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논문KCI 등재

타인 동종 말초혈액 조혈모세포이식 후 발생한 공기-누출 증후군 1예

Air-leakage syndrome after allogeneic peripheral blood stem cell transplantation from an unrelated donor

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초록

Bronchiolitis obliterans, a late, non-infectious pulmonary complication of bone marrow transplantation (BMT), is an obstructive airway disease associated with chronic graft-versus-host disease (cGVHD). We report a rare case of air-leakage syndrome including pneumothoraces, pneumomediastinum, and subcutaneous emphysema with bronchiolitis obliterans after allogeneic peripheral blood stem cell transplantation (PBSCT) from an unrelated donor. The pathogenesis of air-leakage syndrome is not fully understood, and its management has not yet been established. This patient was treated with high-concentration oxygen, tube thoracostomy, percutaneous drainage with a pigtail catheter to relieve the tension pneumomediastinum, and mechanical ventilatory support. The patient has now recovered and is being followed on an outpatient basis. (Korean J Med 74:445-450, 2008)Bronchiolitis obliterans, a late, non-infectious pulmonary complication of bone marrow transplantation (BMT), is an obstructive airway disease associated with chronic graft-versus-host disease (cGVHD). We report a rare case of air-leakage syndrome including pneumothoraces, pneumomediastinum, and subcutaneous emphysema with bronchiolitis obliterans after allogeneic peripheral blood stem cell transplantation (PBSCT) from an unrelated donor. The pathogenesis of air-leakage syndrome is not fully understood, and its management has not yet been established. This patient was treated with high-concentration oxygen, tube thoracostomy, percutaneous drainage with a pigtail catheter to relieve the tension pneumomediastinum, and mechanical ventilatory support. The patient has now recovered and is being followed on an outpatient basis. (Korean J Med 74:445-450, 2008)

Abstract

Bronchiolitis obliterans, a late, non-infectious pulmonary complication of bone marrow transplantation (BMT), is an obstructive airway disease associated with chronic graft-versus-host disease (cGVHD). We report a rare case of air-leakage syndrome including pneumothoraces, pneumomediastinum, and subcutaneous emphysema with bronchiolitis obliterans after allogeneic peripheral blood stem cell transplantation (PBSCT) from an unrelated donor. The pathogenesis of air-leakage syndrome is not fully understood, and its management has not yet been established. This patient was treated with high-concentration oxygen, tube thoracostomy, percutaneous drainage with a pigtail catheter to relieve the tension pneumomediastinum, and mechanical ventilatory support. The patient has now recovered and is being followed on an outpatient basis. (Korean J Med 74:445-450, 2008)Bronchiolitis obliterans, a late, non-infectious pulmonary complication of bone marrow transplantation (BMT), is an obstructive airway disease associated with chronic graft-versus-host disease (cGVHD). We report a rare case of air-leakage syndrome including pneumothoraces, pneumomediastinum, and subcutaneous emphysema with bronchiolitis obliterans after allogeneic peripheral blood stem cell transplantation (PBSCT) from an unrelated donor. The pathogenesis of air-leakage syndrome is not fully understood, and its management has not yet been established. This patient was treated with high-concentration oxygen, tube thoracostomy, percutaneous drainage with a pigtail catheter to relieve the tension pneumomediastinum, and mechanical ventilatory support. The patient has now recovered and is being followed on an outpatient basis. (Korean J Med 74:445-450, 2008)

참고문헌 (12)

  1. Holland HK, "Bronchiolitis obliterans in bone marrow transplantation and its relationship to chronic graft-vs-host disease and low serum IgG", Blood, 72, pp.621~627 (1988)
  2. Roca J, "Fatal airway disease in an adult with chronic graft-versus-host disease", Thorax, 37, pp.77~78 (1982)
  3. Philit F, "Post-transplant obstructive lung disease (“bronchiolitis obliterans”): a clinical comparative study of bone marrow and lung transplant patients", Eur Respir J, 8, pp.551~558 (1995)
  4. Crowford SW, "Bronchiolitis associated with bone marrow transplantation", Clin Chest Med, 14, pp.741~749 (1993)
  5. Clark JG, "Risk factors for airflow obstruction in recipients of bone marrow transplants", Ann Intern Med, 107, pp.648~656 (1987)
  6. Dudek AZ, "Bronchiolitis obliterans in chronic graft-versus-host disease: analysis of risk factors and treatment outcomes", Biol Blood Marrow Transplant, 9, pp.657~666 (2003)
  7. Galanis E, "Spontaneous pneumomediastinum in a patient with bronchiolitis obliterans after bone marrow transplantation", Bone Marrow Transplant, 20, pp.695~696 (1997)
  8. Hill G, "Mediastinal emphysema in marrow transplant recipients", Bone Marrow Transplant, 2, pp.315~320 (1987)
  9. Vogel M, "Spontaneous thoracic air-leakage syndrome in patients following allogeneic hematopoietic stem cell transplantation: causes, CT-follow up and patient outcome", Eur J Radiol, 60, pp.392~397 (2006)
  10. Toubai T, "Mediastinal emphysema and bilateral pneumothoraces with chronic GVHD in patients after allogeneic stem cell transplantation", Bone Marrow Transplant, 33, pp.1159~1163 (2004)
  11. Matsumoto K, "Bronchiolitis obliterans in a patient with chronic graft-versus-host disease after bone marrow transplantation", Nippon Kyobu Shikkan Gakkai Zasshi, 34, pp.345~349 (1996)
  12. Chadwick C, "Autologous blood pleurodesis for pneumothorax complicating graft-versus-host disease- related bronchiolitis obliterans", Bone Marrow Transplant, 33, pp.451~453 (2004)

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