Biomedical subjects

Kyung Soo Lee

Publications and source records attributed to Kyung Soo Lee.

At least 19 recordsLinked to original sources

PubMed2007

Solitary pulmonary nodules: detection, characterization, and guidance for further diagnostic workup and treatment.

OBJECTIVE: The purpose of our study is to improve radiologists' understanding of the clinical issues involved in making a diagnosis and to guide further diagnostic workup and treatment of solitary pulmonary nodules (SPNs). CONCLUSION: Information on the morphologic and hemodynamic characteristics of SPNs provided by dynamic helical CT, with high specificity and reasonably high accuracy, can be used for initial assessment. PET/CT is more sensitive at detecting malignancy than dynamic helical CT, and all malignant nodules may be potentially diagnosed as malignant by both techniques. Therefore, PET/CT may be selectively performed to characterize SPNs that show indeterminate results at dynamic helical CT.

Adult↗

PubMed2006

Acute pneumonia and empyema caused by Mycobacterium intracellulare.

Nontuberculous mycobacterial infection is rarely accompanied by pleural involvement. We report a very rare case of M. intracellulare pulmonary disease with pleural empyema. A 56-year-old man was admitted to our hospital because of fever, purulent sputum and pleuritic chest pain. A chest radiograph and CT revealed pneumonic consolidation in the left lower lobe and loculated hydropneumothorax. The sputum smear was positive for acid fast bacilli. The aspirated pleural fluid was grossly purulent and the smear of the pleural effusion was also positive for acid fast bacilli. M. intracellulare was identified by culture and PCR from sputum and pleural fluid specimens. The patient improved with percutaneous tube drainage of the purulent effusion and antibiotic treatment including clarithromycin, rifampicin, ethambutol and streptomycin.

Acute Disease↗

PubMed2006

Stage T1 non-small cell lung cancer: preoperative mediastinal nodal staging with integrated FDG PET/CT--a prospective study.

PURPOSE: To prospectively evaluate the sensitivity and specificity of integrated fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT) (PET/CT) for the preoperative diagnosis of mediastinal nodal metastasis in stage T1 non-small cell lung cancer (NSCLC), with surgical and histologic results as reference standards. MATERIALS AND METHODS: Institutional review board approval and informed consent were obtained. From June 2003 to February 2005, 150 patients (89 men and 61 women; mean age, 59 years) with stage T1 NSCLC at stand-alone CT underwent integrated PET/CT and surgical staging. Two observers (one radiologist and one nuclear medicine physician) evaluated prospectively and in consensus the mediastinal nodes by analyzing both PET (functional) and CT (anatomic) images. Nodal stages were determined by using the American Joint Committee on Cancer staging system and surgical and histologic findings as the reference standard. Statistical evaluation of malignant lymph nodes was performed on per-nodal-station and per-person bases. RESULTS: A total of 568 mediastinal nodal stations were evaluated. Nodes were positive for malignancy in 34 (23%) of 150 patients and 55 (10%) of 568 nodal stations. For depiction of malignant nodes, the respective sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of integrated PET/CT were 42% (23 of 55), 100% (513 of 513), 100% (23 of 23), 94% (513 of 545), and 94% (536 of 568) on per-nodal-station basis and 47% (16 of 34), 100% (116 of 116), 100% (16 of 16), 87% (116 of 134), and 88% (132 of 150) on a per-patient basis. CONCLUSION: Integrated FDG PET/CT provides high specificity and positive predictive value of mediastinal nodal staging in stage T1 NSCLC, although the sensitivity is low.

Adult↗

PubMed2006

Lung metastasis from an immature teratoma of the nasal cavity masquerading as small cell carcinoma of the lung.

We report a case of small cell lung cancer that turned out to be a metastatic teratoma from the nasal cavity rather than a new primary cancer. A 54-year-old woman was diagnosed with an immature teratoma of the nasal cavity with a predominant neuroblastomatous component. Small cell lung cancer was detected by bronchoscopic biopsy 21 months later, and it was treated with concurrent radiochemotherapy as if it had been a new primary cancer. Since a recurrent tumor containing fat- like density grew slowly on the serial chest CT scans after achieving complete response, we reached the conclusion that the small undifferentiated cells could be metastatic neuroblastomatous components from the immature teratoma of the nasal cavity.

Biopsy↗

PubMed2006

Bronchoalveolar lavage in fibrotic idiopathic interstitial pneumonias.

The purpose of this study was to assess the role of bronchoalveolar lavage (BAL) in differentiating usual interstitial pneumonia (UIP) from non-specific interstitial pneumonia (NSIP) and in predicting the prognosis in fibrotic idiopathic interstitial pneumonia (IIP). A retrospective review of 122 patients (age 58+/-8 years, 70 male) with UIP (n=87) and NSIP (n=35) was carried out. Prior to surgical lung biopsy, all of them underwent BAL and high-resolution-computed tomography (HRCT) of the chest. Neutrophil count in BAL fluid was higher in UIP (7.0%) than NSIP (3.0%) (P=0.027). In contrast, BAL lymphocyte count was significantly higher in NSIP (29.0%) than UIP (5.5%) (P<0.0001). In 62 patients whose HRCT findings were atypical for UIP, BAL lymphocytosis was more frequently observed in NSIP (20/33) than UIP (4/29) (P<0.001) and the absence of BAL lymphocytosis suggested a diagnosis of UIP rather than NSIP (odds ratio 12.7, P<0.001). Pathologic diagnosis of NSIP was the only independent factor predicting a longer survival of our patients (median follow-up 21 months) (hazard ratio (HR) 0.035, P=0.005). When NSIP was not included in the survival analysis, higher BAL lymphocyte count was the only independent predictor of a longer survival (HR 0.909, P=0.029). BAL is an useful non-invasive tool in fibrotic IIP, not only for excluding a variety of specific non-IIP diseases but also for narrowing the differential diagnosis and predicting the prognosis in the absence of the histopathologic diagnosis.

Bronchoalveolar Lavage↗

PubMed2006

Pulmonary fungal infection: imaging findings in immunocompetent and immunocompromised patients.

Histoplasmosis is the most common endemic mycosis in North America, and is followed by coccidioidomycosis and blastomycosis. Although the majority of these infections in immunocompetent persons are self-limited, some patients can develop severe pneumonitis or various forms of chronic pulmonary infection. Cryptococcoci, Aspergillus, Candidas, and Mucorals are ubiquitous organisms, which may affect immunocompromised patients. Specific imaging findings can be expected, depending on the organisms involved, underlying patients' conditions (immune status), and specific situations after immune depleting procedures.

Humans↗

PubMed2006

Drug-sensitive tuberculosis, multidrug-resistant tuberculosis, and nontuberculous mycobacterial pulmonary disease in nonAIDS adults: comparisons of thin-section CT findings.

The aim of this work was to compare thin-section CT (TSCT) findings of drug-sensitive (DS) tuberculosis (TB), multidrug-resistant (MDR) TB, and nontuberculous mycobacterial (NTM) pulmonary disease in nonAIDS adults. During 2003, 216 (113 DS TB, 35 MDR TB, and 68 NTM) patients with smear-positive sputum for acid-fast bacilli (AFB), and who were subsequently confirmed to have mycobacterial pulmonary disease, underwent thoracic TSCT. The frequency of lung lesion patterns on TSCT and patients' demographic data were compared. The commonest TSCT findings were tree-in-bud opacities and nodules. On a per-person basis, significant differences were found in the frequency of multiple cavities and bronchiectasis (P < 0.001, chi-square test and multiple logistic regression analysis). Multiple cavities were more frequent in MDR TB than in the other two groups and extensive bronchiectasis in NTM disease (multiple logistic regression analysis). Patients with MDR TB were younger than those with DS TB or NTM disease (P < 0.001, multiple logistic regression analysis). Previous tuberculosis treatment history was significantly more frequent in patients with MDR TB or NTM disease (P < 0.001, chi-square test and multiple logistic regression analysis). In patients with positive sputum AFB, multiple cavities, young age, and previous tuberculosis treatment history imply MDR TB, whereas extensive bronchiectasis, old age, and previous tuberculosis treatment history NTM disease.

Adult↗

PubMed2006

Mycobacterium abscessus pulmonary infection presenting as a solitary pulmonary nodule.

Nontuberculous mycobacterial pulmonary infection is a rare cause of a solitary pulmonary nodule. All previously reported cases were caused by Mycobacterium avium complex, and a solitary pulmonary nodule caused by other NTM species has been very rarely reported. We describe the first case of Mycobacterium abscessus infection presenting as a solitary pulmonary nodule in a 51-year-old asymptomatic adult patient.

Female↗

PubMed2006

Drug-associated organizing pneumonia: high-resolution CT findings in 9 patients.

OBJECTIVE: To assess the high-resolution computed tomography appearances of drug-associated organizing pneumonia (OP). MATERIALS AND METHODS: Nine patients with clinical and biopsy proven drug-associated OP were included in the study. High-resolution computed tomography exams were retrospectively reviewed by 2 observers for the presence, extent, and distribution of parenchymal abnormalities. RESULTS: The commonest findings consisted of air space consolidation (n = 8) and ground-glass opacification (n = 7). The air space consolidation was bilateral and asymmetric in 7 patients, symmetric in 1 patient and in all cases involved mainly the peribronchial or subpleural regions or both. The ground-glass opacities were predominantly bilateral and asymmetric in 6 patients and unilateral in 1 patient. They had a patchy distribution in 4 patients, were diffuse in 2 patients, and subpleural in 1 patient. CONCLUSION: Drug-associated OP most commonly presents with bilateral, asymmetrical air space consolidation in a predominantly peribronchial and subpleural distribution.

Adult↗

PubMed2006

Clinical significance of nontuberculous mycobacteria isolated from respiratory specimens in Korea.

STUDY OBJECTIVES: Precise epidemiologic data regarding nontuberculous mycobacterial (NTM) lung infection in many Asian countries have been relatively unavailable. In order to determine the clinical significance of NTM isolated from respiratory specimens, we reviewed medical records from all patients from whom NTM isolates were recovered within a 2-year period. MATERIALS AND METHODS: We identified all NTM isolates from respiratory specimens at the Samsung Medical Center (Seoul, South Korea) obtained from January 2002 to December 2003. We then reviewed the clinical and radiologic characteristics of the patients from whom NTM was isolated. Patients were classified as having either definite, probable, or unlikely NTM lung disease, as defined by the guidelines of both the American Thoracic Society and the British Thoracic Society. RESULTS: During the study period, 1,548 NTM isolates were recovered from 794 patients. Of these 794 patients, 131 patients (17%) were determined to have definite NTM lung disease, and 64 patients (8%) were designated as probable disease candidates. The most commonly involved organisms in the definite and probable NTM lung disease cases were Mycobacterium avium complex (n = 94, 48%) and Mycobacterium abscessus (n = 64, 33%). In 195 patients with NTM lung disease, 82 patients (42%) manifested the upper lobe cavitary form, 101 patients (52%) exhibited the nodular bronchiectatic form, and 12 patients (6%) exhibited the unclassifiable form. CONCLUSIONS: About one fourth of the patients in whom NTM was isolated from respiratory specimens were found to have clinically significant NTM lung infections. The spectrum of organisms responsible for the NTM lung disease in these Korean patients differed from those reported in other regions of the world. However, the estimates of clinical significance in this study may be underestimates due to the retrospective analysis. Some of the patients might have "true" NTM lung disease that could be diagnosed with continued evaluation and follow-up.

Adult↗

PubMed2006

Early intervention can improve clinical outcome of acute interstitial pneumonia.

STUDY OBJECTIVES: To report on our experience with acute interstitial pneumonia (AIP) in which patients underwent early diagnostic procedures and received mechanical ventilation with a "lung-protective" strategy and early institution of immunosuppressive therapy. DESIGN: A retrospective chart review. SETTING: A tertiary referral hospital. PARTICIPANTS: Ten patients with AIP who presented with idiopathic ARDS and showed diffuse alveolar damage on surgical lung biopsy specimens from July 1995 to March 2004. MEASUREMENTS AND RESULTS: The median age of patients was 65.5 years (age range, 38 to 73 years). Patients presented with a median duration of severe dyspnea of 9.5 days (range, 2 to 34 days) at the hospital visit. All patients required mechanical ventilation beginning at median time of hospital day 1 (range, hospital day 0 to 5), which continued for a median duration of 9.5 days (range, 4 to 98 days). Patients received ventilation in the pressure assist-control mode with a median tidal volume of 6.97 mL/kg (range, 6.05 to 8.86 mL/kg) and median positive end-expiratory pressure of 11 cm H(2)O (range, 8 to 16 cm H(2)O). An aggressive diagnostic workup for respiratory infection, including BAL at a median time of hospital day 2 (range, hospital day 1 to 5) was performed. High-dose steroid pulse therapy was initiated on median hospital day 3.5 (range, hospital day 1 to 8), while surgical lung biopsy was performed on median hospital day 4 (range, hospital day 2 to 7). Eight patients (80%) survived to hospital discharge. CONCLUSION: Earlier intervention, such as an aggressive diagnostic approach, mechanical ventilation with lung-protective strategy, and the early institution of immunosuppressive may improve clinical outcome in patients with AIP.

APACHE↗

PubMed2006

Idiopathic interstitial pneumonias: prevalence of mediastinal lymph node enlargement in 206 patients.

OBJECTIVE: The purposes of our study were to determine the prevalence of mediastinal lymphadenopathy in idiopathic interstitial pneumonias, correlate their presence with high-resolution CT (HRCT) findings, and assess the potential value of mediastinal lymphadenopathy in the differential diagnosis of idiopathic interstitial pneumonias. MATERIALS AND METHODS: The study included 206 consecutive patients from three medical centers with pathologically proven idiopathic pulmonary fibrosis (n = 136), non-specific interstitial pneumonia (NSIP) (n = 47), cryptogenic organizing pneumonia (COP) (n = 16), respiratory bronchiolitis-interstitial lung disease (RB-ILD) (n = 5), and desquamative interstitial pneumonia (DIP) (n = 2). HRCT scans were retrospectively reviewed for the presence of mediastinal lymphadenopathy (short-axis diameter, >or= 10 mm), predominant parenchymal pattern, and extent of disease. RESULTS: Mediastinal lymphadenopathy was seen in 139 (67%) of 206 patients, including 90 (66%) of 136 with idiopathic pulmonary fibrosis, 38 (81%) of 47 with NSIP, six (38%) of 16 with COP, and five (71%) of seven with RB-ILD or DIP. The presence of enlarged nodes was less common in COP than in the other idiopathic interstitial pneumonias (p = 0.04). No significant difference was found in the prevalence of lymphadenopathy in patients with predominant ground-glass opacity (53%) or predominant reticulation (40%). The extent of parenchymal abnormalities was 25-50% in 74 patients (53%), 50-75% in 30 (22%), < 25% in 22 (16%), and > 75% in 13 (9%). A positive correlation between the extent of disease and presence of lymphadenopathy was seen in patients with NSIP (p = 0.01). CONCLUSION: Mediastinal lymphadenopathy is a common feature in idiopathic interstitial pneumonias, being slightly less common in COP than in the other idiopathic interstitial pneumonias. The presence of lymphadenopathy therefore has limited value in the differential diagnosis. In patients with idiopathic pulmonary fibrosis, the presence of lymph node enlargement did not correlate to any specific HRCT pattern or to the extent of disease.

Diagnosis, Differential↗

PubMed2006

Do hemodynamic studies of stage T1 lung cancer enable the prediction of hilar or mediastinal nodal metastasis?

OBJECTIVE: We aimed to identify CT enhancement characteristics that predict hilar or mediastinal nodal metastasis in patients with stage T1 lung cancer. SUBJECTS AND METHODS: Eighty-four patients (50 men and 34 women; age range, 39-80 years; mean age, 61 years) with stage T1 lung cancer underwent a hemodynamic and a conventional morphologic CT study before curative surgical resection. Peak enhancement (maximum attenuation over the entire time course), net enhancement (peak enhancement minus preenhancement attenuation), maximum enhancement ratio (MER), time to peak enhancement, slope of enhancement on dynamic studies, nodule size, presence of tumor necrosis or thickening of bronchovascular bundles, and marginal characteristics on morphologic studies were analyzed and correlated with the presence of histologically determined mediastinal or hilar nodal metastasis. RESULTS: Mediastinal or hilar nodal metastases were found at surgery in 26 (31%) of 84 patients: mediastinal nodes in 13 (15%) and hilar nodes in 19 (23%). Six (7%) had both mediastinal and hilar nodal metastasis. Peak enhancement, net enhancement, and MER were significantly associated (p = 0.001, 0.002, and 0.008, respectively) with the presence of mediastinal or hilar nodal metastasis. A peak attenuation of 110 H or greater and a net enhancement of 60 H or greater predicted nodal metastasis with accuracies of 73% (61/84 nodules) and 73% (61/84 nodules) and odd ratios of 4.98 and 5.94, respectively. CONCLUSION: Stage T1 lung cancers showing peak enhancement of 110 H or greater or net enhancement of 60 H or greater on dynamic CT indicate a high likelihood of hilar or mediastinal nodal metastasis.

Adult↗

PubMed2006

Focal parenchymal lung lesions showing a potential of false-positive and false-negative interpretations on integrated PET/CT.

OBJECTIVE: We describe a number of benign focal lung lesions with increased 18F-FDG uptake that simulate lung cancer and malignant lesions that lead to false-negatives due to little 18F-FDG uptake on integrated PET/CT images. CONCLUSION: The integration of clinical history, morphologic findings of lung parenchymal lesions on the CT component, and metabolic activities on the PET component of integrated PET/CT can help reduce false interpretation of the study. A lung biopsy may be needed for lesions showing increased 18F-FDG uptake on PET for tissue confirmation irrespective of their morphology on CT.

Adult↗

PubMed2006

Bronchial and nonbronchial systemic arteries in patients with hemoptysis: depiction on MDCT angiography.

OBJECTIVE: In this pictorial essay, we show the usefulness of MDCT angiography for visualization of the bronchial and nonbronchial systemic feeder vessels responsible for hemoptysis. CONCLUSION: By providing thin-section transaxial, multiplanar reconstruction, and 3D images, CT angiography using MDCT allows comparable or better images than conventional angiography with respect to the depiction of bronchial or nonbronchial systemic arteries. CT angiography is particularly useful for visualizing the ectopic origin of bronchial arteries and nonbronchial systemic collateral arteries.

Adult↗

PubMed2006

Adenovirus pneumonia in adults: radiographic and high-resolution CT findings in five patients.

OBJECTIVE: The purpose of this study was to describe the radiographic and high-resolution CT (HRCT) findings of adenovirus pneumonia in five patients. CONCLUSION: Adenovirus pneumonia in adults appears as bilateral patchy parenchymal opacities on chest radiographs and as bilateral ground-glass opacities with a random distribution with or without consolidation on HRCT images. These findings, however, are not specific for adenovirus pneumonia.

Adenovirus Infections, Human↗

PubMed2006

Pulmonary sclerosing hemangioma presenting as solitary pulmonary nodule: dynamic CT findings and histopathologic comparisons.

OBJECTIVE: The purpose of this study was to describe the dynamic CT findings of pulmonary sclerosing hemangioma presenting as a solitary pulmonary nodule and to compare these findings with histopathologic findings. CONCLUSION: On dynamic CT, sclerosing hemangioma has strong and rapid enhancement attributed histopathologically to the presence of hemangiomatous or papillary components in the tumor.

Adult↗

PubMed2006

Main bronchial reconstruction with sparing of pulmonary parenchyma for benign diseases.

Main bronchial reconstruction is anatomically suitable for benign main bronchial stenosis. But, it has been hardly recommended for operative mortality and morbidity. This study was aimed at providing validity and the proper clinical information of bronchoplasty for benign main bronchial stenosis by reviewing the results we obtained over the last ten years for main bronchial reconstruction operations. We retrospectively reviewed admission and office records. Twenty eight consecutive patients who underwent main bronchoplasty were included. Enrolled patients underwent main bronchial reconstruction for benign disease (tuberculosis in 21, trauma in 4, endobronchial mass in 3). Concomitant procedures with main stem bronchoplasty were performed in 19 patients. There were no incidences of postoperative mortality and significant morbidity. There were 2 cases of retained secretions, and these problems were resolved by bronchoscopy or intubation. All of the patients are still alive without obstructive airway problem. Bronchoplasty should be considered as one of the primary treatment modalities, if it is anatomically feasible.

Adolescent↗