• Journal of the Korean Society of Radiology
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• v.82 no.4
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• pp.770-790
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• 2021

Idiopathic pulmonary fibrosis (IPF), based on the 2018 international clinical practice guidelines, can be diagnosed with a usual interstitial pneumonia (UIP) pattern on high-resolution computed tomography (HRCT) and compatible clinical findings. Given that imaging is pivotal for IPF evaluation and diagnosis, more emphasis should be placed on the integration of clinical, radiological, and pathologic findings for multidisciplinary diagnosis. Interstitial lung abnormality (ILA), on the other hand, has a purely radiological definition based on the incidental identification of CT abnormalities. Taken together, differentiation between ILA and clinically significant interstitial lung disease (ILD) must be based on proper clinical evaluation. With this review, the recent updates in IPF diagnosis and the radiologic considerations for ILA can be well understood, which can be helpful for the proper diagnosis and management of patients with diffuse interstitial pulmonary fibrosis.

• Tuberculosis and Respiratory Diseases
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• v.43 no.3
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• pp.388-402
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• 1996

Background : To compare the diagnostic accuracies of High-resolution CT(HRCI) and chest radiography in the diagnosis of diffuse infiltrative lung disease(DILD). Methods : This study included ninety-nine patients with a diagnosis of acute or chronic DILD, representing 20 different diseases. Twelve normal subjects were included as control. The disease state was confirmed either pathologically or clinically. Radiographs and CT scans were evaluated separately by three independent observers without knowledge of clinical and pathologic results. The observers listed three most likely diagnoses and recorded degree of confidence. Results : The sensitivity of HRCT in the detection of DILD was 98.9% compared to 97.9% of chest radiography. Overall, a correct first-choice diagnosis was made in 48% using chest radiographs and in 60% using HRCT images. The correct diagnosis was among the top-three choices in 64% when chest radiographs were used, and in 75% when HRCT images were reviewed. Overally a confident diagnosis was reached more often with HRCT(55%) than with chest radiography(26%). The correct first-choice diagnosis increased remarkably when the HRCT was used in usual interstitial pneumonia, miliary tuberculosis, diffuse panbronchiolitis and lymphangitic carcinomatosis. Conclusion : HRCT is confirmed to be superior to conventional radiography in the detection and accurate diagnosis of DILD. HRCT is especially valuable in the diagnosis of usual interstitial pneumonia, miliary tuberculosis, diffuse panbronchiolitis, and lymphangitic carcinomatosis.

• Tuberculosis and Respiratory Diseases
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• v.41 no.2
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• pp.158-164
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• 1994

Pulmonary alveolar proteinosis is a disease of unknown etiology characterized by the accumulation of PAS positive lipoproteinaceous material in the alveolar spaces sparing septum. The therapy which has enjoyed the greatest success is whole lung lavage. The authors reported here, a case of 44 year old male patient with pulmonary alveolar proteinosis, and this is the 7th case in Korea. The patient underwent whole lung lavage but expired due to brain edema complicated by the procedure. He complained exertional dyspnea and cyanotic lips, and presented fine inspiratory crackle at both lower lung fields, decreased arterial oxygen pressure, and diffuse infiltration at whole lung field. Light microscopic finding of lung tissue obtained by transbronchial lung biopsy revealed PAS positive amorphous, granular material filled in the alveolar spaces, and electron microscopy of bronchoalveolar lavage fluid concentrate showed many electron-dense multi-lamellated structures. To treat the disease, the authors tried whole lung lavage of left lung with $37^{\circ}C$ isotonic saline under general anesthesia. However, he expired due to brain edema probably due to dilutional hyponatremia complicated by the procedure, 11 days after the procedure. Whole lung lavage is known relatively safe, but fatal complication may occur like this case.

• Tuberculosis and Respiratory Diseases
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• v.71 no.5
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• pp.368-372
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• 2011

Acute fibrinous and organizing pneumonia is a newly recognized pattern of acute lung injury. A 49-year-old female presented with a cough and worsening dyspnea on exertion. She had no history of smoking and no specific past medical history except exposure of home humidifier containing sterilizer. A chest computed tomography scan showed patchy consolidation with fibrosis in the right lower lobe and ill-defined centrilobular ground glass opacity in both lungs. The pathological findings were patchy areas of lung parenchyma with fibrin deposits in the alveolar ducts and alveoli, and fibrin balls with hemosiderin deposition in the alveolar spaces. The histological pattern of our case is differentiated from diffuse alveolar damage by the absence of hyaline membranes, and from eosinophilic pneumonia by the lack of eosinophils. In our case, the patient was treated with corticosteroid pulse therapy. However, the clinical course became aggravated and she died within two weeks.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.5-19
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• 1998

Introduction: Direct histologic and bacteriologic examination of a representative specimen of lung tissue is the only certain method of providing an accurate diagnosis in various pulmonary diseases including diffuse pulmonary diseases. The purpose of national survey was to define the indication, incidence, effectiveness, safety and complication of open and thoracoscopic lung biopsy in korea. Methods: A multicenter registry of 37 university or general hospitals equipped more than 400 patient's bed were retrospectively collected and analyzed for 3 years from the January 1994 to December 1996 using the same registry protocol. Results: 1) There were 511 cases from the 37 hospitals during 3 years. The mean age was 50.2 years(${\pm}15.1$ years) and men was more prevalent than women(54.9% vs 45.9%). 2) The open lung biopsy was performed in 313 cases(62%) and thoracoscopic lung biopsy was performed in 192 cases(38%). The incidence of lung biopsy was more higher in diffuse lung disease(305 cases, 59.7%) than in localized lung disease(206 cases, 40.3%) 3) The duration after abnormalities was found in chest X-ray until lung biopsy was 82.4 days(open lung biopsy: 72.8 days, thoracoscopic lung biopsy: 99.4 days). The bronchoscopy was performed in 272 cases(53.2%), bronchoalveolar lavage was performed in 123 cases(24.1%) and percutaneous lung biopsy was performed in 72 cases(14.1%) before open or thoracoscopic lung biopsy. 4) There were 230 cases(45.0%) of interstitial lung disease, 133 cases(26.0%) of thoracic malignancies, 118 cases(23.1%) of infectious lung disease including tuberculosis and 30 cases (5.9 %) of other lung diseases including congenital anomalies. No significant differences were noted in diagnostic rate and disease characteristics between open lung biopsy and thoracoscopic lung biopsy. 5) The final diagnosis through an open or thoracoscopic lung biopsy was as same as the presumptive diagnosis before the biopsy in 302 cases(59.2%). The identical diagnostic rate was 66.5% in interstitial lung diseases, 58.7% in thoracic malignancies, 32.7% in lung infections, 55.1 % in pulmonary tuberculosis, 62.5% in other lung diseases including congenital anomalies. 6) One days after lung biopsy, $PaCO_2$ was increased from the prebiopsy level of $38.9{\pm}5.8mmHg$ to the $40.2{\pm}7.1mmHg$(P<0.05) and $PaO_2/FiO_2$ was decreased from the prebiopsy level of $380.3{\pm}109.3mmHg$ to the $339.2{\pm}138.2mmHg$(P=0.01). 7) There was a 10.1 % of complication after lung biopsy. The complication rate in open lung biopsy was much higher than in thoracoscopic lung biopsy(12.4% vs 5.8%, P<0.05). The incidence of complication was pneumothorax(23 cases, 4.6%), hemothorax(7 cases, 1.4%), death(6 cases, 1.2%) and others(15 cases, 2.9%). 8) The 5 cases of death due to lung biopsy were associated with open lung biopsy and one fatal case did not describe the method of lung biopsy. The underlying disease was 3 cases of thoracic malignancies(2 cases of bronchoalveolar cell cancer and one malignant mesothelioma), 2 cases of metastatic lung cancer, and one interstitial lung disease. The duration between open lung biopsy and death was $15.5{\pm}9.9$ days. 9) Despite the lung biopsy, 19 cases (3.7%) could not diagnosed. These findings were caused by biopsy was taken other than target lesion(5 cases), too small size to interpretate(3 cases), pathologic inability(11 cases). 10) The contribution of open or thoracoscopic lung biopsy to the final diagnosis was defininitely helpful(334 cases, 66.5%), moderately helpful(140 cases, 27.9%), not helpful or impossible to judge(28 cases, 5.6%). Overall, open or thoracoscopic lung biopsy were helpful to diagnose the lung lesion in 94.4 % of total cases. Conclusions: The open or thoracoscopic lung biopsy were relatively safe and reliable diagnostic method of lung lesion which could not diagnosed by other diagnostic approaches such as bronchoscopy. We recommend the thoracoscopic lung biopsy when the patients were in critical condition because the thoracoscopic biopsy was more safe and have equal diagnostic results compared with the open lung biopsy.

• Applied Microscopy
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• v.21 no.1
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• pp.86-107
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• 1991

An experimental study was performed to observe the early effects of monocrotaline on pulmonary vascular system by means of light microscopy and scanning electron microscopy, attempting to expore the mechanism behind the process of pulmonary hypertension. Experimental animal(Sprague-Dawley male rats ; 150-200g B. W.) were intra-peritoneal administered with 100mg/kg B. W. monocrotaline. Authors observed light microscopically various gradational increase of wall thickness in pulmonary muscular and non-muscular arteries in duration from 2 weeks to 5 weeks after monocrotaline administration and the changes were more sever in the latter than the former. The scanning electron microscopy shows severe and diffuse endothelical cell swelling, microvilli and microbleb formation since 1 hour after monocrotaline administration and during the course, after 5 hours the severity of endothelial cell damage was prominent with presence of fibrin, webs, platelet thrombi and white cell adherence. It was concluded that the monocrotaline primarily induced severe and diffuse endothelial cell damage of pulmonary arteries and laterly added the participation of platelets, which attributed to the pathogenesis of monocrotaline induced pulmonary vascular lesions in relation to pulmonary hypertension.

• Tuberculosis and Respiratory Diseases
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• v.42 no.3
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• pp.375-380
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• 1995

The lymphangioleiomyomatosis(LAM) is a rare disorder, which afflicts mainly young woman of childbearing age, characterized by proliferation of immature smooth muscle cell in the lymphatics. We experienced a case of LAM in 26-years-old pregnant woman, confirmed pathologically by inguinal lymph node biopsy. She has suffered from exertonal dyspnea and dry coughing. The symptoms and chest X-ray were aggravated with pregnancy, but improved after delivery with two times of pregnancy. The chest X-ray showed diffuse reticulonodular infiltration and chest HRCT showed diffuse scattered tiny thin-walled cyst of lung parenchyma. We noted chylous ascites of which triglyceride level is 396 mg/dl. After delivery, the symptoms were getting better. We treated with medroxyprogesterone and planned close observation and follow-up.

• The Korean Journal of Nuclear Medicine
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• v.26 no.1
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• pp.111-115
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• 1992

Miliary Tuberculosis is an illness produced by acute dissemination of tubercle bacilli via the blood stream. In chest roentgenogram, a diffuse "miliary" infiltrates are usually seen, but normal or suspicious ground glass pattern also can be seen in early manifestation. Ten patients of miliary tuberculosis who underwent whole-body $^{67}Ga-citrate$ scintigraphy were evaluated retrospectively to study usefulness of Ga-scan for early diagnosis of miliary Tbc and evaluation of disease activity. All of ten patients demonstrated significantly diffuse bilateral pulmonary uptakes on 48 hours image. All of three patients of ground-glass pattern in chest roentgemogram also demonstrated increased uptakes. In the statistical analysis, the severity of chest roentgenographic findings showed positive correlation with the activity on Ga?scan. These results suggest that Gallium scan is useful for diagnosis of early miliary tuberculosis and for evaluation of disease activity on follow-up examination of miliary tuberculosis of lung.

• Journal of Chest Surgery
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• v.48 no.1
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• pp.82-85
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• 2015

Pyothorax-associated lymphoma is a relatively rare type of lymphoma that occurs in patients who have long histories of tuberculous pleuritis or induced pneumothorax. It is a type of non-Hodgkin's lymphoma of mainly the B-cell phenotype and is strongly associated with Epstein-Barr virus infection. A majority of these cases have been reported in Japan, although some cases have occurred in Western countries. Here, we describe a case of pyothorax-associated lymphoma in a patient with a 30-year history of chronic tuberculous empyema. The patient underwent decortication under the impression of chronic empyema with fistula. The histopathologic diagnosis was a diffuse large B-cell lymphoma associated chronic inflammation.

• Journal of Chest Surgery
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• v.29 no.3
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• pp.360-364
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• 1996

Chylothorax is denned by extravasation of the milky fluid to pleural cavity from the thoracic duct or it's main branches due to operative trauma, congenital lesions, diagnostic procedures, tumor, etc. Another rare cause is diffuse pulmonary Iymphangiomatosis which is uncommon and not well charact rized. We experienced a case of the bilateral chylothorax caused by the diffuse pulmonary Iymphangiomatosis. The patient was at years old girl with symptoms of coughing and febrile sensation, and the chest radiographs showed bilateral pleural effusion and interstitial infiltrates. The laboratory data of the pleural effusion was identified as chile. Uncontrollable with closed tube thoracostomy, division of tHe thoracic duct and biopsy were decided. Biopsy showed anastomosing endothelial lined spaces along the pulmonary Iymphatic routes especially in pleural and interlobar septum, and smooth muscle at the proliferative interstitium of the Iymphatic duct was observed. Postoperatively, chylothorax was controlled with several trial of chemical pleurodesis. Af'leer discharge from the hospital, she was well for ten months follow up.