Measurement of maxillary sinus volume and available alveolar bone height using computed tomography / 대한구강악안면방사선학회지

PURPOSE: To aid in determining the volume of graft bone required before a maxillary sinus lift procedure and compare the alveolar bone height measurements taken by panoramic radiographs to those by CT images. MATERIALS AND METHODS: Data obtained by both panoramic radiographs and CT examination of 25 patients were used in this study. Maxillary sinus volumes from the antral floor to heights of 5 mm, 10 mm, 15 mm, and 20 mm, were calculated. Alveolar bone height was measured on the panoramic images at each maxillary tooth site and corrected by magnification rate (PBH). Available bone height (ABH) and full bone height (FBH) was measured on reconstructed CT images. PBH was compared with ABH and FBH at the maxillary incisors, canines, premolars, and molars. RESULTS: Volumes of the inferior portion of the sinuses were 0.55+/-0.41 cm 3 for 5 mm lifts, 2.11+/-0.68 cm 3 for 10 mm, 4.26+/-1.32 cm 3 for 15 mm, 6.95+/-2.01 cm 3 for 20 mm. For the alveolar bone measurement, measurements by panoramic images were longer than available bone heights determined by CT images at the incisor and canine areas, and shorter than full bone heights on CT images at incisor, premolar, and molar areas (p< 0.001). CONCLUSION: In bone grafting of the maxillary sinus floor, 0.96 cm 3 or more is required for a 5 mm-lift, 2.79 cm 3 or more for a 10 mm-lift, 5.58 cm 3 or more for a 15 mm-lift, and 8.96 cm 3 or more for a 20 mm-lift. Maxillary implant length determined using panoramic radiograph alone could result in underestimation or overestimation, according to the site involved.

Percutaneous Transthoracic Biopsy for Thoracic Lesions: Comparison of the Utility of Fine Needle Aspiration (FNA), Percutaneous Cutting Needle Biopsy (PCNB) and Combination of Both Methods

PURPOSE: To assess the diagnostic role of FNA, PCNB, and a combination of both methods in patients who underwent percutaneous transthoracic biopsy for a malignant or benign intrathoracic lesion. MATERIALS AND METHODS: We retrospectively reviewed the findings of 213 patients with an intrathoracic mass or consolidation who underwent FNA (Group A, n=98), PCNB (Group B, n=31) or a combination of both methods (Group C, n=84). Under fluoroscopic guidance, diagnoses were based on the findings of surgery, biopsy at another site or clinical and radiologic follow-up. In the differential diagnosis of benign and malignant disease, and in the diagnosis of small-cell lung cancer, pulmonary tuberculosis, non-tuberculous infectious disease and benign mass, sensitivity, specificity and accuracy were statistically analysed in each group. RESULTS: Among 213 patients, lesions were malignant in 134 and benign in 79. In group A, sensitivity and specificity were 90.1% and 100% for malignant lesions, and 91.5% and 90.1% for benign, while in group B, the corresponding findings were 90.4% and 100%, and 90.0% and 90.1%. In group C, corresponding rates of 95.1% and 100% (p<0.05) and 100% and 92% (p<0.05) were recorded. In group C, accuracy and sensitivity were higher than in group A or (p<0.05). Post-procedural pneumothorax occurred in 15.3% of group A, 13.3% of group B, and 20.6% of group C, while hemoptysis was found in 7.1% of group A, 13.3% group B, and 2.9% of group C. Among the three groups, the complication rate showed no statistically significant variation (p<0.05). In the specific diagnosis of small-cell lung cancer, the sensitivity and specificity of FNA and PCNB were, respectively, 100% and 98.5%, and 90.0% and 98.0% (p<0.05) ; for tuberculosis, the corresponding figures were 35.0% and 100%, and 20.0% and 97.2 (p<0.05). FNA was better in the diagnosis of non-tuberculous infectious disease, while PCNB was better in the specific diagnosis of benign masses, without statistical significance. Conclusion: FNA is superior to PCNB in the diagnosis of tuberculosis and the differentiation of small cell lung cancer, and is thus the indicated initial approach for the majority of patients who are to undergo transthoracic bigosy. A combination of FNA and PCNB can provide more accurate differentiation between malignant and benign thoracic disease, without increasing the complication rate, than can one method used alone.

Chronic Necrotizing Bronchopulmonary Aspergillosis With Elements of Bronchocentric Granulomatosis

Chronic necrotizing pulmonary aspergillosis (CNPA) is an unusual form of pulmonary aspergillosis arising in the setting of mildly immune compromised state or altered local defense system. CNPA rarely shows histological findings mimicking bronchocentric granulomatosis (BCG), which is characterized by peribronchiolar granulomatous destruction. We describe a case representing CNPA with elements of BCG. A-64 year-old woman was admitted because of atypical pneumonia with multi-focal variable sized consolidations and cavitary lesions on high-resolution computed tomography (HRCT). The open lung biopsy specimen showed large areas of necrotizing pneumonia with some scattered aspergillus hyphae within the lung parenchyma. Some terminal bronchioles were found to be destroyed and were replaced by peribronchiolar granulomatous inflammation. There was no evidence of angioinvasion by aspergillus or aspergillous emboli. Despite vigorous antifungal agent and steroid treatment, she died of acute airway obstruction by bronchial casts on the thirty-fourth hospital day.

A Case of Spontaneous Pneumomediastinum and Pneumopericardium in a Patient with Acute Exacerbation of Idiopathic Pulmonary Fibrosis / 결핵

Background: Spontaneous pneumopericardium is a very rare condition. Spontaneous pneumothorax and pneumomediastinum have been reported to be associated with an idiopathic pulmonary fibrosis (IPF). However, spontaneous pneumopericardium has not yet been reported in association with IPF. Here we report a case of spontaneous pneumomediastinum and pneumopericardium in a patient with acute exacerbation of IPF with a review of the relevant literature.

A Case of Mediastinal Angiomyolipoma

Angiomyolipoma is a common tumor of the kidney but has rarely been found in the mediastinum. We report a case of angiomyolipoma of the posterior mediastinum in a 62-year-old woman. She experienced exertional dyspnea and intermittent cough at admission. Computed tomography indicated a tumor located at the left paravertebral and upper posterior mediastinum and MRI imaging demonstrated a mass with low signal intensity in T1-weighted image at T4-5 level. Thoracotomy was done for surgical removal of the tumor and histologic examination revealed a mesenchymal tumor composed of mature fat, capillaries and smooth muscle fibers. The tumor was immunohistochemically positive for CD34 and factor-VIII (for vascular component) smooth muscle actin (for smooth muscle component) and S-100 protein (for fat component). There have been four case reports about mediastinal angiomyolipoma, namely three Japanese cases and one French case. It is suggested that angiomyolipoma could be considered for the differential diagnosis of mediastinal tumors.

Nontraumatic Disorders in Mediastinum and Thoracic Aorta: Chest RadiographicFindings

BACKGROUND: Rupture of thoracic aortic aneurysm and dissection into the chest space results in the death of the patient from uncontrolled hemorrhage. The purpose of our study is to evaluate chest radiographic findings that may assist in the rapid detection of nontraumatic disorder in mediastinum and thoracic aorta. MATERIAL AND METHOD: Thirteen consecutive chest radiographs obtained at emergency room of patients with hemorrhage from ruptured thoracic aortic aneurysms or aortic dissections were randomized with radiographs of 8 subjects with nonruptured thoracic aortic aneurysms, 11 subjects with nonruptured aortic dissections, and 20 control subjects. Diagnoses were confirmed by computed tomography(CT) and transesophageal echocardiography(TEE). A retrospective study was performed by assessment of 14 parameters on each of these 52 radiographs to screen the mediastinum and thoracic aortic disorder. RESULTS: Significant difference between patients with mediastinum and thoracic aortic disorder(aneurysm and dissection) and normal subjects occurred in mediastinal/chest ratio>0.25, aortic knob width>4cm, tracheal shift to right loss of paratracheal stripe & azygos vein, and left pleural & extrapleural fluid of chest radiographs(p<0.05). The most useful predictors of mediastinum and thoracic disorder were aortic knob widening above 4cm and combining signs of mediastinum/chest ratio above 0.25 and abnormal aortic arch. These plain radiographic signs had a sensitivity of 9.1~96.9% and a specificity of 40~100% for mediastinum and thoracic aortic disorder. CONCLUSION: The chest radiograph obtained at emergency room remains the best available screening test for mediastinum and thoracic aortic disorder and can be used effectively, though not perfectively, to eliminate unnecessary CT or TEE.

A case of tuberculous pericarditis presenting as pericardial mass compressing pulmonary artery / 대한내과학회지

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.

A case of tuberculous pericarditis presenting as pericardial mass compressing pulmonary artery / 대한내과학회지

Tuberculous pericarditis is a rare form of tuberculosis usually presenting as pericardial effusion or constrictive pericarditis. But rarely it may present as pericardial mass. We experienced a case of tuberculous pericarditis presenting as pericardial mass which was confirmed by open thoracotomy. The patient was 34-year-old female, who was previously treated for tuberculous pleurisy. She admitted for dyspnea on exertion and imaging study including chest CT and echocardiography showed pericardial mass. Open thoracotomy showed hard adhesive mass lesion around pulmonary artery and pathology showed chronic granulomatous inflammation with caseation necrosis. We report a rare case of tuberculous pericarditis presenting as pericardial mass.

Objective in Vivo Quantification of Emphysema by Thin-Section CT: Correlation with Physiologic Findings / 결핵

BACKGROUND: To correlate the emphysema score for quantification of the overall extent of emphysema in both lungs by CT with physiologic findings and 13 get more objective and simple method to assess the extent of em physema. METHOD: Thin-section CT and pulmonary function test(PFT) were performed in 17 patients with emphysema (all males, mean age, 62 years). Emphysema score was obtained as percentage of emphysematous lung area, dividing the total area of the emphysema(voxels with attenuation value less than -880, -900, -920HU, respectively) by the overall area of both lungs(voxels with attenuation value less than -400HU) with highlighting voxels using "Density mask" program. Emphysema score was calculated from whole lung(ESW) sod 5 representative scans(ESR) using "Density mask". Visual emphysema score(ESV) was obtained by visual assessment from 5 representative scans. Correlation of these emphysema scores(ESW, ESR, ESV) and physiologic findings were performed, comparing the ESW with ESR and ESV. RESULTS: ESW had correlation with DLCO(r=0.53-0.64) and FEVl/FVC(r=0.42-0.57) among PFT parameters. ESR had good correlation with ESW and with PFT parameters as well. ESV did not correlate with PFT parameters except DLCO. CONCLUSION: CT quantification of emphysema using "density mask" correlated well with physiologic findings. To assess the severity of emphysema, both ESW and ESR are more reliable than ESV, and ESR is recommended in routine practice as it is objective, simple and reliable.

A Serial MR Imaging of Myocardial Infarction with Non-Surgical Animal Model

Objectives: The purpose of study is to evaluate serial MR imaging of myocardial infarction using non-surgical model of myocardial infarction after percutaneous transcatheter coronary arterial embolization in dogs. MATERIALS AND METHODS: We evaluated serial pre- and post-contrast MR images with Gd-DTPA (gadolinium-diethylenetriamine-pentaacetic acid) of heart of the eleven mongrel dogs (immediate group (n=3), one week group (n=3), three weeks group (n=5)) after making non-surgically induced myocardial infarction. We confirmed the infarct with TTC staining and microscopically. The location and extents of the myocardial infarction were correlated. RESULTS: A total of 24 MR images were archived; 11 images of the immediate post-embolic period, 8 images of one-week follow-up, and five of 3-week follow-up images. Comparing with the signal intensity of normal myocardium, immediate post-embolic MR images showed low or iso signal intensities (SI) of the infarct area on T1-weighted images (T1WI) and high SI on T2-weighted images (T2WI). No contrast enhancement with Gd-DTPA was made in all cases of the immediate post-embolic MRI. One-week and 3-week follow-up MR images showed low or iso SI on T1WI and slight high or iso SI on T2WI. Contrast enhancement images in both one-week and 3-week follow-up MRI showed denser enhancement of infarct area in one-week follow-up. The myocardial wall thinning was seen in 5 of eight dogs after one week and in 3 of five after 3 weeks. CONCLUSION: In non-surgical animal models of myocardial infarction, MR images showed low or iso SI on T1WI, and high SI on T2WI in various stages, and contrast enhancement was maximum after one week and gradual decrease to 3 weeks. The myocardial wall thinning was seen in one-to 3-week follow-up MR images.

Mosaic Pattern of Lung Attenuation on Thin-Section CT: Review of 31 Cases

PURPOSE: To correlate radiologic findings with clinical findings in patients with a mosaic patten of lungattenuation, as seen on thin-section CT. MATERIALS AND METHODS: Thirty-one cases in which a mosaic pattern oflung attenuation was detected on combined expiratory and inspiratory scans of thin-section CT were retrospectivelyanalyzed. Cases involving infiltrative lung disease were excluded. Both thin-section CT and clinical findings wereanalyzed and the relationship between the extent of the area of hyperlucency -as seen on expiratory scan- andphysiologic parameters was evaluated. The subjects were 10 men and 21 women ranged in age from 25 to 76 (mean 50)years. RESULT: Twenty-nine patients with small airway disease, [chronic bronchitis and/or bronchiolitis(n=11),bronchiectasis(n=8), bronchial asthma(n=8), mycoplasmic pneumonitis(n=1) and hypersensitive pneumonitis(n=1),] andtwo patients with pulmonary vascular disease, [chronic pulmonary thromboembolism(n=1) and stenosis of the leftupper pulmonary artery(n=1)] were included in our study. Commonly associated thin-section CT findings in the casesinvolving small airway disease(n=29) were bronchial wall thickening(n=25), nodular opacity(n=25), bronchial andbronchiolar dilatation(n=20) and small branching opacity(n=16). These findings were not observed in two patientswith pulmonary vascular disease, though bronchial wall thickening was seen in the patient with chronic pulmonarythromboembolism. At expiratory scan level, there was statistical correlation between FEV1/FVC and the number ofpulmonary segments(r= 0.982, p0.05). CONCLUSION: The mosaic pattern of lung attenuation seen on thin-section CT isindicative of various diseases, involving small airways such as bronchiolitis, bronchitis, bronchiectasis andbronchial asthma, and vascular lung disease. Bronchial wall thickening and nodular opacity can be associated withsmall airway diseases.

Congenital Anomalies of the Coronary Arteries Detected in Adulthood

BACKGROUND: Although congenital anomalies of the coronary arteries are rare, which may cause serious clinical problems in diagnostic or surgical procedures, the accurate knowlegde and understanding of these are essential. We are to assess the clinical and angiographic characteristics of congenital anomalies of the coronary arteries detected in adulthhood. METHODS: We retrospectively analyzed a total of 67 cases of primary congenital anomalies of the coronary arteries with particular emphasis in angiographic findings in corelation with the clinical and surgical findings, reviewing 16,099 coronary angiography performed during last 6 years in three institutes. RESULTS: The incidence of congenital anomalies of the coronary arteries detected in coronary angiography was 0.4% and all were primary anomalies, among which major anomalies were 53 cases(79%) and minor anomalies were 14 cases(21%). Twenty-nine cases had associated cardiac defects. Among them congenital heart disease were 10 cases(34%), valvular heart disease were 10 cases(34%), coronary atherosclerotic disease were 8 cases(28%) and hypertrophic obstructive cardiomyopathy was 1 cases(4%). The coronary artery fistula were 40 cases, which was the most common anomaly among major group and the communication between coronary artery and bronchial artery were 6 cases, which was the most common one among minor group. Myocardial ischemia was observed in 49% of major and in 29% of minor anomalies. CONCLUSION: We are reporting 67 cases of the congenital anomalies of the coronary arteries detected in adulthood with the clinical and the angiographic characteristics. We suggest that new modified classification of the congenital coronary anomalies is necessary, because symptoms and signs of myocardial ischemia were observed in a significant number of patients among minoranomaly group.

Pulmonary Edema: Radiographic Differential Diagnosis

PURPOSE: To evaluate the feasibility of using chest radiography to differentiate between three different etiologies of pulmonary edema. MATERIALS AND METHODS: Plain chest radiographs of 77 patients, who were clinically confirmed as having pulmonary edema, were retrospectively reviewed. The patients were classified into three groups: group 1(cardiogenic edema : n=35), group 2(renal pulmonary edema : n=16) and group 3(permeability edema :n=26). We analyzed the radiologic findings of air bronchogram, heart size, peribronchial cuffing, septal line, pleural effusion, vascular pedicle width, pulmonary blood flow distribution and distribution of pulmonary edema. In a search for radiologic findings which would help in the differentiation of these three etiologies, each finding was assessed. RESULTS: Cardiogenic and renal pulmonary edema showed overlapping radiologic findings, except for pulmonary blood flow distribution. In cardiogenic pulmonary edema(n=35), cardiomegaly(n=29), peribronchial cuffing(n=29), inverted pulmonary blood flow distribution(n=21) and basal distribution of edema(n=20) were common. In renal pulmonary edema(n=16), cardiomegaly(n=15), balanced blood flow distribution(n=12), and central(n=9) or basal distribution of edema(n=7) were common. Permeability edema(n=26) showed different findings. Air bronchogram(n=25), normal blood flow distribution(n=14) and peripheral distribution of edema(n=21) were frequent findings, while cardiomegaly(n=7), peribronchial cuffing(n=7) and septal line(n=5) were observed in only a few cases. CONCLUSION: On plain chest radiograph, permeability edema can be differentiated from cardiogenic or renal pulmonary edema. The radiographic findings which most reliably differentiated these two etiologies were air bronchogram, distribution of pulmonary edema, peribronchial cuffing and heart size. Only blood flow distribution was useful for radiographic differentiation of cardiogenic and renal edema.

A case of Tocolytics Induced Pulmonary Edema / 결핵

Tocolytics are agents widely used in the treatment of premature labor to inhibit uterine contractions. Ritodrine is most commonly used tocolytic agent and acts by increasing intracellular cyclic adenosine monophosphate, which decreases the activity of myosin light-chain kinase, the rate-limiting enzyme in the signal network leading to contraction. Physiologic effects associated with the use of ritodrine are due to their effect on beta-1 as well as beta-2 receptors. Some of material complications o? therapy are tachycardia, hyperglycemia, hypokalemia, lactic acidosis, myocardial ischemia, and pulmonary edema. Tocolytic induced pulmonary edema is a serious complication that can lead to marternal death, although infrequent. The incidence varies from 0.5% to 5% of those receiving these agents. Predisposing factors include the concommitant use of corticosteroid, twin gestation, fluid overload(particularly with saline), and anemia. Several mechanisms have been postulated, but the pathogenesis is uncertain. It is suggested that both types of mechanism, hydrostatic and Permeability induced, might be involved. The association of tocolytic therapy with pulmonary edema appears to be unique to the pregnant state, because this complication has never been reported in asthmatic patients exposed to high dosages. We report a case of tocolytic induced pulmonary edema developed in 24 hours after delivery.

Extra-Articular Synovial Chondromatosis: A case Report

A 60-year-old female presented with a slowly growing, painful mass in the superolateral portion of the rightt high. Physical examination, roentgenography, bone scan and magnetic resonance imaging revealed a soft tissue masswith mineralization which did not involve bone or joint. A triangular-shaped, mineralized lesion was found in the superior side of the greater trochanter on simple radiograph and on magnetic resonance imaging. It had not been detected clinically, and was asymptomatic. The masses were removed en bloc and diagnosed as extra articular osteochondroma. Eight months postoperatively, pain had almost been relieved.

Constrictive Bronchiolitis Accompanied By Non-Hodgkin's Lymphoma / 결핵

Constrictive bronchiolitis, one of small airway diseases, is very rare and occupies one of the two arms of bronchiolitis obliterans together with proliferative bronchiolitis. Proliferative bronchiolitis, presenting the prototype with bronchiolitis obliterans with organizing pneumonia(BOOP), can be easily taken into diagnostic consideration in terms of relatively rapid clinical course and radiologic presentation as if atypical pneumonia with interstitial and alveolar infiltrations. Meanwhile constrictive bronchiolitis is not only very rare but also easily overlooked as chronic obstructive pulmonary diseases such as emphysema, because it usually shows normal chest radiographic finding and obstructive pattern in pulmonary function test. In the aspects of the reponse to treatment, proliferative bronchiolitis showed dramatic response to the corticosteroid while constrictive bronchiolitis is intractable, which is easily explained on the basis of the pathologic characteristics of cicartrical replacement of bronchiolar walls. The bronchiolitis, both proliferative and constrictive, can be associated with diverse conditions such as inhalational injury, postinfectious process, drug or chemical induced reactions, connective tissue diseases, and organ trasplantation. And there is idiopathic type which has no associated condition. There is one explanation that both types of bronchiolitis lie on the same disease spectrum because the different disease pattern can be evoked from the same etiology. In contrast, another explanation is suggested that both types of bronchiolitis are one of nonspecific tissue reaction rather than a disease specific histologic finding because the various types of causes can provoke the same histologic findings. These dilemma remains for further investigation. With literature investigation, the authors report a case of constrictive bronchiolitis proven by open lung biopsy in 47 year old female who was diagnosed as non-Hodgkin's lymphoma and simultaneously had relatively rapid progression of airflow obstruction and showed negative radiographic finding without the risk factors for the development of chronic obstructive lung disease. We consider it as idiopathic because we could not find any relationship between constrictive bronchiolitis and non-Hodgkin's lymphoma on the literature search and it requires further investigation.

Computer-Assited Instruction : MR Imaging of Congenital Heart Disease

PURPOSE: To develop a software program for computer-assisted instruction on MR imaging of congenital heart disease for medical students and residents to achieve repetitive and effective self-learning. MATERIALS AND METHODS: We used a film scanner(Scan Maker 35t) and IBM-PC(486 DX-2, 60 MHz) for acquisition and storage of image data. The accessories attached to the main processor were CD-ROM drive(Sony), sound card(Sound blaster-Pro), and speaker. We used software of Adobe Photoshop(v 3.0) and Paint Shop-Pro(v 3.0) for preprocessing image data, and Paint brush from Microsoft Windows 3.1 for labelling. The language used for programming was Visual basic(v 3.0)from Microsoft Corporation. RESULTS: We developed a software program for computer-assisted instruction on MR imaging of congenital heart disease as an effective educational tool.

Incidence of the Appearance of the Proximal Humeral Ossification Center of the Neonates and Infants on Plain Chest Radiograph

PURPOSE: To ascertain the incidence of proximal humeral epiphyseal ossification centers, as shown on chest radiographs, in neonates and infants. MATERIALS AND METHODS: The distribution of corrected age(CA) of the infantswas from 24 weeks of gestational age to 6 months of postnatal age. They were obtained from inborn and outborn infants without developmental problems. Proximal humeral epiphyseal ossification centers were evaluated by two radiologists from a total of 440 chest radiographs. Of these, 196 were of the female chest and 244 were of themale. Corrected ages based on postnatal age are expressed as weeks before two months of age and as months after two months of age. The ossified or nonossified epiphyses of the humeral heads were plotted against corrected age. From these graphs, the percentages of ossification according to their corrected age was observed. RESULTS: 37weeks of corrected age in which 9.1%(1/11) was ossified was the earliest age of humeral epiphyseal ossification in the female. While 35 weeks of CA in which 6.3%(1/16) was ossified was the earliest age in the male. In full-term neonates(=40 weeks of CA), 20%(6/30) of epiphysis was ossified in the female and 23.3%(7/30) in the male. The female group of 43-44 weeks of corrected age showed ossification of 50% and the male group of 44-45 weeks of corrected age showed ossification of 50%. By five months of corrected age, 100% of epiphyses, both in the female and in the male, were ossified. CONCLUSION: Humeral ossification centers are seen from 35-37 weeks of correctedage. By five months of age, all humeral epiphyses are ossified.

Primary Malignant Mesothelioma of the Pericardium: A Case Report

Primary malignant mesothelioma of the pericardium is a very rare and highly lethal neoplasm. Diagnosis is a difficult problem and most of the cases reported in the literature were diagnosed at postmortem. We report a caseof primary malignant mesothelioma of the pericardium in a 22 year-old man. CT and MR imaging both showed diffuse irregular pericardial thickening, soft tissue density with cystic lesion, nodular bulging into the myocardium, permeative growth of the tumor, and encasement of the heart and two great vessels.

A Case of Late Presentation of Congenital Cystic Adenomatoid Malformation of the Lung / 결핵

Congenital cystic adenomatoid malformation of the Lung(CCAM) is characterized by anomalous fetal development of terminal respiratory structures, resulting in an adenomatoid proliferation of bronchiolar elements and cystic formation. CCAM was first described and differentiated from other cystic lung disease in the English literature by Ch'in and Tang in 1949. CCAM is a rare, potentially lethal form of congenital pulmonary cystic disease and the salient features of lesion are an irregular network of terminal respiratory bronchiole-like structures and macrocysts variably lined by pseudostratified ciliated columnar epithelium and simple cuboidal epithelium. Adult presentation of CCAM of the lung is so tare that only 9 cases have been reported in the literature of date. The pathogenesis of CCAM remains disputed and reseachers have variously proposed that the lesion represents a developmental anomaly, hamartoma, or a form of pulmonary dysplasia. Van Dijk and Wagenvoort divided CCAM into three subtypes: cystic, intermediated, and solid. These correspond to types I, II, and III of Stocker. In adults, the evaluation of cystic or multicystic lung disease requires consideration of a differential diagnosis including the acquired lesions of lung abscess, cavitary neoplasm or inflammatory mass, bullous disease, bronchiectasis, and postinflammatory pneumatocele. Congenital lesions such as sequestration, bronchopulmonary-foregut anomalies, and bronchogenic cyst are also encounted. The definitive treatment for CCAM is complete removal of the involved lobe. Partial lobectomy leads to multiple complications, including severe post-operative infection. We report a case of CCAM in a 14-year-old female presentated with a pneumothorax and large bullae, who was treated by surgical remove of the involved lobe.