대한방사선의학회지 1991 ; 27 (3) : 363~367 Journa l of Korea n Radiological Society. May 자발성기흉을동반한폐암 경희대학교의과대학진단방사선과학교실 - Abstract - 성동욱 정승혜 윤 엽 임재훈 조규석
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1 대한방사선의학회지 1991 ; 27 (3) : 363~367 Journa l of Korea n Radiological Society. May 자발성기흉을동반한폐암 경희대학교의과대학진단방사선과학교실 - Abstract - 성동욱 정승혜 윤 엽 임재훈 조규석 앙문호 Spontaneous Pneumothorax Associated with Lung Cancer Dong Wook Sung, M.D., Seung Hyae Jung, M.D., Yup Yoon, M.D., Jae Hoon Lim, M.D., Kyu Soek Cho, M.D.*, Moon Ho Yang, M.D.** Department of Diagnostic Radiology. Kyung Hee University Hospital Spon taneous pneumothorax is a rare manifestation of lung cancer. Eight cases of pneumothorax found in 1648 patients with lung cancer from are reported. Histopathologic ty pes of cancer were adenocarcinoma in three cases squamous cell carcinoma in two cases. bronch ioloalveolar carcinoma in two cases. and metastatic renal cell carcinoma in one case. The primary tumor mass was not found even a fter thoracotomy in two cases. Sponta n eou s pneumothorax occurred on the ipsilateral side of the cancer. All the patients were more than 40 years old with a history of smoking 1-2 packs a day for 20 to 50 years and had chronic lung diseases. The authors e mphasize that bronchogenic carcinoma may be one of the causes of spontaneous pneumothorax in appropriate cli nical settings lndex Words: Lung. Neoplasm Lung Spontaneous pneumothorax 서 르르 대상및방법 폐앙의단순흉부방사선학적소견은종괴형성, 무기 년 3 월부터 년 12 윌까지폐암으로확진된 폐, 국소적폐기종, 흉막삼출액혹은폐염들이며, 자발성기흉은매우드문폐암의소견이다 년 Heim li ch 등 (1) 이최초로폐암에동반된자발성기흉을보고한이래원발성폐암뿐만아니라전이폐암, 화학요법제치료중, 방사선조사치료중발생한자발성기흉이보고되 명중자발성기흉이동반된 8 예를대상으로하였으며이는같은기간에발생한자발성기흉 547 명중 8 예에서폐암이동반되었으며, 후향적으로내원초기방사선학적소견과, 임상적소견을비교분석하였다. 폐암의확진방법은객담암세포검사, 기관지경검사, 경피 었다. 기전, 저자들은자발성기흉을동반한폐암에서그발생 임상적및방사선학적소견들을분석하여진단에 세침흡인생검, 혹은개흉술들이었다. 도웅을주는소견들을찾아내고자본연구를시행하였다 걸 과 8 예의연령분포는모두 40 세이상의남자이었으며, * 경희대학교의과대학흉부외과학교실 * Deparlment of Tlwracic Surgery. Kyung Hec University Hospital ** 경희대학교의과대학병랴학교실 Departmenl of Pathology. Kyung Hee Universily Hospilal 이논문은 1991 년 3 월 5 일접수하여 년 4 월 23 일에채택되었음 )( ) J\.) -
2 대한방사선의학회지 1991 ; 27 (3) : 363~367 환자모두가하루 1-2 갑의담배를 20년에서 50년까지피운병력이있었다. 동반된질환으로는폐기종, 만성기관지염, 폐기포퉁의만성폐질환이었다. 폐암의조직세포분류로는선암 3 예, 편평세포암 2 예, 세기관지폐포암 2 예, 전이폐암 l 예이었다. 진단된 8 예중 6예에서는입원당시폐암및전이폐암을진단하였으나, 2 예에서는자발성기흉의치료로폐쇄성흉강삽관술후에도 종괴를발견하지못했다. 이중 1 예에서는우중간기관지를막고있는종괴로우중엽과우하엽이허탈되어흉강삽관술후에도허탈이남아있어종괴가보이지않았고, 심한좌측수기흉중이있는 1 예에서는흉강삽관술에도많은양의흉막삼출액이있어종괴를발견하지못하였다. 양쪽폐에전이된전이폐암을제외한 7 예모두에서폐암이위치한통측부위에자발성기흉이발생되 Table 1. Summary of 8 Cases of Spontaneous Pneumothorax Associated with Lung Cancer Cases Age/Sex Radiologic Findings Histology Associated Diseases 6 l/m LLL mass (3.5 x 3.5cm) Adenocarcinoma Emphysema CT: mass & pneumothorax 2 66/M LUL Tuberculosis Adenocarcinoma Emphysema F/U: mass & hydropneumothorax 3 42/M RUL mass (8 x 8cm) Adenocarcinoma Emphysema Pneumothorax 4 55/M RLL mass Squamous cell carcinoma Emphysema CT: mass & hydropneumùthorax T -12 metastasis 5 62/M Pneumothorax Squamous cell carcinoma Emphysema RML, RLL collapse Multiple bullas 6 55/M RUL mass (2.5 x 2.5cm) Bronchioloalveolar Pneumothorax carcmoma 7 43/M Massive left hydropneumothorax Bronchioloalveolar Pericardial effusion carcmoma 8 42/M Hematogenous lung metastasis, both Renal cell carcinoma Emphysema PneumothoraJl". LUL (3 years ago) LLL=left lower lobe, LUL=left upper lobe, F/U=follow up, RUL=right upper lobe, RML = right middle lobe, RLL = right lower lobe T-12= 12th thoracic spine Fig, 1. a. Mass on the left lower lobe. Pneumothorax is not visible. b. CT reveals pneumothorax and m ass (M) attached to pleura. (case 1) a b
3 성동욱외 자발성기흉을동반한폐암 톰 F a b c Fig. 2. a. Mass is located on the periphery of the right upper lobe, attached to pleura, adenocarcinoma. b. Gross specimen. Very thin pleura (arrowsj, invasion site c. Microphotography reveals tumor involvement ofvisceral pleural with extensive tumor necrosis (H-E stain, x40). (case 2) a 4 Fig. 3. a. Pneumothorax with total collapse of right middle and lower lobes. Mass is not identified b. CT after chest tube insertion reveals expansion ofright upper lobe. But still collapse ofrml, RLL due to obstructive mass located on intermediate bronchus. (case 5) Fig. 4. There is minimal pneumothorax on the left upper lobe in patient of hematogenous lung metastasis from renal cell carcinoma. (case 8)
4 대한방사선의학회지 1991 ; 27 (3) : 363"-'367 었다. 8 예에대한요약은표와같다 ( T a bl e 1). 였다 (F i g. 4). 보고되는환자의대부분이 40 세이상의 장기간흡연자로, 동반된폐질환으로는폐기종, 폐기포, 고 찰 자발성기흉은대개폐기포의파열에의해나타나며 대 남자에서 흔히 발생한다. 그러나벌집모양 (honeycomb) 을나타내는폐질환, 엑스조직구증식증 ( hi s. tiocytosis X), 경피증 ( scl eroderma), 미만성간질성폐 포섬유증 (diffu se interstitial fibrosis), 결절성 경화증 (tuberous sclerosis), 진폐증 (p n e um oco ni osis) 에서도발 생하며, 나이든환자에서는만성기관지염이나폐기종도 중요한원인이되어 전체 기흉의 약 10 % 를차지한다 (2) 폐암에서의자발성기흉발생빈도는 % 로 매우드문소견이며 그발생기전은 1) 종양에의한폐쇄 성폐기종으로인해말초부위에확장된폐포가파열되거 나 2) 흉막에직접 종양이침윤되거나 3) 혈관침윤으로 인해흉악하에위치한종괴가괴사, 파열되어기관지흉 막누공을형성하기때문이다 (1-9). 저자들의경우수술 로확진된 l 예에서우상부흉막하에 병리조직학적으로 괴사가심한폐암이 위치하고인접한흉막에도종양의 침윤으로인한괴사가있어 흉악에 직접종양이침윤되 어자발성기흉이발생한것으로생각된다 (F ig. 2). 만성기관지염, 기관지확장증, 전식, 결핵동만성폐쇄성폐질환들이다 (4-6, 8, 13, 14). Yeung 둥 (7) 은 1 6 예의문헌보고를분석하면서기흉이우측에 11 예로더많이발생하였고, 기흉의정도는지료가필요없는경미한정도에서흉강삽관술이필요한정도까지다양하였다. 저자들의경우우측에 4 예, 좌측에 4 예발생하였으며흉강삽관술은 3 예에서시행하였다. 자발성기흉은저자들의경우와같이모두폐암이있는 동측부위에서생겼으며, 반대측에생긴경우는외국문헌에는보고가없었다. 그러나박 (13) 동은 6 예의자발성기흉중반대측에발생한 l 예를보고하였다. 폐암과반대측에발생한자발성기흉과의관련기전에대하여서는기술된바없으나저자들의가정으로는반대측에기흉이생기는경우는단순흉부촬영상으로는보이지않는작은 전이결절이흉막하에전이되어이것이흉막강으로괴사혹은파열되었을가능성이있다고생각한다. 걸론 1) 1979 년 3 월부터 년 1 2 월까지폐암 명중자발성기흉의발생은 8 예로 0.49% 의발생빈도를보 임상적소견으로는기흉에의한호흡곤란, 기침, 흉통, 객혈들이며, 간혹기흉이경미한경우는증상이없을수도있다 ( 2). 저자들의경우도흉추에암세포전이가있는 l 예와신장암에서전이된폐암에서기흉이경미하여흉부증상이없었다. 자발성기흉이특히호발하는폐암의암세포종류는없으나편평세포암의발생빈도가높기때문에가장흔히자발성기흉이나타나고 (4, 8) 선암과세기관지폐포암이소세포암보다흔하며, 이것은선암이나세기관지폐포암이더폐말초부위에발생하여주로폐중심성발생인소세포암보다더흉막을침범할확률이높기때문이다 (9, 10). 그외거대세포암은그원인이폐말초부위에위치하고심한괴사를초래하여기흉이발생할수있다 (4). 폐전이암인경우육종특히골육종과, Wi lm s tum o r 가젊은나이에서기흉을동반할수있는가장흔한악성종양이다 (1 1, 12) 였다. 2) 모든환자가 40 세이상으로장기간하루에담배 1-2 갑을피운심한흡연가이고대부분에서만성폐쇄성질환을가지고있었다. 3) 폐암의분류별로는선암 3 예, 편평세포암 2 예, 세기관지폐포암 2 예, 전이폐암 1 예이었다 4) 전이폐암을제외한 7 예모두폐암이있는통측에자발성기흉이발생하였으며, 2 예에서는흉곽절개술후에도종괴를발견하지못했다. 결론적으로자발성기흉을통반하는폐암은매우드문소견이지만 40세이상의심한흡연자에서비록환자가폐기종, 만성기관지염퉁의만성폐질환이있다하더라도자발성기흉이발생하거나, 흉강삽관술에도폐확장이불완전하거나, 추적겁사에서반복기흉이발생할때는객담암세포검사, 기관지경검사, 흉부전산화단충촬영술동폐암을발견하기위한적극적인검사가필요 항암제치료중이나, 방사선조사치료중에자발성기흉하다. 의발생이보고되었고이는이런처치가종양의괴사와재생과정을방해하여종양에동공형성을촉진시켜기잠고문헌흉의원인이된다 ( 1 2). 저자들의 l 예에서도 3년전신장암으로수술을받은후폐전이암이있었고 3 차례에걸 1. Heimlich MJ. Rubin M. Sponta neous pneumothorax 친항암제치료중폐전이암에서자발성기흉이발생하 as a presenting feature of prim a ry carcinoma of the - :3fìfì -
5 성동욱외 자발성기흉을동반한폐암 lung. Dis Chest 1955: 27: Dines DE.CorteseDA.BrennanMD etal. Malignant Chest 1985: 88: pulmonary neoplasms predisposing to spontaneous pneumothorax. Mayo Clin Proc 1973; 48: pneumothorax. A complicating of lung cancer? 9. Ayres JG. Pitcher DW. Rees PJ. Pneumothorax associated with primary bronchial carcinoma. Br J 3. Laurens Jr RG Pine J R. Honig EG. Spontaneous Dis Chest 1980: 74: pneumothorax in primary cavitating lung car- 10. Williams HO. Kidner PH. Alveolar cell carcinoma cinoma. Radiology 1983: 146: Mahajan V Kupferer CF. Van Ordstrand HS. 1971: 103: Pneumotharax. A rare manifestation of primary presenting as a pneumothorax. Ame Rev Resp Dis 11. Wright FW. Spontaneous pneumothorax and lung cancer. Chest 1975: 68: pulmonary malignant disease-a syndrome 5. Lundgren R. Stjernberg N. Spontaneous sometimes associated with cavitating tumors. Clin pneumothorax as first symptom in bronchial car- Radiol 1976; 27: cinoma. Acta Med Scand 1980: 207: Smevik B. Klepp O. The risk of spontaneous 6. Watt AG. Occult carcinoma of the lung presenting pneumothorax in patients with osteogenic sarcoma as spontaneous pneumothorax. Med J Aust 1978: and testicular cancer. 1982: 49: : 박금수, 구철회, 안철민퉁폐암에동반된자연기흉 6 7. Yeung AG. Bonnet JD. Bronchogenic carcinoma 예. 대한의학협회지 1985 ; 28 : presenting as spontaenous pneumothorax. Cancer 14 임종수, 김원곤, 조규석동. 폐암에동반된자발성기 1977: 39: 흉 3 예. 대한흉부외과학회지 1990 ; 23 : Steinhauslin CA. Cuttat JF. Spontaneous
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Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar
ECG & EP CASES Young-Keun On, MD, PhD Division of Cardiology, Department of Medicine Cardiac & Vascular Center, Samsung Medical Center Sungkyunkwan University School of Medicine, Seoul, Korea A case of
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Abstract Musculoskeletal Symptoms and Related Factors for Nurses and Radiological Technologists Wearing a Lead Apron for Radiation Pro t e c t i o n Jung-Im Yoo, Jung-Wan Koo 1 ) Angio Unit, Team of Radiology,
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2012 0910 Vol. 95 Smart choice Best care Sept + Oct 04 / 05 그릇된 의심까지 담는, 베푸는 신뢰 쌓기 가끔사람들에게서 가장기억나는환자가누구냐? 또는 가장가슴아팠던환자는누구냐? 라는 질문을 받는다. 이럴 때 떠오르는 환자는 선물을 주거나 의학적으로 관심이 있는 질병을 가진 환자 가아니고, 의사인나의치료를가장잘믿고따라주었던환자와,
최악의암사망률, 폐암 : 발암의원인그리고예방과치료 서론암은현대인의건강한삶을위협하는질환이다. 암은인구 10만명당 153명으로국내에서독보적인사망원인 1위질환으로알려져있다. 이중폐암으로인한사망자는인구 10만명당 35.1명으로성별을불문하고암으로인한사망자중가장큰비중을차지하며,
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대흉외지 2009;42:497-501 임상연구 Panda Pneumothorax Set with Heimlich Valve 에의한외래에서의흉관관리 최순호 * ㆍ이미경 * ㆍ류대웅 * Outpatient Chest Tube Management with Using a Panda Pneumothorax Set with a Heimlich Valve Soon Ho
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Received : 2015. 12. 09 Reviewed : 2015. 12. 16 Accepted : 2015. 12. 16 Sternal Fracture occurred after Thai Massage : A Case Report Young-Il Song, K.M.D. 1, Dong-Eun Kim, K.M.D. 1 1 Department of Rehabilitation
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암! 알아야이겨낼수있죠! - 항암치료란? - 한림대학교성심병원 혈액종양내과 암? 도대체왜? 암의두가지큰특징 1) 정상적인범위를벗어나끊임없이세포분열을하고성장 - 양성및악성종양 2) 다른세포가차지하고있는고유영역을침범함 - 악성종양 대부분의암은한개의비정상세포로부터 알수가없어요? 암전이의단계 조기발견할경우암의 5년생존율 유방암 : 95% (0 기암 : 100%)
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CASE REPORT Journal of Breast Cancer J Breast Cancer 2010 December; 13(4): 443-7 DOI: 10.4048/jbc.2010.13.4.443 유방암에서발생한악성흉막삼출에대한흉강내 Paclitaxel 화학요법 박신영ㆍ최정은ㆍ전명훈ㆍ강수환ㆍ이수정 영남대학교의과대학외과학교실 Intrapleural Paclitaxel
1087 대한방사선의학회지 1994 : 31(6) : 특발성폐섬유화증에동반된폐암 : 발생빈도및 CT 소견 1 이학졸 임정기 안중모 연경모 목적 : 특발성폐섬유화증을가진환자는폐암발생가능성이높다고알려져있다. 특발성폐섬유화증환자에서발생한폐암의발생빈도를파악하
1087 대한방사선의학회지 1994 : 31(6) : 1087-1091 특발성폐섬유화증에동반된폐암 : 발생빈도및 CT 소견 1 이학졸 임정기 안중모 연경모 목적 : 특발성폐섬유화증을가진환자는폐암발생가능성이높다고알려져있다. 특발성폐섬유화증환자에서발생한폐암의발생빈도를파악하고 CT소견을정리하기위하여특발성폐섬유화증과폐암이병발한 19 명의환자를대상으로연구하였다. 대상및방법