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肺吸蟲症의 X-線學的硏究

Roentgenological Studies of the Pulmonary Paragonimiasis

중앙의학 1964년 7권 6호 p.713 ~ 734
김재섭,
소속 상세정보
김재섭 (  ) - 서울적십자병원 방사선과

Abstract


A group of 41 puppies and adult dogs were subjected to artificial infection with metacercariae of Paragonimus Westermani, and x-rays were taken at one week intervals.
Then a ccmparative study was made with the roentgenological findings and the histopathological findings of autopsy. Bithionol treatment was given to 8 of these animals in order to make a comparative observation with the control group, and the following results were obtained:
1) Roentgenological findings of the experimental pulmonary paragonimiasis are classified as increasing in lung markings, pneumothorax, infiltrative, nodular and. ring shadows, pleural effusion, pleural thickening with adhesions and hilar enlargement. In this experiment pneumothorax and infiltrative shadows appeared in two, weeks following infection, formation of nodular and ring shadows in three weeks. After 4?5 weeks all of the above findings appeared in all infected cases but the ether findings were observed only in a few infected cases.
2) The outstanding pathological changes in the lung tissue within 3?4 weeks of infection were hemorrhagic and exudative inflammations due to invasion of the worms. The subsequent changes, such as exudative and proliferative inflammations in the worm cysts and around them were noted at the end of 7?8 weeks after infection. From 8?10 weeks following infection and thereafter, proliferative inflammations were also observed in the firmly established worm cysts, nodular worm eggs and around them.
3) It wr s assumed the t the pneumothorax was produced by the injury to the pleura caused by the worms; the infiltrative shadows are due to exudative inflammations; the nodular shadows are caused by the worm cysts and ether well-defined lesions and the ring shadows are caused by the air-containing worm cysts
which are communicating with the bronchus.
The shadows cf foci cf infection as appeared on the x-ray which frequently increase cr decrease in size and density, and are disappearing, interchanging or appearing as a new form are chiefly attributable to instability of lesion.
4) Of the 33 untreated cases cf the experimental pulmonary paragonimiasis, the total number of worm cysts and ether lesions determined by autopsy was 364 in contrast with the, number of shadows of lesions detected by x-ray taken immediately preceeding autopsy was 301 which correspond to 82.4% of the autopsy findings, Throughout the autopsy findings and the roentgenological examinations the right lung harbored mere lesions than the left.
5) Among the shadows cf the lesions as appeared in the x-rays of the experimental pulmonary paragonimiasis with Bithionol therapy, it is worth noting that the homogeneous infiltrative shadows most rapidly decrease and disappear or tend to stabilize, and the same changes take place in the ring, nodular and non-homogeneous shadows in order mentioned, It is, therefore, understood that these tendencies are attributable to diminution cf hemorrhage and inflammation, shrinking and collapsing of worm cysts including degenerative changes and death with eventual dissolution of worms.
6) In view cf this experimentation the characteristic appearing of infiltrative, nodular and ring shadows and their subsequent changes are not only significant guides to diagnosis of human pulmonary paragonimiasis but the process of comparatively rapid decrease and disappearance or stabilization following administration of drug may also be very helpful to determine their healing process as well as diagnosis.
(II) Roentgenological Studies of the Human Pulmonary Paragonimiasis
In cases of proven pulmonary paragonimiasis, routine x-ray films of 610 patients, tomograms of 35 patients and follow-up x-rays of 110 cases who have been treated with Bithionol were studied and the following results were obtained:
1) Of the 610 cases of routine x-rays 75 cases (12.3%) were found to be negative while the rema ining 535 cases (87.7%) showed positive pathology, such as infiltrative shadows were found in 70% of the total 640 cases, nodular shadows in 48.2% and ring shadows in 44.7% respectively, The total number of cases which showed such shadows were 513 cases (84.1%), From the standpoint of radiographic anatomy they are characteristic of pulmonary paragonimiasis, and may be recognized as essential findings.
The other accompanying findings were pleural thickening with adhesions in 69.4% of the total cases, increased lung markings in 16.4%, pleural effusion in 10.5%, hilar enlargement in 7.9% and pneumothorax in 7.2%.
Streaked shadows, tunnel observed-in a few cases.
In consideration of the above findings the essential findings constitute the jority of 610 cases observed, and they provided a strong evidence for feasibility of radiographic diagnosis of pulmonary paragonimiasis.
2) The size of pathological shadows varied from a smallest ring shadow of pin-point to a largest infiltrative shadow covering one-third of one lung field. But in majority the infiltrative shadows varied from thumb-tip to walnut size, the nodular shadows being 5?10mm. and the multiform ring shadows ranged from 2 to 5mm, in diameter.
3) In observing the distribution of pathological shadows, it was found that there were more in the right lung field than in the left, in the lower field 34.3%, in the middle field 34.1%, in the upper field 31.3% the lowest while the apicies contained only 3.3%.
Such a tendency as there were less involvements in the upper lung field than in lower is distinctively different from that of pulmonary tuberculosis, and it seems to be significant in making differential diagnosis radiographically.
4) It is assumed that the instability of infiltrative, nodular and ring shadows as shown by the frequent appearence of-increasing or decreasing in size and density; or undergoing disappearance, interchange and new formation was the results of changeable inflammatory reactions against worms and their products in cases of the infiltrative and nodular shadows, and depending on the conditions of air content in the cysts in case of ring shadows. It is, therefore, thought that such changes are characteristic findings in pulmonary paragonimiasis.
5) The accompanying findings as appeared in the radiograph were not s %ecific for this pathology but they provide diagnostic clue for pulmonary paragonimiasis since they appeared in £7.7% of the total cases Especially the pleural thickening with adhesions as noticed in high rntio of 69.4% of all cases may serve as a high diagnostic value.
6) Tomograms are advantageous in diagnosis of pulmonary paragonimiasis, for they eliminate the interfering shadows and the inter-burying and inter-superimposing in the pathological shadows themselves, thereby the structural changes can be observed in detail as the contrast of the pathological shadows increases considerably. Furthermore, the shadows which fail to show up on the routine radiography may appear by this method.
7) About half the total number of radiographic pathological shadows disappeared after completion of treatment with Bithionol, about three-quarters after 4?6 months and the majority disappeared after 16?18 months. It was also noted that two months after treatment the interchanging and new forms disappeared from the shadows. The effect of Bithionol which directly reflects upon the x-ray fndings was so rapid that determination of therapeutic effect as well as differential diagnosis of the pulmonary paragonimiasis is made quite possible during comparatively early stage of treatment.

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