The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
WCIM 2014 SEOUL KOREA 307
Poster Session
PS 1227 Cardiology
A Case of Idiopathic Aortitis with Left Renal Vein Thrombosis
Hyeon Jeong Yun1, Ki Tae Bang1 Daejeon Eulji University Hospital, Korea1
A 38-year-old man was admitted to the hospital because of abrupt left fl ank pain. He had no fever and physical examination revealed tenderness of the left costovertebral angle. Laboratory data revealed WBC 16060/μl, CRP 0.93 mg/dl. Urinalysis showed more than 1/2 red cells per high-power fi eld with severe proteinuria (4+). Enhanced computed tomography (CT) showed the thickened abdominal aorta wall with partial thrombus. The thickened aorta wall compressed the left renal vein and it caused left renal vein thrombosis. Abdominal CT fi ndings suggested aortitis of the abdominal aor- ta with complication. We could exclude other types of aortitis including autoimmune aortitis, Takayasu’s arteritis, GCA, and infectious causes based on a serologic test and the history of the patient. Therefore, the patient was diagnosed with idiopathic aor- titis and treated with glucocorticoid. After treatment, his symptoms disappeared and a follow-up CT showed decreased mural thickening of the abdominal aorta. Isolated idiopathic aortitis presented with renal vein thrombosis is extremely rare and has not been reported in Korea yet. We present a rare case report on idiopathic aortitis of the abdominal aorta with complication of left renal vein thrombosis.
PS 1228 Pulmonology
Is Economic Status Related to Chronic Obstructive Pulmonary Disease? Results from a Population-Based Survey
Tae-Seon Oh1, Yousang Ko1, Mi-Yeong Kim1, Hyun-Kyung Lee1, Young Min Lee1, Young Seok Lee1
Division of Pulmonary Allergy and Critical Care Medicine, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Korea1
Background: The prevalence of chronic obstructive pulmonary disease (COPD) has increased annually and is predicted to be the third most frequent cause of deaths world- wide by 2020. Though economic status was known as the risk factor of COPD, little has been studied between these conditions. We evaluated the relationship between econom- ic status and COPD in a representative sample of the general population in South Korea.
Methods: We retrospectively analyzed 2,844 individuals included in the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV), a prospectively administered survey performed in 2009 by a government organization within the Ministry of Health and Welfare. After adjustment of risk factors for COPD (age, sex, chemical exposure, asthma history, bronchiectasis, sinusitis, pulmonary tuberculosis history, smoking history, air pollution exposure, and economic status), multivariate logistic regression analysis was performed to evaluate the association between eco- nomic status and COPD.
Results: Of the 2,844 subjects included in this analysis, 392 (13.8%) had COPD. The mean age of these 2,844 individuals was 56±11 years and 1616 (56.8%) were female.
In economic status, 790 subjects (27.8%) was high, 700 (24.6%) was middle to high, 671 (23.6%) was low to middle, and 658 (23.1%) was low. The prevalence of COPD was 8.6% in high economic status, 10.1% in middle to high, and 14.6% in low to middle, 22.6% in low. Multivariate logistic regression showed that the odds ratios for COPD were 1.0 (95% CI: 0.65-1.53) in middle to high economic status, 1.4 (95% CI:
0.92-2.14) in low to middle economic status, and 1.9 (95% CI: 1.22-3.07) in low eco- nomic status (reference, high economic status; P=0.014).
Conclusions: Individuals with low economic status are at higher risk of COPD than those with high economic status, suggesting poverty is a risk factor for COPD.
PS 1229 Pulmonology
Copd-Assessment Test (CAT) and Modifi ed Medical Research Council (MMRC): Prognostic Factors for Associated the Readmission or Mortality Due to Re-Ex- acerbation of Copd within 6 Months
Jiwon Choi1, Myoung kyu Lee1 Wonju Christian Hospital, Korea1
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are important causes of hospital admission and mortality. We evaluated CAT score and mMRC as prognostic factors associated the readmission or mortality due to re-exac- erbation of COPD within 6 months.
Methods: Prospective study was enrolled 314 patients who hospitalized with severe AECOPD. We collected demographic, clinical and laboratory fi ndings at admission. Lung function was evaluated using the COPD assessment test (CAT) questionnaire, the modi- fi ed Medical Research Council (mMRC) dyspnea scale, and spirometry in the stable state.
Results: The mean age was 72.2 ± 9.4 years (76.4% of male), and the rate of re- admission within 6 months was 50.0% and 180-day-mortality rate was 18.2%.The baseline CAT score categorized into four groups (0-9, 10-19, 20-29, and 30-40) and mMRC was also categorized into 4 groups (0-1, 2, 3 and 4) as a dyspnea scale. The 180-day-mortality according CAT score was 0/11 (0%) 9/102 (8.8%), 30/146 (20.5%) and 18/55 (32.7%) and re-admission was 0/11 (0%), 20/102 (19.6%), 91/146 (62.3%) and 46/55 (83.6%) respectively. The 180-day-mortality according mMRC was 1/29 (3.4%), 25/158 (15.8%), 19/100 (19.0%) and 12/27 (44.4%) and re-admission was 2/29 (6.9%), 63/158 (39.9%), 70/100 (70.0%) and 22/27 (81.5%) respectively. CAT score (P < 0.001) and mMRC (P < 0.001) were signifi cantly associated with both 180–day-mortality and readmission due to severe AECOPD in multivariate analysis and showed a good accuracy to predict the mortality and readmission due to severe AECOPD.
Conclusions: Our study suggested that CAT and mMRC could be valid prognostic fac- tors to identify patients at further risk of exacerbation and mortality so can be used in clinical practice for more appropriate management and follow up on patient with severe AECOPD.
PS 1230 Pulmonology
A Case of Allergic Bronchopulmonary Aspergillosis with Broncholithiasis in a 55-Year-Old Woman
Chi Young Kim1, Joo Han Song1, Song Yee Lee1, Eun young Kim1, Ji Ye jung1, Young Ae Kang1, Moo Suk Park1, Young sam Kim1, Se Kyu Lee1, Joon Chang1, Kyung Soo Lee1 Division of Pulmonology, Department of Internal Medicine, The Institute of Chest Diseases, Yonsei Uni- versity College of Medicine, Korea1
Allergic bronchopulmonary aspergillosis(ABPA) is a complex hypersensitivity reaction, often in patients with asthma or cystic fi brosis that occurs when bronchi become col- onized by Aspergillus species. There are rare reports about ABPA with broncholithiasis.
We hereby report a case of ABPA with broncholithiasis in a 55-year-old woman. A 55-year-old woman was referred to the pulmonology division because of recurrent cough at night, blood tinged sputum and wheezing for 3 months. Chest computed tomography scan showed bronchiectasis and broncholith in the lateral segmental bronchus of the right middle lobe and the anterobasal segmental bronchus of the right lower lobe. Bronchoscopy revealed that broncholith was impacted in the opening of lateral segment bronchus of the right middle lobe without recent endobronchial bleeding. She was discharged with symptoms improvement after conservative care with antibiotics. However she readmitted 2month later because previous symptoms of cough, wheezing and blood tinged and purulent sputum were aggravated. We decided bronchoscopic broncholith removal because purulent exudate outfl owed behind bron- cholith in the lateral segment bronchus of the right middle lobe. The about 1cm sized broncholith was broken to pieces with a lithotomy forcep and completely removed.
Pathology of the specimen showed degenerated septate fungal hyphae and spores, morphologically consistent with Aspergillus spp. At the same time, the laboratory re- sults revealed a peripheral eosinophilia and positive precipitating serum antibodies to A.
fumigatus, which was satisfi ed with a diagnosis of ABPA. ABPA with broncholith is an extremely rare condition. This is the second reported case of ABPA with broncholithia- sis in Korea. This can contribute to literature due to its rarity and unusual presentation of ABPA. We recommend that the clinicians should consider broncholith as a possible result of ABPA.
