흉막질환 pleural disease

목차

1. 개요

2. Diagnostic procedures

3. Transudate(濾出液)의 원인

4. Exudate(渗出液)

5. Pleural Inflammation and Effusion

본문내용

uid (10%)
· pleural biopsy (25-30%)
· tract implantation이 흔히 보인다.
· metastatic adenocarcinoma와 병리적으로 감별진단이 요한다.
· prognosis : poor, median survival < 6-12 mo after Tx
· Treatment : Surgery ; not possible
Radiation and Chemotherapy : Unsuccessful
C. Pneumothorax (氣胸)
accumulation of gas within pleural space
Causes :
1) Perforation of visceral pleura
e.g. blebs rupture or instrumentation, bronchoscopy(TBLB), mechanical ventilation
2) Penetration of chest wall, diaphragm, mediastinum and esophagus
3) Gas generated by microorganism (gas forming bacteria) in an empyema
1. Simple spontaneous pneumothorax (primary)
· 특별한 원인 없이 visceral pleura의 rupture로 lung으로부터 air가 pleural space로 들어온다.
· 흔히 20-40세의 남자에 호발
· 대개 apex의 subpleural blebs의 rupture에 기인(paraseptal emphysema)
· Rt. side - more frequent
recurrence (30-50%)
30% on same side
10% on opposite side
Clinical symptoms
- caused by increased positive pressure through a ball valve" air leak
· sudden onset of chest pain with dyspnea
· small amounts of pleural fluid (25%)
· Tension pneumothorax - rare
→ inspiration and expiration 중에 intrapleural pressure가 대기압 이상인15-25cmH2O의 positive pressure를 보인 경우(usually 10-20cmH2O) 이때 mediastinum을 displace시키고 heart로의 venous return을 방해하여 true medical emergency 상태를 만든다.
Size of Pneumothorax(quantitative)
PNX%=100 -{ (허탈된 폐의 너비)^3} over{ (한쪽 흉곽의 너비)^3 }times 100
=100 - (4)^3 over (5)^3 times 100 = 49(%)
1 cm 15%
2 cm 20%
3 cm 30%
4 cm 40%
5 cm 50%
Management
목적 : affected lung을 reexpand 시키고 재발을 감소시킨다.
1) small PNX (<20% of hemithorax)
치료하지 않고 observation
7 - 14 days 이내에 reabsorbed
O2 inhalation시 4 x 빨리 흡수
2) Large PNX (20-50% of hemithorax)
· simple aspiration using iv polyethylene catheter
3) PNX (> 50% of hemithorax)
Chest tube connected to a water seal
2-4일간 유치 후 lung이 완전히 reexpand되면 24시간 clamp하고 recurrence가 없으면 remove한다.
4) Recurrent primary spontaneous PNX
· pleurodesis (tetracycline): 젊은 사람은 가능한 한 pleurodesis시행 안 함
· open thoracotomy (surgical obliteration)
tube drainage후 5-6일간 air leak가 계속하거나 Chemical pleurodesis 후에도 계속되면 시행
5) Tension PNX
intercostal space를 통해 large-bore needle을 involved side에 insesrtion하여 immediately로 decompression 해준다.
(부위: 주로 2nd interspace의 mid-clavicular line에 needle을 insertion한다)
2. Secondary or Complicated Pneumothorax
원인
1. Trauma or iatrogenic
2. COPD, emphysema - most common
Bronchial asthma
Staphylococcal pneumatoceles
Idiopathic pulmonary fibrosis, eosinophilic granuloma, sarcoidosis
Tuberculosis
Lung abscess
Acute respiratory distress syndrome
Paragonimiasis
Complication of mechanical ventilation
특징
simple PNX와는 반대로 비교적 small PNX도 pre-existing pulmonary
disease가 superimposed되면 severe respiratory symptom을 일으킨다.
Tx.
· Tube thoracostomy promptly
· Pleurodesis using tetracycline - 처음 발생시 바로 시행
참 고 문 헌
1. Harrison's Principles of Internal Medicine 13th eds p1229-1234
2. Cecil. Textbook of Medicine 19th eds p.443-452
3. Murray Textbook of Respiratory Medicine 2nd eds p2145-2290
4. Fishman. Pulmonary Disease and Disorders 2nd eds

키워드

흉막,   흉수,   폐,   심장,   세포,   내과