PURPOSE: In pediatric intubation, it is difficult to select the correct tracheal tube size and proper depth. Children have as many different tube size as they have ages. This study was performed to evaluate the Pediatric Advanced Life Support (PALS) guideline for intubation in Korean children. METHODS: We studied pediatric patients who were admitted with intubation from 1996 to 2001 at our hospital. We selected 33 Korean patients under 15 years of age for evaluation in this study. Their medical records and chest radiographs were compared. The distance of the tracheal tube tip from the carina on the postintubation chest X-ray was determined. RESULTS: Thirty-three patients were enrolled in the study. The depth of tracheal intubation was proper in 12 patients (36.3%), too deep in 16 patients (48.4%) and too shallow in 5 patients (15.1%). The reasons for intubation were respiratory failure (24.2%), mental change (57.6%) and status epilepticus (18.1%). CONCLUSION: We conclude that the PALS guideline for tracheal intubation is not suitable for Korean children. Determination of the proper depth of tracheal intubation for Korean children is needed through further study.
Child* ; Humans ; Intubation* ; Medical Records ; Radiography, Thoracic ; Respiratory Insufficiency ; Status Epilepticus ; Thorax

Purpose: To determine the differences in the radiographic findings of miliary tuberculosis between patients with and without associated acute respiratory failure (ARF). MATERIALS AND METHODS: We retrospectively reviewed 32 patients in whom miliary tuberculosis had been diagnosed, and assigned them to one of two groups: with ARF (n=10), and without ARF (n=22). Chest radiographic findings such as the presence of miliary nodules, cosolidation, ground-glass opacity (GGO), pleural effusion, small calcified nodules and linear opacities were assessed, the size and profusion of nodules in each of four zones were analyzed and scored using the standard radiographs of the International Labor Organization, and the extent of consolidation and GGO were scored according to the percentage of involved lung. We compared the radiologic findings between the two groups. RESULTS: Ground-glass opacity, consolidation, and pleural effusion were seen more frequently in miliary tuberculosis patients with ARF than in those without ARF. Although the size and profusion of nodules were similar in both groups (p>0.05), consolidation and ground-glass opacity in cases of miliary tuberculosis with ARF were significantly more extensive than in those without ARF (p<0.005). CONCLUSION: GGO and consolidation were more extensive in miliary tuberculosis patients with ARF. A finding of ground-glass opacity in miliary tuberculosis patients might be an early indication of developing ARF.
Humans ; Lung ; Pleural Effusion ; Radiography, Thoracic ; Respiratory Insufficiency* ; Retrospective Studies ; Tuberculosis, Miliary* ; Tuberculosis, Pulmonary

Pulmonary lymphangioleiomyomatosis is a rare disorder of unknown cause and characterised by hamartomatous proliferation of smooth muscle occurring in women of reproductive age exclusively. It causes dyspnea, recurrent pneumothorax, chylothorax, hemoptysis and respiratory failure eventually. Chest radiographs show diffuse interstitial infiltrates and cysts of uniform size, and pulmonary function tests often show airflow limitation with increase in residual volume. Hormonal factors are thought to play a role because it generally affects premenopausal women, but there is no definite treatment yet. We present an unusual case of pulmonary lymphangioleiomyomatosis during normal pregnancy with a review of literature.
Chylothorax ; Dyspnea ; Female ; Hemoptysis ; Humans ; Lymphangioleiomyomatosis* ; Muscle, Smooth ; Pneumothorax ; Pregnancy* ; Radiography, Thoracic ; Residual Volume ; Respiratory Function Tests ; Respiratory Insufficiency

Acute respiratory distress syndrome (ARDS) is a syndrome identified as acute respiratory failure and is characterized by wide spread infiltrates on chest radiograph, impaired oxygenation, and noncardiogenic pulmonary edema. This syndrome is identified very uncommonly during neonatal period. We experienced a case of ARDS in a 3-day old fullterm neonate who had had the sign of pulmonary edema. He was improved with the treatment of mechanical ventilation, but pulmonary interstitial emphysema and periventricular leukomalacia were complicated.
Emphysema ; Humans ; Infant, Newborn* ; Leukomalacia, Periventricular ; Oxygen ; Pulmonary Edema* ; Radiography, Thoracic ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency

Acute cytomegalovirus (CMV) infection occurs commonly in immunocompromised and immunocompetent patients, but is usually asymptomatic in the latter. Vascular events associated with acute CMV infection have been described, but are rare. Hence, such events are rarely reported in the literature. We report a case of pulmonary embolism secondary to acute CMV colitis in an immunocompetent 78-year-old man. The patient presented with fever and diarrhea. Colonic ulcers were diagnosed based on colonoscopy findings, and CMV was the proven etiology on pathological examination. The patient subsequently experienced acute respiratory failure. Pulmonary embolism was diagnosed based on the chest radiography and computed tomography findings. A diagnosis of acute CMV colitis complicated by pulmonary embolism was made. The patient was successfully treated with intravenous administration of unfractionated heparin and intravenous ganciclovir.
Administration, Intravenous ; Aged ; Colitis* ; Colon ; Colonoscopy ; Cytomegalovirus* ; Diagnosis ; Diarrhea ; Fever ; Ganciclovir ; Heparin ; Humans ; Pulmonary Embolism* ; Radiography ; Respiratory Insufficiency ; Thorax ; Ulcer

Diaphragmatic hernia may be either congenital or acquired. Acquired cases may be secondary to trauma, infection, pregnancy, or surgery. In adults, diaphragmatic hernia causes chronic and variable symptoms such as abdominal discomfort, dyspepsia, and chronic dyspnea; in infants, however, it frequently causes acute respiratory failure. We report herein a case of diaphragmatic hernia in an adult patient who presented with left chest pain. Left pleural effusion was revealed on a plain chest radiograph. Computed tomography confirmed the presence of a diaphragmatic defect and a shift of the omentum to the thoracic cavity. The patient underwent omental resection and primary repair of the diaphragmatic muscle defect via exploratory thoracotomy.
Adult ; Chest Pain ; Dyspepsia ; Dyspnea ; Hernia, Diaphragmatic* ; Humans ; Infant ; Omentum ; Pleural Effusion* ; Pregnancy ; Radiography, Thoracic ; Respiratory Insufficiency ; Thoracic Cavity ; Thoracotomy

Rhinovirus infection is typically associated with the common cold and has rarely been reported as a cause of severe pneumonia in immunocompetent adults. A 55-year-old previous healthy woman, who consumed half a bottle of alcohol daily, presented with respiratory failure after one week of upper respiratory infection symptoms. Radiography revealed bilateral, diffuse ground glass opacity with patchy consolidation in the whole lung field; bronchoalveolar lavage fluid analysis indicated that rhinovirus was the causative organism. After five days of conservative support, the symptoms and radiographic findings began to improve. We report this rare case of rhinovirus pneumonia in an otherwise healthy host along with a review of references.
Adult* ; Alcohol Drinking ; Bronchoalveolar Lavage Fluid ; Common Cold ; Female ; Glass ; Humans ; Lung ; Middle Aged ; Pneumonia ; Radiography ; Respiratory Insufficiency* ; Rhinovirus*

BACKGROUND: Severe community-acquired pneumonia (CAP) can develop into respiratory failure that requires mechanical ventilation (MV), which is associated with a higher rate of mortality. It was recently reported that a hydrocortisone infusion in severe CAP patients was associated with a significant reduction in the length of the hospital stay and mortality. This study evaluated efficacy of a hydrocortisone infusion for patients with severe CAP requiring MV. METHODS: From February 2005 to July 2005, 13 patients (M : F = 10 : 3, mean age: 68.6+/-14.1 years), who were diagnosed with severe CAP and required MV, were enrolled in this study. Hydrocortisone was administered as an intravenous 200mg loading bolus, which was followed by an infusion at a rate of 10mg/hour for 7 days. The control group was comprised of patients with severe CAP requiring MV but in whom corticosteroid was not used before study period. The clinical and physiologic parameters on or by day 8 and the outcome in the hydrocortisone infusion group were compared with those in the control group. RESULTS: 1) There was no significant difference in age, gender ratio, SAPS II, SOFA score, temperature, leukocyte count, PaO2/FiO2 (P/F) ratio, the number of patients with P/F ratio < 200, chest radiograph score, lung injury score and catecholamine-dependent septic shock between the hydrocortisone infusion group and control group at day 1. 2) At day 8, the proportion of patients with an improvement in the P/F ratio > or = 100 and the chest radiograph score was significantly higher in the hydrocortisone infusion group than in the control group (61.5% vs. 15.4%, 76.9% vs. 23.1%, p<0.05). However, there was no significant difference in the other clinical and physiologic parameters. 3). There was no significant difference in the duration of the MV, ICU stay, hospital stay and 10th and 30th day mortality between the two groups. CONCLUSION: Hydrocortisone infusion for patients with severe CAP requiring invasive mechanical ventilation may be effective in improving the level of oxygenation and the chest radiograph score.
Humans ; Hydrocortisone* ; Length of Stay ; Leukocyte Count ; Lung Injury ; Mortality ; Oxygen ; Pneumonia* ; Radiography, Thoracic ; Respiration, Artificial* ; Respiratory Insufficiency ; Shock, Septic

We report a case of pulmonary fibrosis in a 32-year-old man, who had worked at a steel mill and who died of respiratory failure due to interstitial fibrosis despite vigorous treatment. He showed SLE-associated symptoms, such as pleural effusion, malar rashes, discoid rashes, arthritis, leukopenia, and positive antinuclear antibody and anti-histone antibody. However, he did not present anti-DNA antibody. A thoracoscopic lung biopsy showed interstitial fibrosis, chronic inflammation and a small non-caseating granuloma in lung tissues, which could be induced by external agents such as metals. The manganese concentration in the lung tissue was 4.64 microg/g compared to 0.42-0.7 microg/g in the controls. The levels of other metals, such as iron, nickel, cobalt and zinc in patient's lung tissue were higher than those in the controls. The patient was probably exposed to Si and various metal dusts, and the lung fibrosis was related to these exposures. Exposure to Si and metal dusts should be sought in the history of any patient with SLE, especially in a male with pulmonary signs, and if present, exposure should be stopped. In the meantime, steps should be taken to ensure that workers exposure to Si and metal dusts in all environments have adequate protection.
Adult ; Biopsy ; Case Report ; Fatal Outcome ; Human ; Male ; Occupational Diseases/radiography* ; Occupational Diseases/pathology ; Occupational Diseases/chemically induced* ; Occupational Exposure ; Pulmonary Alveoli/pathology ; Pulmonary Fibrosis/radiography* ; Pulmonary Fibrosis/pathology ; Pulmonary Fibrosis/chemically induced* ; Respiratory Insufficiency/radiography ; Respiratory Insufficiency/pathology ; Respiratory Insufficiency/chemically induced ; Steel/adverse effects*

Myasthenia gravis (MG) is often complicated by respiratory failure, known as a myasthenic crisis. However, most of the patients who develop respiratory symptoms do so during the late course of disease and have other neurological signs and symptoms. However, in some patients respiratory failure is the initial presenting symptom. We report the case of a 68-year-old woman with MG who presented with isolated respiratory failure as her first presenting symptom. As illustrated by this case, it is important to consider neuromuscular disorders in cases of unexplained respiratory failure.
Acute Disease ; Aged ; Electromyography ; Female ; Humans ; Myasthenia Gravis/*complications/*diagnosis ; Pulmonary Atelectasis/etiology/radiography ; Respiratory Insufficiency/*etiology/*radiography ; Tomography, Spiral Computed