전산화 단층 촬영을 통해 발견된 소아 기관기관지(Tracheal Bronchus)의 임상적 고찰
The Clinical Consideration of Tracheal Bronchus Detected by Computed Tomography Scan in Children
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목적:기관기관지는 기관분기부 상부의 기관의 측벽에서 기원하는 이소성 기관지로, 대개 무증상으로 우연히 발견되며, 다른 기형과 동반되는 경우가 많다. 본 연구에서는 기관기관지의 임상 양상에 대해서 알아보고자 한다. 방법:2000년 1월부터 2011년 12월까지 흉부 전산화 단층 촬영 스캔을 실시하여 기관기관지로 진단된 19례를 대상으로 이들의 증상, 방사선학적 소견, 동반 기형의 유무 등 임상 양상을 후향적으로 조사하였다. 결과:기관기관지로 진단될 때 나이는 2일부터 14세까지(평균 51개월)였으며, 남아가 12명(63.2%), 여아가 7명(36.8%)이었다. 우측 기관기관지가 18명(94.7%), 좌측 기관기관지가 1명(5.3%)으로 대부분 우측에서 기원하였고, 기관지의 수에 따라 전위형이 14명(73.7%), 과다형이 5명(26.3%)으로 전위형이 많았다. 증상은 없는 경우가 13명(68.4%)이었고, 기침 5명(26.3%), 반복적 천명이 4명(21.1%)에서 관찰되었다. 동반기형은 17명(89.5%)에서 확인되었고, 선천 심혈관계 기형이 16명(84.2%), 기관-식도루 3명(15.8%), 다운증후군 2명(10.5%)이었다. 결론:기관기관지 환자에서 호흡기계 증상은 심하지 않았으나, 다른 동반 기형들이 많이 발견되었다. 따라서 반복되는 천명과 같은 증상이 있는 경우 기관기관지 여부를 확인하고, 기관기관지로 진단된 경우에는 동반 기형 여부 등에 대한 평가가 필요하겠다. 본 연구는 연구 대상에 심혈관계 기형을 가진 환자의 빈도(84.2%)가 높아 한계를 가진다.
Abstract
Purpose:Tracheal bronchus is an aberrant bronchus arising from tracheal wall above the carina. Most cases of tracheal bronchus are asymptomatic, so they are diagnosed incidentally. Tracheal bronchus may be associated with other anomalies. The aim of this study is to evaluate the clinical characteristics of tracheal bronchus. Methods:This study was conducted on 19 children who were diagnosed as tracheal bronchus by the chest computed tomography from January 2000 to December 2011. Based on the medical record, clinical features, such as symptoms, radiologic findings, combined anomalies were evaluated retrospectively. Results:The age at diagnosis was ranged from 2 day to 14 years (mean, 51 months). Among the 19 children, twelve children (63.2%) were boys and seven children (36.8%) were girls. Eighteen children (94.7%) had right-side tracheal bronchus and one child (5.3%) had left-side tracheal bronchus. Displaced type were fourteen children (73.7%), supernumerary type were five children (26.3%). Thirteen children (68.4%) had no respiratory symptoms, but five children (26.3%) had persistent cough and four children (21.1%) had recurrent wheezing. Combined congenital abnormalities were present in seventeen children (89.5%), including congenital cardiovascular anomaly (n=14, 73.7%), trachea-esophageal fistula (n=3, 15.8%), Down syndrome (n=2, 10.5%). Conclusion:The patients with tracheal bronchus had not severe respiratory symptoms, but had many combined anomalies. So, it is necessary to consider the presence of tracheal bronchus in children with respiratory symptom, like recurrent wheezing, and to evaluate clinical significance, like combined anomaly, in tracheal bronchus patients. The limitation of this study is that the study group includes many cardiovascular disease patients (84.2%).
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