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Table 1. Results of FEV 1.0, Methacholine Challenge Test, and Exercise Provocation Test in Eight Patients Who Performed PFT Pts Tests 1 2 3 4 5 6 7 8 FEV 1.0 (%pred) 66.6 88.8 120 101 90.5 95.4 91.6 89.5 Methacholine challenge test (PC 20 <8 mg/dl) ND + + + Exercise provocation test + + + + %pred : percentage of predicted, : decrease, + : positive, - : negative, ND : not done, PC 20 : provocation concentration required to reduced FEV 1.0 by 20% Table 2. Abnormal Findings in Eight Patients Who Performed HRCT Scan Pts HRCT 1 2 3 4 5 6 7 8 air trapping (n=4) + + + + bronchial wall thickening (n=1) + parenchymal opacity (n=1) + airway hyperresponsiveness + + + + + + + : positive, : negative 224
A B Fig. 1. Patient 6. A 12-year-old male presented with dyspnea and cough. There is no abnormal finding on full inspiratory phase HRCT scan (A), but noted multifocal air trapping in only full expiratory phase HRCT scan (B). A B Fig. 2. Patient 1. A 13-year-old male presented with cough and sputum. On full inspiratory phase HRCT scan (A), there is a masslike consolidation (arrow) in left lower lobe posterior basal segment. Also, air trapping in both lower lobes is noted on full expiratory phase HRCT scan (B). 225
A B Fig 3. Patient 8. A 9-year-old-male presented with dyspnea, cough, and hoarseness. Multifocal air trapping was shown on full expiratory HRCT sacn (A) after eight months of exposure to irritant gas. The result of PFT of that time was positive. After 12 months of treatment (B), the extent of air trapping and the density of lungs were decreased, and the PFT was negative. Also, cough and dyspnea on exertion was improved. 226
juries in rescue/recovery workers after the World Trade Center collapse. Crit Care Med 2005;33:S102-106 5. Brooks SM, Weiss MA, Bernstein IL. Reactive airway dysfunction syndrome Case reports of persistent airways hyperreactivity following high-level irritant exposures. J Occup Med 1985;27:473-476 6. Crapo RO, Casaburi R, Coates AL, Enright PL, Hankinson JL, Irvin CG, et al. Guidelines for metacholine and exercise challenge testing-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med 2000;161:309-329 7.,,,,,. (Smoke Inhalation). 2000;42:933-937 8. Boulet LP. Increases in Airway Responsiveness Following Acute Exposure to Respiratory Irritant: reactive airway dysfunction syndrome or occupational asthma. Chest 1988;94:476-481 1.. :. 2003;48:407-9.. Isocyanate 412 reactive airway dysfunction syndrome 1. 2.,,,,,. 1994;14:318-322. 2000;42:637-10.,,,,,. 642 1. 1996;16:553-559 3. Putman CE, Loke J, Matthay RA, RAvin CE. Radiographic manifestations of acute smoke inhalation. AJR Am J Roentgenol 2. 2003;46:198-202 11.,,,,. 1997;129:865-870 12. Chan-Yeung M. Occupational Asthma. Environ Health Perspect 4. Banauch GI, Dhala A, Alleyne D, Alva R, Santhyadka G, Krasko 1995;103 Suppl 6:249-252 A, et al. Bronchial hyperreactivity and other inhalation lung in- 227
Chronic Complications of Inhalation Injury: Chest HRCT Findings and a Correlation with the Pulmonary Function Test in Reactive Airway Dysfunction Syndrome 1 Ki Hyeok Song, M.D., In Sun Lee, M.D., Eun Hee Jung, M.D. 2, Young Gu Ji, M.D. 3,Young Seok Lee, M.D. 1 Department of Diagnostic Radiology, 2 Pediatry, and 3 Internal Medicine, Dankook University Hospital Purpose: To evaluate the HRCT findings and to correlate the findings with the results of a pulmonary function test (PFT) in patients with reactive airway dysfunction syndrome (RADS). Materials and Methods: On March 2003, a fire at a boarding house of primary school soccer players caused a multiple casualty disaster. After 8 months, nine boys that presented with chronic cough and dyspnea were treated, and were subjected to follow-up evaluations. Eight patients underwent a chest radiograph, HRCT, and a PFT. Two patients with severe symptoms received extended follow-up after 1 year. Two radiologists retrospectively reviewed the chest radiographs and the follow-up HRCT scans. We correlated the HRCT findings with the results of the PFT. Results: Six patients with an inhalation injury were diagnosed with RADS. On the chest radiographs, eight patients showed no abnormal findings. On an HRCT scan, four patients showed abnormal findings. The abnormal findings were mosaic air trapping (n = 4), bronchial wall thickening (n = 1), and parenchymal consolidation (n = 1). In all four patients that showed abnormal findings in the HRCT scan, abnormal results of the PFT were also seen. The two patients that received extended follow-up showed an improvement of the clinical symptoms, as seen by the PFT, and had a decreased extent and degree of mosaic air trapping, as seen on HRCT. Conclusion: An HRCT scan is an essential modality for the diagnosis and follow-up of patients with RADS. Both a full expiratory and inspiratory HRCT scan must be performed for an accurate diagnosis. Index words : Smoke inhalation injury Bronchial hyperreactivity Lung Address reprint requests to : In Sun Lee, M.D., Department of Radiology, Dankook university Hospital 29, Anseodong, Chonan, Choongnam, 330-715, Korea. Tel. 82-41-550-6921 Fax. 82-41-552-9674 E-mail: islee2@dankook.ac.kr 228