serum calcium level was chronically decreased and so large amount of calcium gluconate was infused for the calcium level to be normal. Total transfused blood; whole blood was 33 pints, packed cell was 63 pints and fresh frozen plasma was 70 pints. At the postoperative[reop] 45th day, intrathoracic hemorrhage was stopped and the chest tube was removed. In conclusion, this suggest that uncontrollable bleeding after pleuropneumonectomy of the tuberculous empyema with BPF could be treated without reoperation in case of the mediastinal fixation due to fibrosis and calcification of the pleura and the mediastinum.

• Tuberculosis and Respiratory Diseases
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• 제40권4호
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• pp.345-352
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• 1993

The role of magnetic resonance(MR) imaging in the evaluation of thoracic disease has been limited Nontheless, MR has inherent properties of better contrast resolution than CT allowing tissue-specific diagnosis. MR has capability of direct imaging in sagittal, coronal, and oblique planes which provide better anatomic information than axial images of CT such as lesions in the pulmonary apex, aorticopulmonary window, peridiaphragmatic region, and subcarinal region. MR is sensitive to blood flow making it an ideal imaging modality for the evaluation of cardiovascular system of the thorax without the need for intravenous contrast media. Technical developments and better control of motion artifacts have resulted in improved image quality, and clinical applications of MR imaging in thoracic diseases have been expanded. Although MR imaging is considered as a problem-solving tool in patients with equivocal CT findings, MR should be used as the primary imaging modality in the following situations: 1) Evaluation of the cardiovascular abnormalities of the thorax 2) Evaluation of the superior sulcus tumors 3) Evaluation of the chest wall invasion or mediastinal invasion by tumor 4) Evaluation of the posterior mediastinal mass, especially neurogenic tumor 5) Differentiation of fibrosis and residual or recurrent tumor, especially in lymphoma 6) Evaluation of brachial plexopathy With technical developments and fast scan capabilities, clinical indications for MR imaging in thorax will increase in the area of pulmonary parenchymal and pulmonary vascular imaging.

• Tuberculosis and Respiratory Diseases
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• 제52권3호
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• pp.278-282
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• 2002

특발성 섬유화성 종격동염은 일반적으로 일차적인 종격동의 섬유화 및 석회화가 종격동 기관을 침범하거나 압박함으로써 상대정맥증후군 등의 임상양상을 나타내는 질환이다. 그러나 저자등은 종격동의 침범은 아주 경미하면서도 광범위하고 심한 종격동 혈관의 섬유성 폐쇄를 동반한 특발성 섬유화성 종격동염 1예를 경험하였기에 보고하는 바이다.

• 대한영상의학회지
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• 제83권3호
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• pp.744-749
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• 2022

섬유성 종격동염은 종격동 내 고밀도 섬유 조직의 증식을 특징으로 하는 드문 양성 질환이다. 섬유성 종격동염은 일반적으로 중간 종격동 또는 폐문 부위의 국소적 또는 침윤성 연조직 종괴로 나타나며, 이는 혈관이나 기도와 같은 인접한 종격동 구조를 둘러싸거나 압박할 수 있다. 본 증례 보고에서 우리는 좌하엽 기관지의 폐색을 유발하는 종격동 종괴의 양상으로 나타난 13세 소녀의 섬유성 종격동염의 드문 증례를 보고하고자 한다. 환자는 전신 코르티코스테로이드 치료 후 증상과 추적관찰 흉부 CT 소견에서 호전되었다. 섬유성 종격동염은 전신 스테로이드 요법으로 호전될 수 있으므로 영상의학과 의사는 종격동의 침윤성 연조직 병변을 감별 진단할 때 섬유성 종격동염의 영상의학적 소견을 알고 있어야 한다.