대한영상의학회지 2010;63: 소아및성인타액선염환자들에있어서의전산화단층촬영소견과임상적인특징의비교 1 한종규 조성식 김상원 김영통 신형철 김일영 이용만 2 목적 : 이하선염이나악하선염으로진단된소아및성인환자들의 CT 소견과임상적인특징들을비교하여통계학적인의미와

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1 대한영상의학회지 2010;63: 소아및성인타액선염환자들에있어서의전산화단층촬영소견과임상적인특징의비교 1 한종규 조성식 김상원 김영통 신형철 김일영 이용만 2 목적 : 이하선염이나악하선염으로진단된소아및성인환자들의 CT 소견과임상적인특징들을비교하여통계학적인의미와 CT의유용성을알아보고자하였다. 대상과방법 : 타액선염으로진단된성인 97명과소아 36명을대상으로 CT 소견과임상기록을후향적으로분석하였다. 첫번째분류는소아및성인군으로, 두번째는이하선및악하선군으로마지막으로 7개연령군으로분류하여조사하였다. 결과 : 농양형성은소아및성인모두에서이하선염군이악하선염군에많았고, 결석은성인군및악하선염군에서많았으며, 10세이하의소아군이현저히적었다. 봉와직염은성인및이하선염군에서많았다. CT에서의림프절염소견이있었던환자에서실제로림프선이만져졌던경우가많았다. 소아군이편도선염의빈도가높았고, 소아군은이하선염군에서, 성인군은악하선염에서치료기간이길었다 (p < 0.05). 결론 : CT는타액선염을진단하는데유용하고농양형성, 결석, 림프절염을확인하고관련된임상적인특징들을예측할수있어치료계획을세우거나예후를예측하는데유용하다. 타액선염 (sialadenitis) 의가장흔한원인은세균과바이러보다적으나다른연령군들과마찬가지로이하선에서타액선스감염이다. 세균감염은타액선에서타액의분비속도가느려염이가장잘생기며, 특히신생아화농성이하선염 (neonatal 짐으로써생기는구강내감염이가장흔하다. suppurative parotitis) 이잘생긴다. 신생아는미성숙한면이처럼타액의분비속도를감소시키는요인들로는외상, 수역력과구강내세균들이산재하여타액분비속도가감소하여술, 방사선조사및쇼그렌증후군 (Sjögren s syndrome) 등이생기는것으로알려져있다 (6). 반면악하선감염의경우신생있으며타액선관 (salivary duct) 을폐쇄하는종양이나타석증아에서는드물게보고되고있는데이는악하선이이하선보다 (sialolithiasis) 등도타액선염을일으키는원인이될수있다점액성분이많으며이로말미암아세균을비활성화시키는기 (1). 능이탁월하기때문이다 (6). 타액선염은타액선에생기는급성감염을의미하며모든타대부분의타액선염환자들은영상진단이필요치않으며임액선에서생길수있는질환이다. 이하선염은타액선에생기는상적인소견만으로도진단할수있다. 그이유는타액선들이발생하는염증중에서가장흔하고, 결석과연관이없는경우피부가까이있기때문이다. 영상의학적검사가필요한경우는가더흔하며급성화농성이하선염 (Acute suppurative 첫째, 지속적또는반복적인염증이있을때그원인을확인하 parotitis) 의경우는주로소모성전신질환이나큰수술을받거나둘째, 급성감염은농양형성이의심되거나감염성림프염은병력이있는노인들에게주로일어난다 (2). 이의심될때주로시행하게된다 (7). 악하선은이하선다음으로타액선염이잘발생하는부위로단순촬영은타액선염의질환을평가하는데있어서매우제이하선의절반정도크기이다 (3). 악하선의경우는이하선보한적인정보만을제공하나초음파검사는비침습적인대표적다타석증 (sialolithiasis) 이잘발생하며이는소아및성인인검사로서이를이용하여비교적작은결석도발견할수있모두에서현저한차이가있다 (4, 5). 고타액선관확장 (sialectasis) 를관찰하는데매우유용하며타신생아의경우에서타액선염이발생할확률은소아나성인액선자체의변화를보여줄뿐아니라주변조직의변화도잘보이는장점이있다 (7, 8). 타액선에염증이있는경우타액선이 1 순천향대학교천안병원영상의학과 2 커지면서저에코의소견을보이며농양이형성되면수개의작순천향대학교천안병원이비인후과이논문은 2010년 5월 10일접수하여 2010년 7월 22일에채택되었음. 은무에코의병변으로보인다. 그러나턱뼈에의해이하선이나 311

2 한종규외 : 소아및성인타액선염환자들에있어서의전산화단층촬영소견과임상적인특징의비교 악하선을정확히평가하기에어려운단점이있다. 타액선관조영술 (sialography) 은타액선관의결석이나협착또는확장등을평가하기위해서시행할수있는데급성이하선염환자와같이연부종창이심한환자나결석이원위부에위치한경우증상을악화시키거나결석을심부로이동시킬수있어금기시되고 하였고표준방법을사용하여절편두께 3.75 mm 또는 5 mm 로영상을획득하였다. 조영증강은 ml/kg의조영제를자동주입기를통하여주입하였고, 조영제주입후약 3분후에영상을얻었다. 얻어진영상은두명의영상의학과의사가독립적으로분석하였으며, 이견이있는경우는합의하여판정 있다 (7-10). 최근에는 자기공명타액선관조영술 (MR 하였다. sialography) 를이용하여비침습적으로타액선관의병변을조사하는연구들이보고되어있으나 (11) 아직은 CT가가장좋은진단도구이다. CT는타액선염의영상의학적소견들을잘보여주며, 결석이있을때는방사선비투과성의작은결석을발견하는데매우유용하며결석의위치를정확히알수있게해준다. 농양이형성되었을때는위치및크기에대한정보를정확히제공해주며주위조직의동반된변화를잘나타내준다. 그외에도림프절종대, 봉와직염의유무와범위등을가장잘보여줌으로써치료계획을수립하고추적검사하는데있어서매우유용하다 (7). 타액선염을진단하는데임상적인특징이매우중요하다. 연부부종, 발열, 림프절종대, 동통, 종양촉지, 편도선염동반등에대한관찰이진단에매우중요하다. 본연구에서는이하선이나악하선염증이있었던소아및성인환자들을중심으로 CT에서보였던소견들과임상적소견들을고찰하여보고이들을나이에따른차이와통계학적인유의성을알아보고자하였다. 이연구를통해 CT 소견을중심으로임상적소견들을고찰하여향후타액선염이의심되는소아및성인환자들의정확한진단및치료방침을세우는것과치료기간등을예측하는데도움을주고자한다. 소아군과성인군간의성별의차이를조사하였고, CT 소견은농양, 결석, 양측성, 봉와직염동반, 림프절종대등의소견들을분석하였으며임상적소견으로는림프절촉지, 동통, 연부종창, 종괴촉지, 편도선염동반, 치료기간및치료방법을임상기록을통해검토하였다. 소아군과성인군을침범한타액선에따라이하선염군과악하선염군으로분류하여 CT소견들과임상적인소견들을통계학적으로분석하였다. 또한, CT 및임상적소견들의연관성을확인하기위해봉와직염과연부조직종창이나동통, 림프절종대와림프절촉지의상관관계를비교분석하였다. 소아와성인들을연령별 7단계로분류하여 10세미만을 1군 (19명), 11세에서 20세는 2군 (22명), 21세에서 30세는 3군 (13명), 31세에서 40세는 4군 (20명), 41세에서 50세는 5군 (17명), 51세에서 60세는 6군 (17명), 61세이상은 7군 (25명) 으로분류하여, CT소견들과임상적소견들을비교분석하였다. CT 소견중에서농양은이하선또는악하선내부에변연부에조영증강을, 중심부에저음영으로보이는종괴로정의하였다. 림프절내부나타액선주변의농양은제외하였다. 봉와직염은주위피하조직이넓게두꺼워져있으며주변지방조직에침 윤소견이보일때로정의하였다 (Fig. 1). 림프절종대는악하 대상과방법 선주변은 1.5 cm 이상, 그외부위는 1 cm 이상의림프절이 관찰될때로정의하였다 (Fig. 2). 결석은소아환자에서그수 이하선염또는악하선염으로진단된환자중에서 CT 검사를 시행받은 133명을대상으로하였으며, 환자군은 19세이상의 성인군과 18세이하의소아군으로나누었다. 성인군은 2005년 12월부터 2008년 2월까지진단된 97명을대상으로하 였고, 소아군은 2003년 3월부터 2008년 2월까지진단된 36 명을대상으로하였다. 이하선염또는악하선염을침범하는특징적인 CT 소견들과 임상소견들을알아보고자이하선염또는악하선염을단독으로 침범한환자들을대상으로하였으며두개이상의타액선을침 범한경우는제외하였다. 소아군에서설하선염을침범한예가 없었기때문에본연구에서제외하였다. 성인군은남자는 53명, 여자는 44명이었고나이는 19-81세 ( 평균 46.9세 ) 였다. 소아군은남아가 25명, 여아는 11명이었 고나이는 1-17세 ( 평균 9.5세 ) 였다. 각각의환자들의 CT를후향적으로분석하였고임상정보는 의무기록을통하여얻었다. CT는모든환자에서조영증강전, Fig. 1. Bilateral submandibular sialadenitis and cellulitis in a 후영상을얻었다. CT 장비는 GE prospeed single, GE 18-year-old girl with diffuse soft tissue swellings. Postcontrast light speed ultra 8, GE light speed VCT 64(GE Medical CT scan shows homogeneous enhancement and enlargement System, Milwaukee, USA) 등세가지기종을이용하였고, 관전압 120 kvp, 관전류는각각 180, 200, 400 mas로검사 in both submandibular glands with fat infiltration (arrow) in both neck portions. 312

3 대한영상의학회지 2010;63: 가많지않았기때문에결석의위치를특별히구분하지않았고결석유무만을알아보았다. 환자들의통증과식사와의상관관계는타액선염진단에서매우중요하지만많은환자의임상기록에서이부분이빠져서특별히구분하지않았다. 넓은부위에서조직팽윤소견이보이면연부조직종창으로, 국소적인팽윤은종괴촉지로정의하였다. 치료기간은초진일로부터투약이중지된날짜까지계산하였다. 통계분석은 SPSS version 15.0 통계프로그램을이용하여각군간의변수들은 Chi-Square test 와 Fisher s exact test를이용하였고, 나이와치료기간과같은연속형변수는 Mann-Whitney test로분석하여통계학적유의성을검토하 였다. 소아군에서연부종창은 1명, 림프절촉지는 5명, 치료기간에서 12명의임상적정보가누락되었고, 성인군에서림프절촉지는 34명, 동통은 25명, 연부조직종창은 26명, 치료기간에서 19명누락이발생하여, 이들을제외하고통계처리하였으며, 모든결과는 p value가 0.05 이하일때유의성이있다고판정하였다. 결과성별간의차이에서는남자가성인군에서 55%, 소아군에서는 69% 로많이발생하였으나, 통계학적인유의성은없었다 Fig. 2. Right submandibular abscess and multiple lymph nodes in a 64-year-old man. Postcontrast CT scan shows an abscess pocket (long arrow) in right submandiublar gland with multiple cervical lymph node enlargements (short arrows). Fig. 4. Acute parotitis with tonsillitis in a 17-year-old girl with palpable mass in left infraauricular neck. Postcontrast CT scan shows left palatine tonsil (black arrow) with diffuse enlargement and enhancement in left parotid gland (white arrow). Fig. 3. Right submandibular sialadenitis and sialoliths in a 67-year-old man with postprandial pain in right neck. A. Precontrast CT scan shows both submandublar stones (black arrows). B. Postcontrast CT scan shows small abscess pockets (white arrows) in right submandibular gland. A B 313

4 한종규외 : 소아및성인타액선염환자들에있어서의전산화단층촬영소견과임상적인특징의비교 (Table 1). 소아와성인군을비교하였을때, 결석은성인군에서, 림프절촉지와편도선염동반은소아군에서통계학적으로유의하게많았다 (Figs. 3, 4). CT 소견에서농양은소아군에서 22.2% 로성인군 (16.5%) 에비해많았지만, 통계학적인유의성은없었다 (Figs. 2, 5). 성인과소아군모두에서양측성의비율이 10% 미만으로대부분편측성의침샘을침범하였다 (Fig. 1). 양측성, 봉와직염과림프절종대소견은성인군이소아군보다많았으나통계학적으로유의한차이는없었다 (Figs. 1, 2). 임상적소견에서소아군에서병변부위의통증호소가흔하였으나통계학적인유의성은없었다. 연부조직종창과종괴촉지는소아와성인군간의통계학적인차이는보이지않았다. 치료기간은성인군이길었으나통계학적인유의성은없었다. 치료방법은성인군에서수술을많이시행하였으나통계학적으로유의한차이는없었다 (Table 1). 소아군에서이하선염군과악하선염군을비교분석한결과에서나이, 농양, 결석, 임파선촉지, 연부조직종창, 종괴촉지의소견과치료기간에서통계적으로유의한차이를보였다 (Fig. 6). 나이는이하선염군 ( 평균 5.3세 ) 이악하선염군 ( 평균 12.9세 ) 보다현저하게어렸다. 이하선염군에서농양 (50%), 림프절촉지 (45%), 종괴촉지 (62.5%) 가많았고, 악하선염군에서결석 (40%), 연부조직종창 (85%) 이많았다 (Table 2). 치료기간은이하선염군 (8.9일) 이악하선염군 (6.4일) 보다길었다 (Table 2). 성인군에서이하선염군과악하선염군을비교한결과에서농양, 결석, 봉와직염, 연부조직종창, 종괴촉지소견과수술여부에서통계적으로유의한차이를보였다. 이하선염군에서농양 (37%), 봉와직염 (63.5%), 종괴촉지 (80%) 가많았고, 악하선염군에서결석 (57%), 연부조직종창 (84.3%) 이많았다. 수술치료는악하선염군 (55.3%) 이이하선염군 (21.1%) 보다 Table 1. Comparison of CT Findings and Clinical Features in Children and Adult Groups Children (n = 36) Adult (n = 97) p value Age: Year (average) 1-17 (9.5) (46.9) Sex (M : F) 25 : : CT Findings Abscess 08 (22.2%) 16 (16.5%) 0.45 Stone 09 (25%) 44 (45.3%) <0.05 Bilaterality 02 (5%) 09 (9.3%) 0.49 Cellulitis 12 (33.3%) 41 (42.3%) 0.35 Lymphadenitis 09 (25%) 42 (43.3%) 0.12 Clinical Features Palpable LN 15/31 (48.4%) 16/63 (25.4%) <0.05 Pain 22 (61.1%) 40/72 (55.5%) 0.69 Swelling 23/35 (65.7%) 53/71 (74.7%) 0.34 Palpable Mass 15 (41.7%) 34/70 (48.6%) 0.5 Tonsillitis 08 (22.2%) 01 (1%) <0.05 Duration of Therapy 07.3 days 11.1 days 0.7 Operation 10 (27.8%) 30/66 (45.5%) 0.08 Note. LN = Lymph nodes Table 2. Parotitis vs Submandibular Sialoadenitis in Children Groups Parotitis (n = 16) Submandibular Sialadenitis (n = 20) p value Age :Year (average) 1-17 (5.3) 7-17 (12.9) <0.05 Sex (M : F) 11 : 5 14 : CT Findings Abscess 08 (50%) 00 <0.05 Stone (40%) <0.05 Bilaterality 01 (6.3%) 02 (10%) 0.69 Cellulitis 07 (43.8%) 05 (25%) 0.24 Lymphadenitis 03 (18.8%) 06 (30%) 0.44 Clinical Features Palpable LN 10/15 (66.6%) 05/16 (31.3%) <0.05 Pain 12 (75%) 10 (50%) 0.13 Swelling 06/15 (40%) 17 (85%) <0.05 Palpable Mass 10 (62.5%) 05 (25%) <0.05 Tonsillitis 02 (12.5%) 06 (30%) 0.21 Duration of Therapy 08.9 day 06.4 day <0.05 Operation 03 (18.7%) 07 (35%)

5 대한영상의학회지 2010;63: 빈도가높았다. 소아군에서는나이, 림프절촉지소견및치료기간이차이가있었으나성인군에서는통계학적인유의성은없었다 (Table 3). 소아및성인군에서이하선염군은종괴촉지를악하선염군은연부조직종창과통계학적으로연관성이높았으며 (Figs. 4-6), 봉와직염은연부조직종창과통계적으로유의한관련성은없었으나통증과는통계적으로연관성이높았다 (p < 0.05) (Fig. 3). 7개의연령군의비교에서는농양, 결석, 편도선염동반여부가통계학적으로유의성을보였다. 농양은 1군에서 42.1% 로다른군 (0-24%) 에비해서많았다. 그러나결석은 1군이 10.5% 로다른군 ( %) 에비해현저히빈도가낮았다. 편도선염의동반은 1군에서 21.1%, 2군에서 18.2% 로다 른군에비해현저히높은비율을보였다 (Table 4). 고찰타액선에서발생하는질환은유아와소아에서는성인보다드물게나타나며또한치료약제도성인과다른점이많다 (10). 그러므로타액선에염증질환이발생하였을때소아와성인환자들의공통적인측면과다른측면들을고려해야한다. 이하선은가장큰타액선으로측면과단면에서삼각형모양에가깝다. CT에서는주변의근육조직에비해 -25에서 10 Housfield unit (HU) 까지의저음영을보이고주변의지방조직보다는고음영을나타내며이하선내에많은림프절들을포함한다 (7). 악하선은이하선의절반정도크기이며하키막대 Table 3. Parotitis vs Submandibular Sialoadenitis in Adult Groups Parotitis (n=24) Submandibular Sialadenitis (n=73) p value Age :Year (average) (44.4) (47.7) 0.42 Sex (M : F) 11 : : CT Findings Abscess 09 (37.5%) 07 ( 9.6%) <0.05 Stone 02 (8.3%) 42 (57.5%) <0.05 Bilaterality 01 (4.2%) 08 (10.9%) 0.32 Cellulitis 15 (62.5%) 26 (35.6%) <0.05 Lymphadenitis 13 (54%) 29 (39.7%) 0.42 Clinical Features Palpable LN 06/18 (33.3%) 10/45 (22.2%) 0.36 Pain 11/19 (57.9%) 29/53 (54.7%) 0.82 Swelling 10/20 (50%) 43/51 (84.3%) <0.05 Palpable Mass 16/20 (80%) 18/50 (36%) <0.05 Tonsillitis (1.4%) 0.56 Duration of Therapy 10.6 days 11.4 days 0.12 Operation 04/19 (21.1%) 26/47 (55.3%) <0.05 Fig. 5. Parotid abscess in a 28-year-old man with palpable mass in right infraauricular neck. Postcontrast CT scan shows solitary abscess (arrow) in right parotid gland. 315 Fig. 6. Left submandibular sialadenitis in a 17-year-old girl with diffuse soft tissue painful swelling. Left submandibular gland shows diffuse enlargement and homogenous enhancement on postcontrast CT scan with cervical lymphadenitis and cellulitis.

6 한종규외 : 소아및성인타액선염환자들에있어서의전산화단층촬영소견과임상적인특징의비교 Table 4. Comparison of CT Findings and Clinical Features Among Seven Age Groups Age group 1 (n=19) 2 (n=22) 3 (n=13) 4 (n=20) 5 (n=17) 6 (n=17) 7 (n=25) p value Sex (M : F) 14 : 5 13 : 9 06 : 7 11 : 9 10 : 7 09 : 8 15 : Abscess 08 (42.1%) (15.4%) 03 (15%) 03 (17.6%) 02 (11.8%) 06 (24%) <0.05 CT Findings Stone 02 (10.5%) 09 (40.9%) 08 (61.5%) 09 (45%) 05 (29.4%) 06 (35.3%) 14 (56%) <0.05 Bilaterality (18.2%) 02 (15.4%) 01 (5%) (16%) 0.1 Cellulitis 08 (42.1%) 06 (27.3%) 04 (30.8%) 06 (30%) 09 (52.9%) 06 (35.3%) 14 (56%) 0.34 Lymphadenitis 03 (15.8%) 09 (40.9%) 05 (38.5%) 10 (50%) 06 (35.3%) 10 (58.8%) 08 (32%) 0.37 Clinical Features Palpable LN 11 (57.9%) 06 (27.3%) 03 (23.1%) 03 (15%) 02 (11.8%) 03 (17.6%) 03 (12%) 0.23 Pain 13 (68.4%) 12 (54.5%) 04 (30.8%) 09 (45%) 07 (41.2%) 07 (41.2%) 10 (40%) 0.55 Swelling 11 (57.9%) 17 (77.3%) 10 (76.9%) 10 (50%) 09 (52.9%) 08 (47.1%) 11 (44%) 0.21 Palpable Mass 10 (52.6%) 07 (31.8%) 03 (23.1%) 09 (45%) 08 (47.1%) 06 (35.3%) 06 (24%) 0.53 Tonsillitis 04 (21.1%) 04 (18.2%) (5%) <0.05 Operation 04 (21.1%) 08 (36.4%) 06 (46.2%) 05 (25%) 03 (17.6%) 06 (35.3%) 08 (32%) 0.15 모양으로악설골근 (mylohyoid muscle) 에덮여있고활경근아군에서이하선염군의평균연령 (5.3세) 이악하선염군 (plastymas muscle) 의하방부위에올려져있으며이하선과 (12.9세) 보다적었으며이는통계학적인유의성을보였다. 그는달리타액선내에림프절은존재하지않으나악하선주변에러나성인군에서이하선염군 ( 평균연령 44.4세 ) 과악하선염많은림프절들이존재한다. CT에서악하선은구형에가까운군 ( 평균연령 47.7세 ) 간에의미있는나이의차이를보이지않모양이며이하선보다 35 내지 60 HU의고음영을나타낸다았다. (7). 소아재발성이하선염의경우남아가여아보다높은유병률을타액선관의병변을진단하는데최근들어자기공명타액선관보였으나 (5, 13, 14) 일반적인타액선염은남녀간의차이가조영술 (MR sialography) 등이많은도움을주고있으나아직통계학적으로의미가있었다는보고는없었다. 본연구에서도은타액선질환을진단하는데 CT가가장중요한역할을하고남자 (78명) 가여자 (55명) 보다다소많은수를보였으나통계있다. CT는단순촬영보다타석의발견에매우민감하며작은학적인의미는없었다. 크기의타석도발견하기쉽게해준다. 초음파도타액선의염증농양은소아와성인군에서이하선염에서악하선염보다통의유무, 농양의형성이나림프절종대및타석을발견할수있계학적으로유의하게많았다. 그러나소아 (22.2%) 와성인으나검사자의영상판독능력에매우의존적이다. 그러나 CT (16.5%) 군간에서는의미있는차이는보이지않았다. 연령별는초음파보다객관성있게비교적정확한정보를주며초음파 7단계의분류에서는 1군 (42.1%) 에서다른군에비해서농양에서는발견하기어려운위치의작은타석등의병변들을보다의발생빈도가높았다. Saarinen 등 (15) 에의하면이하선농쉽게보여준다. 또한고식적타액선관조영술 (conventional 양은어린소아일수록잘발생하며근막염과심부농양을유발 sialography) 에비해비침습적이며타석의위치를잘보여줄하기쉬워치명적인경우가많다고하였다. 그러므로임상적으수있다 (1, 7-9). 타액선에염증이생기면 CT에서타액선의로소아이하선염이의심될때는반드시 CT를촬영하여농양음영이전반적이며불규칙하게증가하며조영증강된다. 또한, 의유무를확인할필요가있다. 본연구에서는타액선주변의타액선주변이염증에의해서지방침윤과연부조직종창소견이농양은배제되었는데실제로타액선주변의농양이나임파선보이며주변의림프절종대소견도나타날수있다. 타석이있내 ( 림프선내 ) 발생한농양까지포함하면농양의발생률과분는경우는없는경우보다만성질환의가능성이크며 CT에서는포는매우달라질것이다. 임파선 ( 림프선 ) 내농양형성이비대부분타석을발견할수있다 (7-9). 교적흔한소아들에서이하선내에림프절을포함하기때문에기존보고들에의하면, 타액선염등타액선의질환은영아나이하선농양이흔하다고한다 (15). 소아가성인에서보다훨씬적은것으로알려져있다 (10). 본기존의보고들과같이소아및성인군뿐아니라이하선염연구에서소아군의환자수가성인군에비해훨씬적었다. 과악하선염군모두에서양측성침범이현저히적었다. 그러 Laskawi 등 (10) 에의하면 18세이하의타액선염환자들은나나이나부위에따른통계적인차이는없었다 (12) 세사이에서유병률이가장높았으며특히이하선염은봉와직염은소아와성인군간에는통계적으로유의한차이 5-10세, 악하선염은 14-18세에서가장많았다. Stong 등 (12) 는보이지않았다. 소아군은이하선염군에서악하선염군보에의하면이하선염의환아의평균연령은 6.5세의어린소아다봉와직염소견이흔하였으나통계적인유의성은없었다. 그에서주로발생하였다고한다. 신생아는타액선에염증발생이러나성인군은이하선염군이악하선염군보다봉와직염의빈매우드물지만, 이하선염은악하선염보다훨씬많이발생하는도가통계적으로의미있게높았다. CT 소견들 ( 소견 ) 중에서데, 이는악하선의점액질이풍부한분비물이세균활성을억제봉와직염은연부조직종창과통계적으로유의한관련성은없하기때문이다 (6). 본연구에서도기존의보고에서와같이소었으나통증과는통계적으로연관성이높았다 (p <0.05). 316

7 대한영상의학회지 2010;63: 타액선의결석을진단하는방법은단순촬영, 초음파, 타액선관조영술등여러가지방법이있으나 CT가아직은가장효율적인방법으로알려져있다 (1, 7, 9, 12, 16). CT는 2 mm 이상의타액선내또는타액선관의결석을대부분발견할수있는것으로알려져있다 (16). Chung 등 (4) 과 Nalhlielis 등 (17) 의연구에의하면, 18세이하의영유아및청소년환자에서타액선의결석이발생할확률은이하선보다악하선에서월등히높게나타났다고보고하였다. 또한, 이들에의하면 18세이하의환자의타석증의발생률은 13.8% 로성인보다월등히적다고하였다. Zeeshan 등 (5) 은결석의발생이대부분악하선 (80-92%) 에서발생하며그다음에이하선 (6-20%) 과설하선순서 (1-2%) 로발생한다고보고하였으며악하선이이하선보다결석이많은이유로악하선은타액선관이길고중력을거슬러주행하므로침분비속도가느리며칼슘성분이많고침의점도가높기때문이라고하였다. 본연구에서도소아및성인군모두악하선염군이이하선염군과비교하면결석의발생빈도가높았으며연령별분류에서도 1군에서결석이현저히작았다. 이는 10세이하의소아는다른연령군에비해악하선질환이드문것과관련이많다 (10). 종괴촉지는소아및성인군모두이하선염군이악하선염군에비해통계학적으로유의하게많았다. 이는악하선환자가연부조직종창소견이많은것과대비되는소견이다. 즉이하선염환자는종괴촉지소견이, 악하선염의경우는연부조직종창소견이많았다. CT에서의림프절종대소견은나이와부위에따른통계적인유의성은보이지않았으나임파선촉지는소아군이성인군보다, 소아이하선염군은악하선염군에비해통계적으로유의하게많았다. CT에서림프절종대소견이있었으면실제로림프절이만져질확률은의미있게높았고 (p < 0.05). 림프절종대가보이지않을경우에도실제림프절이만져지는경우가많았다 (p < 0.05). 그러므로임상적으로림프절촉지여부와상관없이 CT 를시행하여림프절염의유무를확인할필요가있다. 편도선염동반은소아군 (22.2%) 에서성인군 (1%) 에비해월등히높았으나소아와성인군모두이하선염군과악하선염군간의의미있는차이는없었다. 치료기간은나이에따라통계적으로의미있는차이는없었으나소아군에서이하선염군이통계학적으로의미있게길었는데이는이하선의농양발생빈도가높아배액술이필요한경우가많았기때문이다. 또한성인군에서는악하선염군에서이하선염군보다수술적치료의빈도가높았는데이는이하선염군보다악하선염군에서결석이많았기때문으로생각한다. 결론적으로, 타액선염을진단하는데임상적인소견이매우중요하지만, CT는결석의여부, 농양, 림프절종대, 염증의정도, 치료방법의결정등에매우유용하다. 참고문헌 1. Sumi M, Izumi M, Yonetsu K, Nakamura T. The MR imaging assessment of submandibular gland sialadenitis secondary to sialolithiasis: correlation with CT and histopathologic findings. AJNR Am J Neuroradiol 1999;20: Even TE, Niv A, Kraus M, Nash M. Candida parotitis with abscess formation. Acta Otolaryngol 2006;126: Kaneta T, Minami M, Ozawa K, Akimoto Y, Kawana T, Yamamoto H, et al. MR of the submandibular gland: normal and pathologic states. AJNR Am J Neuroradiol 1996;17: Chung MK, Jeong HS, Ko MH, Cho HJ, Ryu NG, Cho DY, et al. Pediatric sialolithiasis: what is different from adult sialolithiasis? Int J Pediatr Otolaryngol 2007;71: Zeeshan WB, Forte V. An unusual case of bilateral submandibular sialolithiasis in a young female patient. Int J Pediatr Otolaryngol 2006;69: Bova R, Walker P. Neonatal submandibular sialadenitis progressing to submandibular gland abscess. Int J Pediatr Otorhinolaryngol 2000;53: Bryan RN, Miller RH, Ferreyro RI, Sessions RB. Computed tomography of the major salivary glands. AJR Am J Roentgenol 1982;139: Mandel L, Bijoor R. Imaging (computed tomography, magnetic resonance imaging, ultrasound, sialography) in a case of recurrent parotitis in children. J Oral Maxillofac Surg 2006;64: Mandel L, Hatzis G. The role of computerized tomography in the diagnosis and therapy of parotid stones: a case report. J Am Dent Assoc 2000;131: Laskawi R, Schaffranietz F, Arglebe C, Ellies M. Inflammatory disease of the salivary glands in infants and adolescents. Int Pediatr Otorhinolaryngol 2006;70: Becker M, Marchal F, Becker CD, Dulguerov P, Georgakopoulos G, Lehmann W, et al. Sialolithiasis and salivary ductal stenosis: diagnostic accuracy of MR sialography with a three-dimensional extended-phase conjugate-symmetry rapid spin-echo sequence. Radiology 2000;217: Stong BC, Sipp JA, Sobol SE. Pediatric parotitis: a 5-year review at a tertiary care pediatric institution. Int Pediatr Otorhinolaryngol 2006;70: Sitheeque M, Sivachandran Y, Varathan V, Ariyawardana A, Ranasinghe A. Juvenile recurrent parotitis: clinical, sialographic and ultrasonographic features. Int J pediatr Dent 2007;17: Miziara ID, Campelo VE. Infantile recurrent parotitis: follow up study of five cases and literature review. Braz J Otorhinolaryngol 2005;71: Saarinen RT, Kolho KL, Pitkaranta A. Cases presenting as parotid abscesses in children. Int Pediatr Otorhinolaryngol 2007;71: Faure F, Querin S, Dulguerov P, Froehlich P, Disant F, Marchal F. Pediatric salivary gland obstructive swelling: sialendoscopic approach. Laryngoscope 2007;117: Nahlieli O, Eliav E, Hasson O, Zagury A, Baruchin AM. Pediatric sialolithiasis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;90:

8 한종규외 : 소아및성인타액선염환자들에있어서의전산화단층촬영소견과임상적인특징의비교 J Korean Soc Radiol 2010;63: Comparative Study of the CT Findings and Clinical Features in Pediatric and Adult Sialadenitis 1 Jong Kyu Han, M.D., Seong Shik Jo, M.D., Sang Won Kim, M.D., Young Tong Kim, M.D., Hyeong Cheol Shin, M.D., Il Young Kim, M.D., Yong Man Lee, M.D. 2 1 Department of Radiology, Soonchunhyang University Cheonan Hospital 2 Department of Otorhinolaryngology, Soonchunhyang University Cheonan Hospital Purpose: We wanted to compare the CT findings and clinical features of parotitis and submandibular sialadenitis in children and adults and to evaluate the statistical significance of these in different age groups and the usefulness of a CT scan. Materials and Methods: Ninety-seven adults and 36 pediatric patients with sialadenitis were included in this retrospective study. Regardless of the site of involvement, we evaluated the CT findings and clinical manifestations between the pediatric and adult groups, and between the pediatric and adult parotitis and submandibular sialadenitis groups. At last, all the patients were classified into seven age groups. Results: Abscess formations were more prominent in the parotitis groups, and sialiths were more common in the submandibular sialadenitis group with the lowest incidence in the young children group ( 10 years). Cellulitis seen on a CT scan showed a higher incidence in the adult parotitis group, and this finding was closely connected with pain. A number of patients showed cervical lymphadenitis on a CT scan and this coincided with lymph node palpation. Tonsillitis associated sialadenitis was common in the pediatric group. The therapeutic durations were longer in the pediatric parotitis patient group and the adult submandibular sialadenitis group. Conclusion: CT scans were very helpful to evaluate for abscess, stone, lymphadenitis and estimating the associated clinical manifestations such as swelling, palpable lymph nodes, pain with operation and the therapeutic plan. Index words : Tomography, X-Ray Computed Sialadenitis Neck Address reprint requests to : Jong Kyu Han, M.D., Department of Radiology, Soonchunhyang University Cheonan Hospital, 23-20, Bongmyung-dong, Cheonan-si, Chungnam , Korea. Tel Fax mdhjk@schmc.ac.kr 318

À̾Ƹ§

À̾Ƹ§ 155 Table 1. CT Findings and Glandular Involvements of Acute Sialadenitis in 50 Child-Adolescent I (n=16) II (n=20) III (n=14) p value Abscess 8 (50.0%) 0 0

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