일측성 폐의 음영감소: 정확한 방사선사진 판독을 위한 체계적 접근

노형준,오유환,최은정,서보경,조규란,강은영,김정혁 대한영상의학회 2002 대한영상의학회지 Vol.47 No.6

The radiographic appearance of a unilateral hyperlucent lung is related to various conditions, the accurate radiographic interpretation of which requires a structured approach as well as an awareness of the spectrum of these entities. Firstly, it is important to determine whether a hyperlucent hemithorax is associated with artifacts resulting from rotation of the patient, grid cutoff, or the heel effect. The second step is to determine whether or not a hyperlucent lung is abnormal. Lung that is in fact normal may appear hyperlucent because of diffusely increased opacity of the opposite hemithorax. Thirdly, thoracic wall and soft tissue abnormalities such as mastectomy or Poland syndrome may cause hyperlucency. Lastly, abnormalities of lung parenchyma may result in hyperlucency. Lung abnormalities can be divided into two groups: a) obstructive or compensatory hyperinflation; and b) reduced vascular perfusion of the lung due to congenital or acquired vascular abnormalities. In this article, we describe and illustrate the imaging spectrum of these causes and outline a structured approach to accurate radiographic interpretation. 흉부X선사진상 일측폐의 음영감소 소견은 여러 가지 질환을 포함한 다양한 상황에서 관찰된다. 따라서 일측폐의 음영감소에 대한 정확한 방사선학적 진단을 하기위해서는 이들 원인에 대한 다양성을 잘 인식하여야 하며 이와 더불어 영상소견에 대하여 체계적인 접근방법이 필요하다. 첫째, 음영이 감소된 편측흉부가 환자 자세의 회전, 격자 절단 (gird cutoff), 힐효과 (heel effect) 등의 인공물에 의한 것인 지를 우선 판단하여야 한다. 다음 단계는 음영 감소된 편측흉부가 비정상인 지를 결정하여야 한다. 왜냐하면 반대쪽 편측흉부가 비정상적으로 음영이 약간 증가하면 정상 편측흉부가 음영이 감소된 것으로 오진할 수가 있기 때문이다. 세번째는 유방절제술 혹은 폴란드 증후군 (Poland syndrome) 등에서와 같이 흉벽 이상으로 인해 편측흉부의 음영이 감소된 것인 지를 구분하여야 한다. 마지막으로 폐실질의 이상에 의해 음영감소가 발생할 수가 있다. 폐실질 이상에는 크게 두 종류로 나눌 수 있으며 여기에는 폐쇄성 혹은 보상성 과팽창과 혈관질환에 의한 폐순환의 감소가 포함된다. 이 임상화보에서는 편측흉부의 음영감소와 관련된 여러 가지 원인과 정확한 판독을 위한 체계적 접근방법에 대한 기술과 예들을 보여주고자 한다.

Histological and Physiological Studies of the Effect of Bone Marrow-Derived Mesenchymal Stem Cells on Bleomycin Induced Lung Fibrosis in Adult Albino Rats

Zakaria Dina Mohamed,Zahran Noha Mahmoud,Arafa Samia Abdel Aziz,Mehanna Radwa Ali,Abdel-Moneim Rehab Ahmed 한국조직공학과 재생의학회 2021 조직공학과 재생의학 Vol.18 No.1

Background: Lung fibrosis is considered as an end stage for many lung diseases including lung inflammatory disease, autoimmune diseases and malignancy. There are limited therapeutic options with bad prognostic outcome. The aim of this study was to explore the effect of mesenchymal stem cells (MSCs) derived from bone marrow on Bleomycin (BLM) induced lung fibrosis in albino rats. Methods: 30 adult female albino rats were distributed randomly into 4 groups; negative control group, Bleomycin induced lung fibrosis group, lung fibrosis treated with bone marrow-MSCs (BM-MSCs) and lung fibrosis treated with cell free media. Lung fibrosis was induced with a single dose of intratracheal instillation of BLM. BM-MSCs or cell free media were injected intravenously 28 days after induction and rats were sacrificed after another 28 days for assessment. Minute respiratory volume (MRV), forced vital capacity (FVC) and forced expiratory volume 1 (FEV1) were recorded using spirometer (Power lab data acquisition system). Histological assessment was performed by light microscopic examination of H&E, and Masson’s trichrome stained sections and was further supported by morphometric studies. In addition, electron microscopic examination to assess ultra-structural changes was done. Confocal Laser microscopy and PCR were used as tools to ensure MSCs homing in the lung. Results: Induction of lung fibrosis was confirmed by histological examination, which revealed disorganized lung architecture, thickened inter-alveolar septa due excessive collagen deposition together with inflammatory cellular infiltration. Moreover, pneumocytes depicted variable degenerative changes. Reduction in MRV, FVC and FEV1 were recorded. BM-MSCs treatment showed marked structural improvement with minimal cellular infiltration and collagen deposition and hence restored lung architecture, together with lung functions. Conclusion: MSCs are promising potential therapy for lung fibrosis that could restore the normal structure and function of BLM induced lung fibrosis. Background: Lung fibrosis is considered as an end stage for many lung diseases including lung inflammatory disease, autoimmune diseases and malignancy. There are limited therapeutic options with bad prognostic outcome. The aim of this study was to explore the effect of mesenchymal stem cells (MSCs) derived from bone marrow on Bleomycin (BLM) induced lung fibrosis in albino rats. Methods: 30 adult female albino rats were distributed randomly into 4 groups; negative control group, Bleomycin induced lung fibrosis group, lung fibrosis treated with bone marrow-MSCs (BM-MSCs) and lung fibrosis treated with cell free media. Lung fibrosis was induced with a single dose of intratracheal instillation of BLM. BM-MSCs or cell free media were injected intravenously 28 days after induction and rats were sacrificed after another 28 days for assessment. Minute respiratory volume (MRV), forced vital capacity (FVC) and forced expiratory volume 1 (FEV1) were recorded using spirometer (Power lab data acquisition system). Histological assessment was performed by light microscopic examination of H&E, and Masson’s trichrome stained sections and was further supported by morphometric studies. In addition, electron microscopic examination to assess ultra-structural changes was done. Confocal Laser microscopy and PCR were used as tools to ensure MSCs homing in the lung. Results: Induction of lung fibrosis was confirmed by histological examination, which revealed disorganized lung architecture, thickened inter-alveolar septa due excessive collagen deposition together with inflammatory cellular infiltration. Moreover, pneumocytes depicted variable degenerative changes. Reduction in MRV, FVC and FEV1 were recorded. BM-MSCs treatment showed marked structural improvement with minimal cellular infiltration and collagen deposition and hence restored lung architecture, together with lung functions. Conclusion: MSCs are promising potential therapy for lung fibrosis that could restore the normal structure and function of BLM induced lung fibrosis.

폐암의 해부학적 부위와 정량적 폐관류 주사와의 관계

이민수,박상선,고영일,장안수,임성철,양주열,김영철,최인석,박경옥 全南大醫大 1993 전남의대학술지 Vol.30 No.1

Morphological variations of the lungs: a study conducted on Indian cadavers

Bincy M George,Satheesha B Nayak,Sapna Marpalli 대한해부학회 2014 Anatomy & Cell Biology Vol.47 No.4

Awareness of anatomical variations in lungs is essential during segmental or lobar resections of lungs. We studied the variations of fissures, lobes and hilar structures in 65 right and 73 left isolated lungs from the dissection hall. Horizontal fissure was absent in 3.07% and incomplete in 35.38% of right lungs. Four point six one percentage of right lungs had 3 fissures and 4 lobes. Three point zero seven percentage of right lungs had 3 arteries, 67.69% had 2 arteries, and 29.23% had only one artery in the hilum. Sixty-three point zero seven percentage of right lungs had two veins in the hilum; 32.30% had 3 veins in the hilum; and 4.61% had more than 3 veins in the hilum. Ninety-eight point four six percentage of right lungs showed 2 bronchi in the hilum, and 1.53% of them showed 3 bronchi in the hilum. Two of the right lungs (3.07%) had an artery passing across the oblique fissure. Fifteen point zero six percentage of left lungs showed incomplete oblique fissure and 2.73% showed 2 fissures and 3 lobes. Five point four seven percentage of left lungs showed 2 arteries and 94.52% had only one artery in the hilum. Eighty point eight two percentage of left lungs had two veins in the hilum and 19.17% had 3 veins in the hilum. Twenty-one point nine one percent of left lungs had 2 bronchi and 78.08% had only one bronchus in the hilum. The knowledge of variations in the lobar and hilar anatomy of the lung presented in this study is clinically important while interpreting the radiological images and performing surgical procedures.

연속 양측 폐이식 실험견에서 LPDG용액을 이용한 폐보존 효과연구

김정식,권건영,유영선,전석길,박창권 啓明大學校 醫科大學 1999 계명의대학술지 Vol.18 No.1

Background: As lung transplantation has recently become successful, the shortage of suitable donor organs has become urgent problems. The current tolerable ischemic time has been accepted until 10 hours. Improvements in lung preservation would increase the number of suitable donor lungs by permitting lung harvest from longer distances, and by promoting the sharing of the two donor lungs between different centers. We prepared LPDG(low potassium dextran glucose)solution for lung preservation study. In this study we examined the efficacy of LPDG solution in 24-hour lung preservation by using of a sequential bilateral canine lung allotransplant model. Method: Seven bilateral lung transplant procedures were performed using weight-matched pairs(23 to 26 kg) of adult mongrel dogs. The donor lungs were flushed with LPDG solution and maintained hyperinflated with 100% oxygen at 10℃ for a planned ischemic time of 24 hours for the lung implanted first. After sequential bilateral lung transplantation, dogs were maintained on a ventilator for 3 hours: arterial oxygen tension, pulmonary arterial pressure, and pulmonary vascular resistance were determined in the recipients hourly after bilateral reperfusion and compared with pretransplant-recipient values, which used as controls. After 2 hours of reperfusion, the chest X-ray, computed tomogram and lung perfusion scan were performed for assessment of early graft lung function. And pathological examinations for ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery were performed. Results: Five dogs of seven experiments had successfully finished the whole assessments after bilateral reperfusion for three hours. Arterial oxygen tension in the recipients was markedly decreased in immediate reperfusion period hut gradually recovered after reperfusion for three hours. The pulmonary arterial pressureand pulmonary vascular resistance showed singificant elevation (p<0.05 versus control values) but also recovered after reperfusion for three hours (p<0.05 versus immediate period value). The ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery showed reversible mild injury in 24 hours of lung preservation and reperfusion. Conclusions: The present study suggests that LPDG solution provide excellent preservation and transplanted lung function after 24 hours of preservation in a canine model in which the dog is completely dependent on the fuction of transplanted lung.

Radiological Report of Pilot Study for the Korean Lung Cancer Screening (K-LUCAS) Project: Feasibility of Implementing Lung Imaging Reporting and Data System

Lee, Ji Won,Kim, Hyae Young,Goo, Jin Mo,Kim, Eun Young,Lee, Soo Jung,Kim, Tae Jung,Kim, Yeol,Lim, Juntae The Korean Society of Radiology 2018 KOREAN JOURNAL OF RADIOLOGY Vol.19 No.4

<P><B>Objective</B></P><P>To report the radiological results of a pilot study for the Korean Lung Cancer Screening project conducted to evaluate the feasibility of lung cancer screening using low-dose chest computed tomography (LDCT) in Korea.</P><P><B>Materials and Methods</B></P><P>The National Cancer Center and three regional cancer centers participated in this study. Asymptomatic current or ex-smokers aged 55–74 years with a smoking history of at least 30 pack-years who had used tobacco within the last 15 years were considered eligible. In total, 256 participants underwent LDCT November 2016 through March 2017. The American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS) was used to categorize the LDCT findings.</P><P><B>Results</B></P><P>In total, 57%, 35.5%, 3.9%, and 3.5% participants belonged to Lung-RADS categories 1, 2, 3, and 4, respectively. Accordingly, 7.4% participants exhibited positive findings (category 3 or 4). Lung cancer was diagnosed in one participant (stage IA, small cell lung cancer). Other LDCT findings included pulmonary emphysema (32.8%), coronary artery calcification (30.9%), old pulmonary tuberculosis (11.7%), bronchiectasis (12.9%), interstitial lung disease with a usual interstitial pneumonia pattern (1.2%), and pleural effusion (0.8%).</P><P><B>Conclusion</B></P><P>Even though the size of our study population was small, the positive rate of 7.4% was like or lower than those in other lung cancer screening studies. Early lung cancer was detected using LDCT screening in one participant. Lung-RADS may be applicable to participants in Korea, where pulmonary tuberculosis is endemic.</P>

성견의 연속 양측 폐이식을 이용한 폐보존 평가 연구

박창권,김재범,유영선,권건영,전석길,김정식 대한흉부심장혈관외과학회 2000 Journal of Chest Surgery (J Chest Surg) Vol.33 No.5

Background: Numerous studies of safe, long term preservation for lung transplantation have been performed using ex vivo models or in vivo single lung transplantation models. However, a safe preservation time which is applicable for clinical use is difficult to determine. We prepared LPDG solution for lung preservation study. In this study we examined the efficacy of LPDG(low potassium dextran glucose) solution in 24-hour lung preservation by using a sequential bilateral canine lung allotransplant model. Material and Method: Seven bilateral lung transplant procedures were performed using weight-matched pairs(24 to 25kg) of adult mongrel dogs. The donor lungs were flushed with LPDG solution and maintained hyperinflated with 100% oxygen at 1$0^{\circ}C$ for a planned ischemic time of 24 hours for the lung implanted first. After sequential bilateral lung transplantation, dogs were maintained on ventilators for 3 hours: arterial resistance were determined if the recipients hourly after bilateral reperfusion and compared with pretransplant-recipient values, which were used as controls. After 2hours of reperfusion, the chest X-ray, computed tomogram and lung perfusion scan were performed for assessmint of early graft lung function. Pathological examinations for ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery were performed. Result: Five of seven experiments successfully finished the whole assessments after bilateral reperfusion for three hours. Arterial oxygen tension in the recipients was markedly decrased in immediate reperfusion period but gradually recovered after reperfusion for three hours. The pulmonary artery and pulmonary vascular resistance showed singificant elevation(p<0.05 versus control values) but also recovered after reperfusion for three hours(p<0.05 versus immediate period value). The ultrastructural findings of alveolar structure and endothelial structure of pulmonary artery showed reversible mild injury in 24 hours of lung perservation and reperfusion. Conclusion : This study suggests that LPDG solution provides excellent preservation in a canine model in which the dog is completely dependent on the function of the transplanted lung.

肺의 氣機에 대한 硏究 : 동의보감중 마황이 포함된 처방을 중심으로

김명동,최석진,이수진 대한동의병리학회 2001 동의생리병리학회지 Vol.15 No.2

To investigate ascending-descending-floating-depositing of lung-qi system, 1 studied many prescriptions which include Ephedra herba, which has quality of making people sweat and evaporate out. After I compared many prescriptions in Korean Encyclopedia Medica(Tong-ui-bo-gam) to study how Ephedra herba is applied to many kinds of diseases, I came to the following conclusions ; When external vicious qi penetrates into human body, it enters first into skin and then lung. Ephedra herba breaks through choked symptom of lung-qi and makes lung-qi spread out, so it can cure pains such as headache, lumbago and hypochondrium. Spreading lung-qi and descending qi, a way of breaking through choked symptom, blows off stasis, and clears away impure thing, and makes good moisture, qi and blood spread through body. Liver-qi and lung-qi control each other. When one ascends, the other descends. Their relative functions promote and control the qi-system. Lung-qi cures the symptom of inner fever which cumulates in meridian. When diseases of eye, ear, nose and throat occur, Ephedra herba lets lung-qi work out, and controls lung-qi and cures diseases. Ephedra herba cures skin diseases and carbuncle which occur when the vicious qi exists between the external layer and deep layer of skin, by scattering the cumulated qi and breaking through vicious qi. Scattering and descending of lung-qi means that lung-qi spreads up and makes sweats come out by opening skin pores, and that spreads down and clears vicious qi by urination. It plays an important role on curing cough, jaundice, beriberi, and dropsy. Comprehensively, scattering and descending of lung-qi play an important role on curing external and internal sickness. Recently, it is reported that by scattering lung-qi, Ephedra herba has a good effect on curing low blood pressure, scleroderma, enuresis, dermatitis, menorrhalgia, leucorrhea, drooping of uterus, acute and subacute nephritis, perception loss, and impotence. From now on, 1 think that more studies are needed to set high rate of curing various diseases and incurable diseases by controling lung-qi. Key word : lung-qi system, Ephedra herba, Tong-ui-bo-gam

Radiological Report of Pilot Study for the Korean Lung Cancer Screening (K-LUCAS) Project: Feasibility of Implementing Lung Imaging Reporting and Data System

이지원,김혜영,구진모,김은영,이수정,김태정,Yeol Kim,Juntae Lim 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.4

Objective: To report the radiological results of a pilot study for the Korean Lung Cancer Screening project conducted to evaluate the feasibility of lung cancer screening using low-dose chest computed tomography (LDCT) in Korea. Materials and Methods: The National Cancer Center and three regional cancer centers participated in this study. Asymptomatic current or ex-smokers aged 55–74 years with a smoking history of at least 30 pack-years who had used tobacco within the last 15 years were considered eligible. In total, 256 participants underwent LDCT November 2016 through March 2017. The American College of Radiology Lung Imaging Reporting and Data System (Lung-RADS) was used to categorize the LDCT findings. Results: In total, 57%, 35.5%, 3.9%, and 3.5% participants belonged to Lung-RADS categories 1, 2, 3, and 4, respectively. Accordingly, 7.4% participants exhibited positive findings (category 3 or 4). Lung cancer was diagnosed in one participant (stage IA, small cell lung cancer). Other LDCT findings included pulmonary emphysema (32.8%), coronary artery calcification (30.9%), old pulmonary tuberculosis (11.7%), bronchiectasis (12.9%), interstitial lung disease with a usual interstitial pneumonia pattern (1.2%), and pleural effusion (0.8%). Conclusion: Even though the size of our study population was small, the positive rate of 7.4% was like or lower than those in other lung cancer screening studies. Early lung cancer was detected using LDCT screening in one participant. Lung-RADS may be applicable to participants in Korea, where pulmonary tuberculosis is endemic.

Endotoxin-induced Acute Lung Injury is Mediated by PAF Produced via Remodelling of Lyso PAF in the Lungs

Young Man Lee,Teoan Kim 대한생리학회-대한약리학회 2000 The Korean Journal of Physiology & Pharmacology Vol.4 No.3

<P> In order to elucidate the role of platelet activating factor (PAF) in the acute lung injury induced by endotoxin (ETX), activities of phospholipase A2, lyso PAF acetyltransferase and oxidative stress by neutrophilic respiratory burst were probed in the present study. To induce acute lung injury, 100μg of <I>E.coli</I> ETX (type 0127; B8) was instilled directly into the tracheae of Sprague-Dawley rats. Five hours after the ETX instillation, induction of acute lung injury was confirmed by lung leak index and protein contents in the bronchoalveolar lavage (BAL) fluid. At the same time, lung phospholipase A2 (PLA2) activity and expression of group I and II secretory type PLA2 were examined. In these acutely injured rats, ketotifen fumarate, known as lyso PAF acetyltransferase inhibitor and mepacrine were administered to examine the role of PAF in the pathogenesis of the acute lung injury. To know the effect of the ETX in the synthesis of the PAF in the lungs, lyso PAF acetyltransferase activity and PAF content in the lungs were measured after treatments of ETX, ketotifen fumarate and mepacrine. In addition, the role of neutrophils causing the oxidative stress after ETX was examined by measuring lung myeloperoxidase (MPO) and enumerating neutrophils in the BAL fluid. To confirm the oxidative stress in the lungs, pulmonary contents of malondialdehyde (MDA) were measured. After instillation of the ETX in the lungs, lung leak index increased dramatically (p<0.001), whereas mepacrine and ketotifen decreased the lung leak index significantly (p<0.001). Lung PLA2 activity also increased (p<0.001) after ETX treatment compared with control, which was reversed by mepacrine and ketotifen (p<0.001). In the examination of expression of group I and II secretory PLA2, mRNA synthesis of the group II PLA2 was enhanced by ETX treatment, whereas ketotifen and WEB 2086, the PAF receptor antagonist, decreased the expression. The activity of the lysoPAF acetyltransferase increased (p<0.001) after treatment of ETX, which implies the increased synthesis of PAF by the remodelling of lysoPAF in the lungs. Consequently, the contents of the PAF in the lungs were increased by ETX compared with control (p<0.001), while mepacrine (p<0.001) and ketotifen (p<0.01) decreased the synthesis of the PAF in the lungs of ETX treated rats. The infiltration of the neutrophils was confirmed by measuring and enumerating lung MPO and the neutrophils in the BAL fluid respectively. Compared with control, ETX increased lung MPO and number of neutrophils in BAL significantly (p<0.001) whereas mepacrine and ketotifen decrerased number of neutrophils (p<0.001) and MPO (p<0.05, p<0.001, respectively). The lung MDA contents were also increased (p<0.001) by ETX treatment, but treatment with mepacrine (p<0.001) and ketotifen (p<0.01) decreased the lung MDA contents. Collectively, we conclude that ETX increases PLA2 activity, and that the subsequently increased production of PAF was ensued by the remodelling of the lyso PAF resulting in tissue injury by means of oxidative stress in the lungs.