A Case of Miliary Tuberculosis Mimicking ARDS due to Bilateral Severe Pneumonia / 결핵및호흡기질환

Miliary tuberculosis is the most serious form of tuberculous disease, but is rarely complicated with acute respiratory distress syndrome (ARDS). When a patient with miliary tuberculosis initially presents with ARDS, the mortality is much higher. Therefore, the early detection of miliary tuberculosis as the underlying cause of ARDS is very important for the prognosis and survival of the patient. The diagnosis of miliary tuberculosis may be easy if the patient presents typical clinical manifestations associated with the characteristic pattern of miliary nodules on chest radiology. However, the diagnosis of miliary tuberculosis when complicated with ARDS can be difficult due to the nonspecific radiologic patterns, such as diffuse bilateral consolidation and ground glass opacity, without miliary nodular infiltration. However, these nonspecific patterns are known as less likely findings of miliary tuberculosis. We experienced a pregnant woman with miliary tuberculosis, mimicking ARDS due to bilateral severe pneumonia. She was admitted, via the emergency room, with sudden onset of fever, chill, cough and dyspnea. The initial chest PA and HRCT showed diffuse bilateral consolidation and ground glass opacity, without miliary nodular infiltration. All bacteriological studies, including blood and sputum cultures, tuberculosis-PCR and serologic study for infectious disease were negative. However, the definite diagnosis of unusual miliary tuberculosis as the underlying cause of ARDS was confirmed from the radiological finding and transbronchial fiberoptic lung biopsy. We report this case, with a review of the literature.

Rupture of a Bleeding Pancreatic Pseudocyst into the Stomach: a Case Report / 대한소화기내시경학회지

Pancreatic pseudocyst is a well-known complication of pancreatitis. However spontaneous perforation and/or fistularization is rare. Perforations into the free peritoneal cavity, stomach, duodenum, colon, portal vein, pleural cavity, and through the abdominal wall have been reported. Rupture of pseudoaneurysm or bleeding pseudocyst following pancreatitis is a severe complication that can lead to massive gastrointestinal bleeding. Especially, rupture of a bleeding pseudocyst into the stomach combined with splenic artery pesudoaneurysm is very rare. We experienced a case of massive bleeding from pancreatic pseudocyst with pseudoaneurysmal rupture into the stomach which was controlled nonoperatively by splenic artery coil embolization and conservative treatment. We report the case with the literatures review.

A Case of Cavernous Hemangioma of Stomach / 대한소화기내시경학회지

A 44-year-old woman who comlpained of dizziness and generalized weakness was admitted. The hemoglobin was 6.6g/dL, hematocrit 25.5%, and serum ferritin 2.14 ng/mL Stool occult blood was positive and microcytic hypochromic anemia was found on periyheral blood smear. Gastroscopic examination showed about 2 x 1 cm sized hemispherical sebmucosal tumor on antrum. The patient underwent operatioh for confirmatory diagnosis and treatment. The final pathologic diagnosis of the resected lesion was hemangioma of stomach. Cavernous hemangioma of stomach is a rare disease.Mostly, it has a benign course clinically, but early diagnosis is important because massive hemorrhage and anemia by chronic blood loss can occur. We report a case of hemangioma of stomach with review of literature.