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대한흉부영상의학회 월례집담회 증례발표 January 2019

대한흉부영상의학회 월례집담회 증례발표 January 2019. 분당서울대병원 신 윤 주. 58/M C.C.: Blood tinged sputum and dyspnea after strenuous exercise PMHx.: none. 2010-07-20 outside chest CT. 2010-08-06 Chest CT (contrast) + 3D. Title. Bronchoscopy (2010-11-03). Bronchoscopy (2010-11-03).

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대한흉부영상의학회 월례집담회 증례발표 January 2019

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  1. 대한흉부영상의학회월례집담회증례발표 January 2019 분당서울대병원 신 윤 주

  2. 58/M C.C.: Blood tinged sputum and dyspnea after strenuous exercise PMHx.: none

  3. 2010-07-20 outside chest CT

  4. 2010-08-06 Chest CT (contrast) + 3D

  5. Title Bronchoscopy (2010-11-03)

  6. Bronchoscopy (2010-11-03) Bronchial washing negative CT상 bleeding focus및endobronchial lesion이의심되었던 LLL posterobasal segment중LB10의subsegemental branch에서 hemoptysis가관찰되나특별한endobronchial lesion은관찰되지않았음. Bronchial washing, "LLL basal", all negative - Cytology: Negative for malignant cells - Gram stain: Rare(<1) WBC , No Bacteria - 일반미생물: no microorganism isolated - M. tuberculosis Complex: Negative for M.tuberculosis

  7. 2015-11-26 Chest HRCT 2015-11-26

  8. 2018-12-19 chest HRCT 2018-12-19

  9. 2015-11-26 Chest HRCT Title 2018-12-19 chest HRCT CBC including eosinophil count, coagulation lab, sputum culture: all negative

  10. 58/M C.C.: Blood tinged sputum and dyspnea after strenuous exercise (*amateur marathoner) PMHx.: none

  11. Hospital course 2010-07-20: 마라톤운동. 2년전부터 호흡이답답함, 정상운동을과하게하면호흡곤란증가, 간혹혈담 2010-08-03: hemoptysis 는 없음 2010-11-02: 최근운동하면서마라톤 후 혈담, 이후호전 2010-11-23: no hemoptysis기침, 가래 2015-11-24: 심한 운동후 : 마라톤, 산악 마라톤 : 100 k 울트라 혈담이 간혹 나옴 : 22일 2018-12-11: 그동안 운동을 계속함, 울트라 마라톤 100km, 9월 300km 달리는 중 심하게 운동하면BTS, 이후 서서히 감소함, 대회중 BTS 2019-01-10: 울트라 마라톤 100km,  하루 15-20km, 강도가 낮아 혈담 -

  12. over 5-6km/hr

  13. Exercise-Induced Pulmonary Hemorrhage (EIPH) • Occurs frequently in Thoroughbred horses; almost all thoroughbreds demonstrate bleeding in the lower respiratory tract after a race. Lung 2006; 184:331–333, Tuberc Respir Dis 2015; 78:375–379 Veterinary Medicine-Research and Reports, 2016; 7:133–148

  14. Exercise-Induced Pulmonary Hemorrhage (EIPH) • Occurs frequently in Thoroughbred horses; almost all thoroughbreds demonstrate bleeding in the lower respiratory tract after a race. • Exercise-induced pulmonary hemorrhage/edema (EIPH/EIPE) in human. • Marathon runners, triathletes, cyclists, and swimmers. • Clinical manifestations: asymptomatic, dyspnea, hemoptysis, epistaxis • Mechanism: capillary wall tearing / remodeling of small pulmonary veins. • Exercise elevates pulmonary capillary pressures, can affect the integrity of the blood-gas barrier. With extreme exertion, these changes result in increased permeability. High pulmonary vascular pressure results in pulmonary vein wall remodeling, and diminished vein lumen diameter. • Image findings • - Radiograph: patchy infiltration in both lower lung fields • - CT: multifocal diffuse, patchy ground glass opacity and interlobular septal thickening on both lungs  permeability pulmonary edema or pulmonary hemorrhage were compatible Lung 2006; 184:331–333, Tuberc Respir Dis 2015; 78:375–379 Veterinary Medicine-Research and Reports, 2016; 7:133–148

  15. Exercise-Induced Pulmonary Hemorrhage (EIPH) Two weeks after avoiding exercise Five days after avoiding exercise Management: lack of information of a medication or management in the treatment and prevention of EIPH/EIPE in humans.

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