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KMID : 0369319930130040509
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Allergy
1993 Volume.13 No. 4 p.509 ~ p.520
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Clinical usefulness of high resolution chest CT in patients with chronic obstructive pulmonary fuction
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박중원
남동호/홍천수/조희경/최규옥
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Abstract
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It is well known that long standing bronchial wall inflammation, smoking and aging process were major etiology of chronic obstructive lung diseases. Bronchial asthma accompanied with COPD is not uncommon in habitual smoker or old ages. Because
the
sympoms of COPD are similar to uncomplicated asthma, distingushing these patients from uncomplicated bronchial asthma is difficult. In chest PA, the findings such as over distention of chest, amputation or distortion of vascular marking , and
thickening
of bronchial wall suggest pulmonary emphysema and bronchiectasis but the diagnostic is low. So the emphysema and bronchiectasis are not infrequently missed in mild tomoderate cases of COPD. The high resolution chest CT(HRCCT) was recently
recognized as
a valuable diagnostic tool for parenchymal lung diseases, emphysema and bronchiectasis. For the evaluation of associated parenchymal or bronchial pathology, we obtained HRCCT in 23 cases with obstructive pulmonary function state; 13 cases of
irreversible pulmonary obstruction ald 10 cases of bronchial asthma and the results were as follow.
1. We could find emphysema in 15(65%) cases, thickening of bronchial wall in 12(52%) cases, bronchiectasis in 6(26%) cases and bullae in 5(22%) cases.
2. In all 13 cases of irreversible chronic obstruction abnormal HRCCT were recognized. Emphysema was the most common finding (10 cases) and bronchial wall thickening (3 cases), and multiple bullae (3 cases) were followed.
3. In HRCCT of 10 cases of chronic bronchial asthma, we could find emphysema in 4 cases, bronchiectasis in 4 cases, emphysematous bullae in 2 cases and bronchial wall thickening in 4 cases. Among the 3 cases of steroid responsive asthma, there
were no
specific abnormal findings of HRCCT in 2 case but mild bronchial wall thickening was noticed in one case.
4. According to the severity of obstruction by the criteria of FEV1/VC, the emphysema scores were significnatly higher in moderately obstructive group(n=10: FEV1/VC<70%) of predicted value) than normal group (n=13:FEV1/VC≥70%) of predicted
value,
55.7±34.1 v.s. 22.1±24.5).
5. The emphysema score was correlated well with FEV1(r=-0.6012), FEV1/VC(r=-0.6270), FEF25 75(r=-0.6506), PEFR(r=-0.5878) and Raw(r=0.5533).
HRCCT is a useful noninvasive diagnostic tool for the evaluation of underlying bronchial and parenchymal pathology in lung. Abnormal HRCCT findings such as emphysema, bronchiectasis, bullae, and bronchial wall thickening were found frequently in
cases
with chronic obstructive pulmonary diseases. Therefore we can conclude that HRCCT is a valuable tool for predicting the prognosis and for deciding the strategy of the management of bronchial asthma.
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KEYWORD
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