농흉 및 폐농양에 대한 전산화단층촬영소견의 비교분석 = Computed Tomographic Evaluation of Emphyema and Lung Abscess

다국어 초록 (Multilingual Abstract)

The differentiation between lung abscess and empyema can be difficult, but has important therapeutic consequences. Thoracostomy tube drainage is essential therapy for an empyema, whereas prolonged antibiotic therapy and postural drainage often suffice for a lung abscess. Conventional radiographic findings are usually relied on to help make correct differentiation between empyema and lung abscess. but overlying lung disease or unfavorable location of lesion often results in ambiguous findings. Although ultrasound has proved useful in differentiating empyema from lung abscess, CT is best accurate diagnostic method. Authors reviewed chest CT of 50 cases(41 empyemas, 9 lung abscesses)which were diagnosed by surgery or clinical background during the period from May 1980 at Dongsan Medical Center, Keimyung University. The results were as follows : 1) Age and sex distribution a)Empyema : The incidence was most common in the 6th and 7th decades. Male to female ratio was 3 : 1 b) Lung bscess : The incidence was most common in the 5 th, 6 th and 7th decades. Male to female ration was 2 : 1 2) Wall characteristics (empyema 32 cases, lung abscess 9 cases ) : The 9 cases of 41 empyemas had not defined their walls. a) Empyema had at least a part of their wall that was thin (81%) uniform width(84%), and smooth on both margins (more than 96%), b) The wall of lung abscess was thick (89%), irregular width(89%), and irregular margins(100%). 3) Separation of uniformly thickened visceral pleural from parietal plura ("spite plura" sign) was seen only in 68 % of all empyemas. 4) adjacent lung compression was seen only in 88% of all empyemas. 5) Chest wall angle : In 78 % of all empyemas had obtuse or mixed angles. whereas in 85% of all lung abscesses had acute angle. 6) Shape of lesion : Empyema had variant shapes from round to crescent, however all lung abscesses had roung ovoid shape. 7) Size of lesion : empyema had medium (41%) or large (44%) size, but the lung abscess had o ly small (33%) or medium (67%) size. 8) Air in lesion was seen in 41% empyemas and in 89% lung abscesses. 9)Adjacent lung consolidation showed in 34% empyemas and in all lung abscesses. 10) Free pleural fluid was seen in 12% empyemas and in 89% lung abscesses. 11) Sepated lesions were seen in 32% empyemas and in 56% lung abscess. 12) Multiple lesions were seen in 44% empyemas and in 55% lung abscesses. 13)Mediastinal shifting was seen in 49% empyemas and I 44% lung abscesses. but which all lung abscesses were coexisted with empyemas. 14) Pleural caldification was seen only in 5 cases(12%) of all empyemas. 15) Location of lesion : Most (93%) of empyemas were located in posterolateral portion of hemithorax, and most (78%) of lung abscesses involved in right lower lobe.ower lobe.