Transcript F/U - 숨이편한내과

10년간 경험한 흥미로운
폐암 증례
숨이편한 내과
호흡기 내과 전문의
이 은우

low dose spiral CT, autofluorescence
bronchoscopy associated protocols
1.LDCT protocol
-GGO pattern -
size(mm)
Pure GGO, Mixed GGO (extent of
solid portion ≤ 50%)
Mixed GGO (extent of solid
portion > 50%)
≤ 5 mm
F/U CT at 12months
 If no change, F/U CT annually
F/U CT at 6 months,
 If no change, F/U CT annually
> 5mm, ≤10mm
F/U CT at 6months
 If no change, F/U CT annually
F/U CT at 6 months,
 If no change, VATS
≥10mm
F/U CT at 6months
 If no change, F/U CT annually
F/U CT at 6 months,
If no change,
PCNB or VATS
If size increased , PCNB or VATS recommanded,F/U: follow up
PCNB: percutaneous needle biopsy, VATS: video assisted thoracic surgery
LDCT protocol
-solid Nodule -
Nodule Size(mm)
≤ 5 mm
F/U
F/U CT at 12 months
 If no change, no further FU
> 5mm, ≤10mm
Initial F/U CT at 3~6 months,
Second F/U CT at 6 months,
Third, fourth F/U CT at 12 months
If no change, no further FU
≥10mm
<Option 1>
Initial F/U CT at 3 months,
Second F/U CT at 6 months,
Third, fourth F/U CT at 12 months
If no change, no further FU
<Option 2>
PCNB or VATS
If size increased , PCNB or VATS recommanded,F/U: follow up
PCNB: percutaneous needle biopsy, VATS: video assisted thoracic surgery
2.Autofluorescence Bronchoscopy
Protocol
AFB : Abnormal lesion
detected
Biopsy
Dysplasia
Carcinoma In Situ and
more
Moderate to Severe
Metaplasia
Mild
Operation,PDT,
F/U AFB
F/U AFB
F/U AFB
electrocautary etc
at 3month
at 6 month
at 6~12 month

형광기관지내시경으로 확진한 조기 폐암
M/61 전 ○ 의
C/C : Dyspnea & chest discomfort with
cough
P/I :상기자는 평소 특별한 증상없이 건강하게
지내던 중, 2006.12.5 상기 C/C로 본원 OPD
방문함

P/H :
Admission Hx (-)
Operation Hx (-)
Pul. Tbc(+) ; 40yrs-ago
DM/ HTN / Hepatitis - / - / 
S/H :
Alcohol (+) ; Social
Smoking (+) ; 100PYs(2yrs-ago, quit)

F/H : N-S
Chest PA (06.12.5)
Chest LDCT
ONCO-LIFE
병리소견
병리소견
Final Diagnosis
1. Severe dysplasia in Lt. lingular segment
2. Old pulmonary Tbc.
M/61 서 ○ 조
C/C :
Rt. Chest discomfort (D; 4-5 years)
P/I : 상기자는 4-5년전부터 상기 C/C로 본원과
전대병원에서 Chest CT & EGD등 시행하였으
나 특이소견없어 특별한 치료없이 지내오다가,
상기 C/C 지속되어 본원 OPD 내원함

P/H : Admission Hx (-)
Operation Hx (-)
DM/ HTN / Pul. Tbc / Hepatitis - /- / - /


S/H : Alcohol (+) ; Social
Smoking (+) ; 40PYs
F/H : N-S
Chest PA (06.12.18)
Chest LDCT (06.12.18)
ONCO-LIFE (06.12.19)
병리소견
병리소견
Final Diagnosis
1. Carcinoma in situ in RUL post. segment
2. Bullae in RUL

수술이 불가능한 환자에서 치료내시경 시
술 후 호흡곤란이 호전된 증례
문 O 기(M/66)


C/C : Rt. Chest pain, coughing, blood tinged
sputum, mild resting dyspnea
(O: 20 days ago)
P/H : 20여년 전 glaucoma Tx.
2년 전 DM, CVA Dx. at 본원
No known Hx. Of HTN, pul. Tbc, Hepatitis
No Operation Hx.


S/H : Alcohol : None
Smoking : None
P/I :
상기 환자는 20일 전부터 발생한 Rt. Chest pain 및
cough, blood tinged sputum, mild resting dyspnea있어
Home observation 중 Sx. Aggravation되어 local 들려 check한
chest X-ray 상 pneumonia 소견보여 further evaluation위해 본
원 OPD visit
Diagnosis plan
1.
Chest X-ray
2.
Laboratory
3.
Chest CT(enhance)
4.
Bronchoscopy
Chest PA/Lt. Lat
Chest CT(enhance)
Onco-Life
bronchoscopy
Bronchoscopy
Chest PA (F/U)

소세포 폐암도 아주 초기에 발견되면 수술
된다는 교훈을 준 증례
M/56 조 ○ 오
C/C : blood-tinged sputum
(o; 내원 3일전)
P/I : 상기 환자는 3달 전부터 cough, sputum 있었으나
observation중 3일전부터 상기 C/C소견 보여 본원 PD OPD 방
문함.

P/H :
No known Hx of DM, Hypertension, Hepatitis, Pul.
Tbc


S/H : Alcohol - None
Smoking - 30pys (1갑 x 30년)
F/H : Non-Specific
Chest PA & Lt. lateral(01.09)
HRCT ( 08.01.09 )
Bronchoscopy( 08.01.09 )
S08-157
LCA
Chromogranin
PET-CT
Final Diagnosis

Small cell lung carcinoma (stage 1)