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7735894 선영기 M/71 (RHM이상원/CS이창영Pf, Pul박무석Pf 협진 )
Churg-strauss Syndrome
Brief Hx
상기 71세 남환 asthma , sinusitis 과거력있는 환자로 내원 20일전부터의 fever 주소로 타병원입원하여 evaluation 진행하였으나,focus 명확치 않고 fever 지속되어 2013.9.2본원입원하였고,PET-CT상 RLL mass소견보여 2013.9.10 wedge resection 시행 후 Churg-strauss Syndrome 진단된 환자임.
Smoking Hx :never
1) Asthma (●) 2) Eosinophils greater than 10% of a differential WBC count3) mononeuropathy or polyneuropathy(●) 4) Non-fixed pulmonary infiltrates(●) 5) Presence of paranasal sinus abnormalities(●) 6) Histological evidence of extravascular eosinophils
** Chest CT (2013.9.3)
Aggravation of diffuse bronchial wall thickening especially in both lower lungs.
Aggravation of bronchial luminal narrowing and nodular infiltrate predominantly in lingular, and BLL.
No change of consolidation/collapse of RML without evidence of endobronchial lesion.
No change of subsegmental consolidation/collapse of RLL medial basal.
Calcified granuloma in left apex.
Multiple small LNs in mediastinum and both hila, probably benign reactive LNs.
No evidence of pleural effusion.
IMP) Aggravated bronchitis and pneumonia in both lungs, r/o airway invasive aspergillosis, ddx) Kaposi sarcoma
** Autoimmune marker (2013.9.24)
MPO(P-ANCA):Positive(29.0), 이외 All negative
** Pathology: Lung, right lower lobe, wedge resection (2013.9.16)
1. Dense peribronchial and perivascular lymphoplasmacytic infiltration with lymphoid follicles and bronchial wall thickening, consistent with follicular bronchiolitis, see note.
2. Organizing pneumonia
Note) 상기 조직학적 소견은 collagen vascular disease, Sjogren`s syndrome, rheumatoid arthritis 등에서 관찰될 수 있습니다. Clinical correlation하시기 바랍니다.
** PFT (2013.9.9)
FVC : 2.38L(66%), FEV1 : 1.18L(48 %) ratio : 49%
**PET-CT(2013.9.4)
1. Diffuse bronchial wall thickening with peribronchial infiltrates and nodules in both lungs, predominantly in lower lungs.
2. Nasal mucosal swelling with increased FDG uptake.
3. Subsegmental consolidation/collapse of RML and RLL without definable obstructive lesion.
4. Diffuse FDG uptake in bone marrow and spleen, probably reactive.
5. No other abnormal FDG uptake to suggest malignant process in the rest of imaged body.
Imp. Bronchitis/pneumonia in both lungs, and rhinitis/sinusitis.
DDx. malignant lymphoma.
7120214 양현숙 F/62 (Pul 박무석Pf. / CS 배미경Pf.)
AIP,Pneumonia,interstitial lung disease
Brief Hx
상기 62세 여환, 특이내과적 과거력 없던 분으로, dizziness, general weakness로 타병원입원력있고, CxR 악화소견보여, 본원 의뢰되어 2013.9.17 입원하였고, lung lesion에 대한 진단 위하여 2013.9.25 VATS 시행 후 AIP 의심되어 IV stroid 및 IV antibiotics 유지하였으나 악화진행되어 2013.10.4일 사망한 환자임.
Smoking Hx :former) -> 10년전 quit, 30 년 * 0.5갑
직업력 -> 미용실 45년 , 2년전 quit
** Chest CT (2013.9.15):외부
Subpleural, peribronchial consolidation with subtle GGO in both lungs,
r/o interstitial lung disease such as NSIP. DDx) BOOP less likely.
Several borderline sized LNs in the mediastinum, probably reactive.
Adv) clinical correlation and further f/up.
** Autoimmune marker (2013.9.24)
ANA IFA:1:40+(Speckled), Anti-SS-A/Ro:Positive(62)
이외 All negative
** FOB c BAL (2013.9.23)
WBC 430, Mono 90%(macrophage 72%, lymphocyte 18%), PMN 10%, Eosinophils 0%
CD4 66.4%, CD8 19.6% (ratio 3.39)
** Pathology: Lung, right, wedge resection (2013.9.27)
Interstitial organizing fibrosis with hyaline membrane-like fibrinous material, type II pneumocyte hyperplasia and fibroblastic plug in alveolar space, most consistent with proliferative phase of diffuse alveolar damage with areas of organizing pneumonia, see note
D-PAS and GMS special staining reveals no fungal organisms.
5384693 김국승 M/68 (Pul 박무석Pf. / CS 정경영Pf.)
Smoking-related interstitial fibrosis or desquamative interstitial pneumonia
Brief Hx
상기 67세 남환은 특이 내과적 과거력 없던 중 inspiration 시의 chest pain 주소로 2013.7.8 본원 응급실 내원하여 시행한 Chest CT상 ILD 소견 보여 2013.8.18 본원 호흡기내과 입원, 2013.8.20 wedge resection under VATS, RLL 시행하였으며 pathology 상 smoking-related interstitial fibrosis의 가능성이 높으나 desquamative interstitial pneumonia/respiratory bronchiolitis interstitial lung disease의 가능성도 완전히 배제할 수 없는 소견 보임. 퇴원 후 호흡기내과 외래 f/u 중임.
흡연력 : 2.5pack*52yrs= 130PYS, current smoker
직업력 : 회사 경영 CEO 40년 - 광산사업 11년, 건설업 30년
** Chest CT (2013.7.8)
Traction bronchiectasis, honeycombing, reticular opacities, dominant on the bilateral subpleural area of BLL.
1cm size irregular solid nodule with parenchymal distortion, and calcified nodule in the right apex, probably post inflammatory.
Paraseptal emphysema in BUL.
Diffuse thickening of distal esophageal wall, etiology uncertain.
No pathologically enlarged LNs in mediastinum and hilum.
IMP: 1. rather likely ILD such as UIP.
2. Diffuse esophageal wall thickening, etiology uncertain.
** PFT (2013.7.23)
FVC : 3.40L(85%), FEV1 : 2.60L(94%) ratio : 77% DLCO Adj : 88%, DLCO/VA : 91%
** Autoimmune marker (2013.2.26)
C-ANCA, IFA positive 이외 All negative
** FOB c BAL (2013.8.19)
WBC 68, Mono 25%(macrophage 19%, lymphocyte 6%), PMN 72%, Eosinophils 3%
CD4 44.8%, CD8 52.6% (ratio 0.85)
**TBLB (2013.3.19) - Chronic non-specific inflammation
** Pathology - Lung, right lower lobe, wedge resection (2013.8.20)
1. Interstitial hyalinized and eosionophilic collagenous fibrosis with lymphoid follicles
2. Emphysematous change
3. Intraalveolar accumulation of pigmented macrophages (smoker's macrophages), see note.
Note) 생검된 조직의 현미경 소견과 환자의 과거력을 종합하여 볼 때 smoking-related interstitial fibrosis의 가능성이 높으나 desquamative interstitial pneumonia/respiratory bronchiolitis interstitial lung disease의 가능성도 완전히 배제할 수 없습니다. Clinical correlation 하시기 바랍니다.
5893069 한상열 M/70 (Pul 김송이Pf. / CS 이창영Pf.)
Brief Hx
상기 70세 남환은 rectal cancer, pT2N1b(2/7)M0 로 2011년 1월부터 3월까지 neoadjuvant CCRTx 시행 후 2011.4.19 LAR 시행받았으며 2011년 8월까지 adjuvant RL CTx 시행받았음. 이후 2011.4.19 leostomy시행 후 종양내과 외래 f/u 하던 중 RUL의 two nodules 의 크기 증가로 2012.3 흉부외과 협진 의뢰되어, 2012.3.30 Wedge resection of lung under VATS, RUL 시행하였고 pathology 상 Metastatic adenocarcinoma, Chondroid hamartoma 소견 보임. 이후 외래 f/u 하던 중 2013.8 Chest CT 상의 subpleural GGO 에 대하여 R/O ILD 로 호흡기내과 협진 의뢰되었고 흉부외과 외래 경유 입원하여 2013.8.23 Wedge resection of RLL under VATS 시행하였고 pathology 상 Emphysema와 동반된 smoking-related interstitial fibrosis 의 가능성 고려하여, 현재 호흡기내과 외래 f/u 중임.
흡연력 : 1pack*40yrs=40PYS, Current smoker 직업력 : 정미소
** Chest CT (2013.8.9)
Compared to prior chest CT of 2013 Ma-7,
No change of subpleural GGO with fine reticulation in both lungs, probably ILD such as NSIP.
However, progression is suggested compared to old chest CTs (from 2011 Jan-7 to 2012 Oct- 29).
No newly developed intrathoracic metastasis.
** PFT (2013.8.20)
FVC : 3.77L(93%), FEV1 : 2.67L(97%) ratio : 71% DLCO Adj : 80%, DLCO/VA : 85%
** Autoimmune marker
ANA IFA (2013.8.13) 1:40+(Speckled)
ANA Titration (2013.9.3) 1:40+,1:160-(Speckled)
** Pathology - Lung, right lower lobe, wedge resection
1. Interstitial hyalinized, ropey, eosionophilic collagenous fibrosis
2. Emphysematous change
3. Intraalveolar accumulation of pigmented macrophages (smoker's macrophages), see note.
Note) Emphysema와 동반된 smoking-related interstitial fibrosis 의 가능성이 있습니다. 임상 소견과 correlation 하시기 바랍니다.
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