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Pulmonary tuberculosis : differential imaging findings between young and elderly patients

Other Titles
 노인과 젊은 환자에서 폐결핵의 방사선학적 차이 
Authors
 고성민 
Issue Date
2005
Description
Dept. of Medicine/석사
Abstract
[한글] 연구 목적: 활동성 성인 폐결핵 환자에서 임상적 소견과 방사선학적 소견을 비교분석하여 노인 환자들이 젊은 환자들과 비교하여 차이가 있는지 알아보았다./연구의 대상과 방법: 균배양 검사로 확진된 성인 폐결핵 환자 295명을 대상으로 65세 이하를 젊은환자, 65세 이상을 노인환자로 구분하여 내원시 증상, 동반 질환, 이전 병력, 그리고 위험 인자 등을 조사하였다. 두 명의 흉부방사선과 의사가 단순흉부사진과 전산화단층촬영 소견을 후향적으로 분석하였다. 통계 분석은 SPSS 10.0을 이용하여 두 집단간의 임상적, 방사선학적 소견의 유의차가 있는지 Chi-square test로 검정하였다. /연구 결과: 295명의 환자들 중 젊은 환자들은 154명 (남:여 = 82 : 72, 평균연령 29세)이었고 노인 환자들은 141명 (남:여 = 76 : 55, 평균연령 73세) 이었다. 노인 환자들에게서 과흡연, 만성폐쇄성 폐질환, 당뇨병, 그리고 악성 종양의 동반 빈도가 높았다, 노인 환자들에게서 호흡곤란이, 젊은 환자들에게선 각혈이 많은 것을 제외하곤 두 집단 간에 임상적인 차이는 없었다. 단순 흉부 방사선학적 소견에서 노인 환자군은 광범위하며 중등도 이상의 폐침윤과 흉막삼출을, 젊은 환자군은 상엽에 국한된 폐침윤과 공동을 많이 보였다. 속립성 미세결절, 종괴양 병변, 그리고 림프절 비대는 두 집단간에 차이는 없었다. 결핵의 경기관지 파급의 빈도, 비전형적 위치, 비분절형 분포, 그리고 위치에 관계없이 하엽의 기저구역 분포는 두 집단간에 차이가 없었다. 그러나 노인 환자군에서 중등도 이상의 경기관지 파급, 융합성 경화, 그리고 흉막 삼출이 많았으며, 젊은 환자군에서 공동의 발생 빈도는 높았으나 병변에서 공동의 숫자는 두 집단간에 차이가 없었다. /결론: 젊은 폐결핵 환자군의 각혈, 전형적 위치의 폐침윤과 공동형성에 비해 노인 환자군은 호흡곤란, 기저부를 포함한 광범위한 폐침윤, 융합성 경화, 그리고 흉막삼출을 보였다.
[영문]This paper is aimed at demonstrating clinical and imaging features helpful for the differentiation of pulmonary tuberculosis in young and elderly patients./This study included 295 adults with positive culture for Mycobacterium tuberculosis who had not been treated for current diseases. The following medical records were collected: concomitant or prior diseases, potential risk factors, and symptoms at the time of presentation. Two chest radiologists analyzed the chest radiographs and CT scans, retrospectively. Statistical analysis was done using a software package (SPSS 10.0). The differences for clinical and radiologic findings were determined with the chi-square test./The following results were found from this study. Among 295 patients with culture-proven TB, 141 were 65 years of age and older (range: 65 to 86; mean: 73) and 154 under 65 years of age (range: 20 to 64; mean: 29). There was a higher incidence of heavy smoking, COPD, DM and malignancy in the elderly patients. Symptoms between both groups had no significant differences. However, dyspnea was more common in elderly patients, and hemoptysis in young adults. Age-related differences in radiographic presentation of disease included the more frequent occurrence of diffuse and moderate to extensive infiltrates in the elderly patients and of localized upper lung zone infiltrates and cavitary lesion in the younger patients. There were no significant differences between the two groups in the incidence of miliary shadows, mass like lesion, and lymph node enlargement on chest radiograph./There were no significant differences in CT findings between the two groups in the incidence, unusual localization, nonsegmental distribution, and basilar involvement of bronchogenic spread of tuberculosis. But it was more common in the elderly group than in the young group to have moderate to severe extent of bronchogenic spread, confluent consolidation and pleural effusion. Cavity within any given lesion was more frequently noted in the young group than the elderly group but the number of cavity was not different between two groups./The above result gives rise to the following conclusion: The elderly patients more commonly presented dyspnea, and showed widespread infiltrates including basal portion and confluent consolidation than the young who showed hemoptysis, typical upper lung zone infiltration, and cavity formation. Our results could help considering TB as a diagnosis in the elderly even in the absence of classic symptoms and radiologic findings./
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1. College of Medicine (의과대학) > Others (기타) > 2. Thesis
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/122314
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