2023-ACM1-4교시-16번

30세 남자가 1개월 전부터 오른쪽 발가락이 아파서 병원에 왔다. 1개월 전부터 5번째 발가락 끝에 통증과 궤양이 시작되었다고 한다. 15갑·년의 흡연력이 있다. 혈압 121/75 mmHg, 맥박 58회/분, 호흡 18회/분, 체온 36.5℃ 이다. 발끝은 차갑고 발등은 벌겋게 보인다. 발가락 사진 (사진 9-1)과 컴퓨터단층촬영 사진(사진 9-2)이다. 치료는?<editable-image src="https://bzxuobvwdrvtfqhmvczv.supabase.co/storage/v1/object/public/images/16106" elements="null"></editable-image><editable-image src="https://bzxuobvwdrvtfqhmvczv.supabase.co/storage/v1/object/public/images/16107" elements="[{&quot;id&quot;:1,&quot;x1&quot;:258.33333333333337,&quot;y1&quot;:1872.048611111111,&quot;x2&quot;:969.4444444444445,&quot;y2&quot;:3038.715277777778,&quot;type&quot;:&quot;rectangle&quot;}]"></editable-image>

ACM1

 30세 남자가 1개월 전부터  오른쪽 발가락이 아파서  병원에 왔다. 1개월 전부터  5번째 발가락 끝에 통증과 궤양 이 시작되었다고 한다. 15갑·년의 흡연력이 있다. 혈압 121/75 mmHg, 맥박 58회/분, 호흡 18회/분, 체온 36.5℃ 이다.  발끝은 차갑고 발등은 벌겋게 보인다 . 발가락 사진 ( 사진 9-1 )과 컴퓨터단층촬영 사진( 사진 9-2 )이다. 치료는?      1. 금연 2. 동맥우회술 3. 항생제 투여 4. 자가골수 이식 5. 혈관내피성장인자 주사 - 해설:  30세 남자가  오른쪽 발가락 통증 으로 내원하였다. 1개월 전부터  새끼발가락 통증, 궤양 이 생겼다.  발끝은 차갑고, 발등은 부어있어   동맥질환 을 의심할 수 있다.  45세 이전, 흡연력 이 있으며  말단부위 허혈 증상 , CTA에서  collateral artery 가 관찰(corkscrew collaterals)되어  버거병 으로 진단할 수 있고 치료로  금연 이 가장 중요하다. 

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p.2110입니다금연 이외의 특별한 치료는 없으며 동맥 우회술은 larger vessel에 시행해볼 수 있는 치료이기에 가장 중요한 치료인 금연을 시행할 수 있습니다:)

버거병 -  버거병에서 2번선지인 동맥 우회술은 왜 답이 될 수 없나요? 

버거병

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