흉수 + 국한성 흡수저류 (loculated), 폐렴에 의한? - 동대문구 답십리, 전농동, 우리안애 우리안愛 내과
- Byoung-Yeon Jun
- 5월 2일
- 2분 분량
60대 중반 남자
22년 부터 혈압/고지혈 처방중
...
담에 걸렸다고 생각하고 정형외과 진료 후 내원; 그곳에서 척추 사진에 흉수가 보이며...
1주일전부터 마른기침... 이 가끔?
전신증상은 없었고..
2일전부터 오른쪽 옆구리가 아프면서.. 숨도 가쁘고..
들이쉴때 아프고 --> 흉부 사진이 있으니 pleuritic chest pain, 늑막성 흉통 모습 ;; 빈도는 흉골연골염이 훨씬 많으니 이것을 먼저 고려해야
한달전 검진때 사진과 비교하면 아래와 같다.
가운데와 위쪽으로 국한성 흡수저류 (loculated pleural effusion) 도 동반되어 있다.
폐렴으로서의 증상이 애매한데... 폐렴에 의한 흉수, 결핵성 흉막염의 감별이 필요 (너무 빠른 변화인데.. 악성흉수? 보다는)
흉수 검사 및 배액의 시도가 필요할 것으로 생각되며 증상은 경미하나 응급실 통한 진료 권유
폐렴에 의한 흉수/농흉, 감기 이후 상기도 기침 증후군 정도로 생각하였으나.. 의외로
입원하여 흉관 삽입하여 배액
폐암 수술 배경에서 흉수, 기침만 2주
과거와 비교할 사진은 없는 폐암 4기
Parapneumonic effusion is classified into 4 groups based on risk for the poor outcome:
Category 1 (very low risk): The effusion is small (less than 10-mm thickness on decubitus) and free-flowing. No thoracentesis is indicated.
Category 2 (low risk): The effusion is small to moderate (equal to 10 mm and less than half the hemithorax) and free-flowing with negative culture and Gram stain regardless of the prior use of antibiotics and pH equal to 7.20.
Category 3 (moderate risk), in which one of the following criteria is present: the fluid equal to half the hemithorax, loculated effusion, thicken pleura on contrast-enhanced CT scan, positive Gram stain or culture or pH less than 7.20.
Category 4 (high risk): This is when pleural fluid is in the form of pure pus.
Patients with category 1 and category 2 may not require drainage. In patients with category 3 and 4, drainage is recommended. Fibrinolytics, VATS, and surgery may be indicated for managing patients with category 3 and category 4 parapneumonic effusion not responding to less invasive drainage methods.
Chest Tube Drainage
Chest tube drainage is generally preferred for patients with uninoculated effusions and free-flowing fluid. Chest tubes are ideally inserted under ultrasound or CT-guidance. The choice of a thoracostomy tube size is controversial. Imaging performed within 24 hours is essential for documenting the correct position of the chest tube. Chest tubes are left in place until the drainage rate is less than 50 ml per day and the empyema cavity has closed.
Thoracoscopy
Thoracoscopy is an alternative therapy for loculated empyemas when antibiotics and tube thoracostomy fail for the drainage. Thoracoscopy disrupts the intrapleural adhesions and allows the drainage of the pleural fluid. Previous studies showed that delay for referral for thoracoscopy more than two weeks was associated with failure of thoracoscopy and conversion to thoracotomy.
동대문구 답십리 우리안애, 우리안愛 내과, 건강검진 클리닉 내과 전문의 전병연
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