1.Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis.
Hyun Jin BAEK ; Doo Hyuk LEE ; Kyu Hyung HAN ; Young Min KIM ; Hyunbeom KIM ; Byeongwook CHO ; Inkuk LEE ; Kanghyun CHOI ; Hojin YONG ; Goohyeon HONG
Korean Journal of Critical Care Medicine 2016;31(2):134-139
In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.
Blood Platelets
;
Critical Illness
;
Dacarbazine
;
Disseminated Intravascular Coagulation*
;
Ecchymosis
;
Gastrointestinal Tract
;
Hemorrhage
;
Humans
;
Intracranial Hemorrhages*
;
Male
;
Middle Aged
;
Mortality
;
Plasma
;
Sepsis*
2.Fatal Massive Hemoptysis Related to a Pulmonary Artery Pseudoaneurysm after Treatment of a Lung Abscess.
Jong Wook BAE ; Se Weon KIM ; Young Min KIM ; Byeongwook CHO ; Hyunjae LEE ; Kyong Wook KUK ; Goohyeon HONG
Korean Journal of Medicine 2016;90(4):341-345
Pulmonary artery pseudoaneurysm (PAP) is a very rare vascular abnormality and is often caused at least in part by infection. While Mycobacterium tuberculosis is a relatively common cause of PAP, it can also result from a lung abscess. Aneurysm rupture resulting in massive hemoptysis is potentially fatal, with death caused by aspiration of blood and consequent asphyxiation. We admitted a 55-year-old man with massive hemoptysis. He had been treated with intravenous antibiotics for three weeks after diagnosing a lung abscess. Contrast-enhanced chest computed tomography revealed a pseudoaneurysm inside the abscess. Diagnostic catheter pulmonary angiography confirmed the diagnosis of pseudoaneurysm of the pulmonary artery. Embolization successfully controlled the airway bleeding. However, the patient died of acute respiratory failure on the seventh hospital day. When hemoptysis is due to sustained inflammation, such as a lung abscess, bleeding from the pulmonary artery should be considered.
Abscess
;
Aneurysm
;
Aneurysm, False*
;
Angiography
;
Anti-Bacterial Agents
;
Catheters
;
Diagnosis
;
Hemoptysis*
;
Hemorrhage
;
Humans
;
Inflammation
;
Lung Abscess*
;
Lung*
;
Middle Aged
;
Mycobacterium tuberculosis
;
Pulmonary Artery*
;
Respiratory Insufficiency
;
Rupture
;
Thorax
3.A Case of Successful Natural Stenting in Tracheobronchial Restenosis with Malignant Tumor after Metallic Stenting.
Goohyeon HONG ; Kyeongman JEON ; Sang Won UM ; Won Jung KOH ; Gee Young SUH ; Man Pyo CHUNG ; O Jung KWON ; Hojoong KIM
The Korean Journal of Critical Care Medicine 2012;27(2):111-114
Tracheal tumors are very rare disease, which may cause dyspnea, obstructive pneumonia and life-threatening hypoxemia, depending on the site of the lesion and the severity of the narrowing. Such patients frequently die within hours or days due to suffocation. Patients who expressed upper airway stenosis, should be secured the airways prior to the diagnosis and treatment commonly. Then, treatment plan should be determined. For the relief of such stenosis, various modalities of therapy including surgery, laser photoresection, balloon dilatation and sometimes stent insertion have been used. Tracheobronchial stent insertion has been a good therapeutic option in these patients in point of avoiding morbidities associated with surgery. We report a case of repeated tracheobronchial stenosis by infiltrating tumor mass after metallic stent insertion in a 48-year-old man. The patient was treated successfully by Natural stent insertion with rigid bronchoscopy after removal of previous inserted metallic stent.
Anoxia
;
Asphyxia
;
Bronchoscopy
;
Constriction, Pathologic
;
Dilatation
;
Dyspnea
;
Humans
;
Laser Therapy
;
Middle Aged
;
Pneumonia
;
Rare Diseases
;
Stents
4.Fatal Intracranial Hemorrhage in a Patient with Disseminated Intravascular Coagulation associated with Sepsis
Hyun Jin BAEK ; Doo Hyuk LEE ; Kyu Hyung HAN ; Young Min KIM ; Hyunbeom KIM ; Byeongwook CHO ; Inkuk LEE ; Kanghyun CHOI ; Hojin YONG ; Goohyeon HONG
The Korean Journal of Critical Care Medicine 2016;31(2):134-139
In critically ill patients, disseminated intravascular coagulation (DIC) is a common and fatal hematological disorder. DIC is a physiological response to a variety of underlying stimuli that provoke generalized activation of the hemostatic mechanism and is common in septic patients and those with hematological or non-hematological malignant neoplasms. Bleeding is a common clinical feature, and diffuse or multiple-site mucocutaneous bleeding, such as petechia, ecchymosis and hemorrhage from gastrointestinal tract, is often seen. A 58-year-old male was recently diagnosed with intracranial hemorrhage (ICH) caused by DIC associated with sepsis. Mortality of ICH caused by DIC is very high because the underlying condition cannot be quickly treated. Awareness of the possibility of DIC developing in a critically ill patient and the need for immediate initiation of plasma or platelet replacement therapy are important. To the best of our knowledge, this is the first reported case of intracranial hemorrhage in a Korean patient with DIC associated with sepsis.
Blood Platelets
;
Critical Illness
;
Dacarbazine
;
Disseminated Intravascular Coagulation
;
Ecchymosis
;
Gastrointestinal Tract
;
Hemorrhage
;
Humans
;
Intracranial Hemorrhages
;
Male
;
Middle Aged
;
Mortality
;
Plasma
;
Sepsis
5.A Case of Pleural Paragonimiasis Confused with Tuberculous Pleurisy.
Junwhi SONG ; Goohyeon HONG ; Jae Uk SONG ; Wooyoul KIM ; Seo Goo HAN ; Yousang KO ; Boksoon CHANG ; Byeong Ho JEONG ; Jung Seop EOM ; Ji Hyun LEE ; Byung Woo JHUN ; Kyeongman JEON ; Hong Kwan KIM ; Won Jung KOH
Tuberculosis and Respiratory Diseases 2014;76(4):175-178
Here, we report a case of pleural paragonimiasis that was confused with tuberculous pleurisy. A 38-year-old man complained of a mild febrile sensation and pleuritic chest pain. Radiologic findings showed right pleural effusion with pleural thickening and subpleural consolidation. Adenosine deaminase (ADA) activity in the pleural effusion was elevated (85.3 IU/L), whereas other examinations for tuberculosis were negative. At this time, the patient started empirical anti-tuberculous treatment. Despite 2 months of treatment, the pleural effusion persisted, and video-assisted thoracoscopic surgery was performed. Finally, the patient was diagnosed with pleural paragonimiasis based on the pathologic findings of chronic granulomatous inflammation containing Paragonimus eggs. This case suggested that pleural paragonimiasis should be considered when pleural effusion and elevated ADA levels are observed.
Adenosine Deaminase
;
Adult
;
Chest Pain
;
Eggs
;
Humans
;
Inflammation
;
Ovum
;
Paragonimiasis*
;
Paragonimus
;
Pleural Effusion
;
Sensation
;
Thoracic Surgery, Video-Assisted
;
Tuberculosis
;
Tuberculosis, Pleural*
6.Nontuberculous Mycobacterial Lung Disease Caused by Mycobacterium lentiflavum in a Patient with Bronchiectasis.
Byeong Ho JEONG ; Jae Uk SONG ; Wooyoul KIM ; Seo Goo HAN ; Yousang KO ; Junwhi SONG ; Boksoon CHANG ; Goohyeon HONG ; Su Young KIM ; Go Eun CHOI ; Sung Jae SHIN ; Won Jung KOH
Tuberculosis and Respiratory Diseases 2013;74(4):187-190
We report a rare case of lung disease caused by Mycobacterium lentiflavum in a previously healthy woman. A 54-year-old woman was referred to our hospital due to chronic cough and sputum. A computed tomography scan of the chest revealed bilateral bronchiectasis with bronchiolitis in the right middle lobe and the lingular division of the left upper lobe. Nontuberculous mycobacteria were isolated twice from three expectorated sputum specimens. All isolates were identified as M. lentiflavum by multilocus sequence analysis based on rpoB, hsp65, and 16S rRNA fragments. To the best of our knowledge, this is the first documented case of M. lentiflavum lung disease in an immunocompetent adult in Korea.
Adult
;
Bronchiectasis
;
Bronchiolitis
;
Cough
;
Female
;
Humans
;
Korea
;
Lung
;
Lung Diseases
;
Multilocus Sequence Typing
;
Mycobacterium
;
Mycobacterium Infections, Nontuberculous
;
Nontuberculous Mycobacteria
;
Sputum
;
Thorax
7.Bronchogenic Cyst Rupture and Pneumonia after Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Case Report.
Goohyeon HONG ; Junwhi SONG ; Kyung Jong LEE ; Kyeongman JEON ; Won Jung KOH ; Gee Young SUH ; Man Pyo CHUNG ; Hojoong KIM ; O Jung KWON ; Sang Won UM
Tuberculosis and Respiratory Diseases 2013;74(4):177-180
We report a 54-year-old woman who presented with a well-defined, homogeneous, and non-enhancing mass in the retrobronchial region of the bronchus intermedius. The patient underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for histological confirmation. Serous fluid was aspirated by EBUS-TBNA. Cytological examination identified an acellular smear with negative microbiological cultures. The patient was finally diagnosed with bronchogenic cysts by chest computed tomography (CT) and EBUS-TBNA findings. However, 1 week after EBUS-TBNA, the patient developed bronchogenic cyst rupture and pneumonia. Empirical antibiotics were administered, and pneumonia from the bronchogenic cyst rupture had resolved on follow-up chest CT. To our knowledge, this is the first reported case of pneumonia from bronchogenic cyst rupture after EBUS-TBNA.
Anti-Bacterial Agents
;
Biopsy, Fine-Needle
;
Bronchi
;
Bronchogenic Cyst
;
Female
;
Follow-Up Studies
;
Humans
;
Needles
;
Pneumonia
;
Rupture
;
Thorax
8.Usefulness of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosis of Sarcoidosis.
Goohyeon HONG ; Kyung Jong LEE ; Kyeongman JEON ; Won Jung KOH ; Gee Young SUH ; Man Pyo CHUNG ; Hojoong KIM ; O Jung KWON ; Joungho HAN ; Sang Won UM
Yonsei Medical Journal 2013;54(6):1416-1421
PURPOSE: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate and minimally invasive technique used routinely for investigation of mediastinal and hilar lymphadenopathy. However, few studies have addressed its role in comparison to the traditional diagnostic approaches of transbronchial lung biopsy (TBLB), endobronchial biopsy (EBB), and bronchoalveolar lavage (BAL) in the diagnosis of sarcoidosis. We evaluated the usefulness of EBUS-TBNA in the diagnosis of sarcoidosis compared to TBLB, EBB, and BAL. MATERIALS AND METHODS: Consecutive patients with suspected sarcoidosis (stage I and II) on chest radiography and chest computed tomography were included. All 33 patients underwent EBUS-TBNA, TBLB, EBB, and BAL during the same session between July 2009 and June 2011. EBUS-TBNA was performed at 71 lymph node stations. RESULTS: Twenty-nine of 33 patients, were diagnosed with histologically proven sarcoidosis; two patients were compatible with a clinical diagnosis of sarcoidosis during follow-up; and two patients were diagnosed with metastatic carcinoma and reactive lymphadenopathy, respectively. Among 29 patients with histologically proven sarcoidosis in combination with EBUS-TBNA, TBLB, and EBB, only EBUS-TBNA and TBLB revealed noncaseating granuloma in 18 patients and one patient, respectively. The overall diagnostic sensitivities of EBUS-TBNA, TBLB, EBB, and BAL (CD4/CD8 > or =3.5) were 90%, 35%, 6%, and 71%, respectively (p<0.001). The combined diagnostic sensitivity of EBUS-TBNA, TBLB, and EBB was 94%. CONCLUSION: EBUS-TBNA was the most sensitive method for diagnosing stage I and II sarcoidosis compared with conventional bronchoscopic procedures. EBUS-TBNA should be considered first for the histopathologic diagnosis of stage I and II sarcoidosis.
Adult
;
Aged
;
Biopsy, Fine-Needle/*methods
;
Bronchoscopy
;
Female
;
Humans
;
Lymph Nodes/pathology
;
Male
;
Middle Aged
;
Sarcoidosis/*diagnosis/*ultrasonography
;
Young Adult
9.Normalization of Elevated CA 19-9 Level after Treatment in a Patient with the Nodular Bronchiectatic Form of Mycobacterium abscessus Lung Disease.
Boksoon CHANG ; Seo Goo HAN ; Wooyoul KIM ; Yousang KO ; Junwhi SONG ; Goohyeon HONG ; Jung Seop EOM ; Ji Hyun LEE ; Byung Woo JHUN ; Won Jung KOH
Tuberculosis and Respiratory Diseases 2013;75(1):25-27
Carbohydrate antigen 19-9 (CA 19-9) is a widely-used tumor marker in patients with pancreatic cancer. However, some patients with respiratory disease also exhibit elevated serum CA 19-9 levels. We report a case of normalization of elevated serum CA 19-9 levels after treatment of the nodular bronchiectatic form of Mycobacterium ab scessus lung disease. A 40-year-old man visited our hospital because of chronic cough and sputum. A computed tomography scan revealed severe bronchiectasis in the right upper and right middle lobes. Nontuberculous mycobacteria were repeatedly isolated and identified as M. abscessus. The serum CA 19-9 level was elevated to 142.35 U/mL (normal range, <37 U/mL). Surgical resection was performed because of failure of sputum conversion after antibiotic treatment. The serum CA 19-9 level returned to the normal range after surgery. This case suggested that serum CA 19-9 levels could be elevated in patients with the nodular bronchiectatic form of M. abscessus lung disease.
Bronchiectasis
;
CA-19-9 Antigen
;
Cough
;
Humans
;
Lung
;
Lung Diseases
;
Mycobacterium
;
Nontuberculous Mycobacteria
;
Pancreatic Neoplasms
;
Reference Values
;
Sputum
10.Pulmonary Pneumatocele in a Pneumonia Patient Infected with Extended-Spectrum beta-Lactamase Producing Proteus mirabilis.
Sung Hyeok RYOU ; Jong Wook BAE ; Hyun Jin BAEK ; Doo Hyuk LEE ; Sang Won LEE ; Gyu Ho CHOI ; Kyu Hyung HAN ; Se Weon KIM ; Hyunbeom KIM ; Goohyeon HONG
Tuberculosis and Respiratory Diseases 2015;78(4):371-374
Pulmonary pneumatoceles are air-filled thin-walled spaces within the lung and are rare in adult cases of pneumonia. We report the case of a 74-year-old male who was admitted with a cough and sputum production. He had been treated with oral dexamethasone since a brain tumorectomy 6 months prior. Contrast-enhanced computed tomography (CT) of the chest revealed a large pneumatocele in the right middle lobe and peripheral pneumonic consolidation. Bronchoalveolar lavage was performed; cultures identified extended-spectrum beta-lactamase (ESBL) producing Proteus mirabilis. A 4-week course of intravenous ertapenem was administered, and the pneumatocele with pneumonia resolved on follow-up chest CT. To the best of our knowledge, this is the first reported case of pulmonary pneumatocele caused by ESBL-producing P. mirabilis associated with pneumonia.
Adult
;
Aged
;
beta-Lactamases*
;
Brain
;
Bronchoalveolar Lavage
;
Cough
;
Dexamethasone
;
Follow-Up Studies
;
Humans
;
Lung
;
Male
;
Mirabilis
;
Pneumonia*
;
Proteus mirabilis*
;
Proteus*
;
Sputum
;
Thorax
;
Tomography, X-Ray Computed