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Hzl Arama




RESPIRATORY CASE REPORTS - Respir Case Rep: 2 (1)
Cilt: 2  Say: 1 - ubat 2013

KAPAK
1.
Kapak
Cover

Sayfa I

KNYE
2.
Knye
Editorial Board

Sayfa II

OLGU SUNUMU
3.
Mesalamine Bal Akcier Toksisitesi
Lung Toxicity Due To Mesalamine
Ali hsan Yldz, Sibel zkurt, Gksel Kter, Zahide Alaam, Belgin Erkan Aydoan
doi: 10.5505/respircase.2013.43531  Sayfalar 1 - 5
Mesalamin, inflamatuvar barsak hastalklar tedavisinde kullanlan bir ila olup baka ilalar gibi interstisyel akcier hastalna sebep olabilmektedir. lseratif Kolit (K) nedeni ile mesalamin tedavisi almakta olan 39 yanda kadn hasta, ksrk, halsizlik, nefes darl yaknmalar ile bavurdu. Akcier grafisi ve toraks bilgisayarl tomografisinde bilateral yamal konsolidasyonlar grld. Klinik ve radyolojik bulgularn, lseratif kolitin akcier tutulumuna bal olabilecei veya mesalamine bal akcier toksisitesi olabilecei dnld ve mesalamin tedavisi kesildi. zleminde, 10 gn sonraki akcier grafisinin bavuru srasndakine gre belirgin dzeldii grld. Hastann solunumsal ikyetleri de geriledi. Sonu olarak; inflamatuvar barsak hastalnn akcier tutulumu yerine mesalamine bal akcier toksisitesi dnld.
Mesalamine, a widely used drug for inflammatory bowel disease, could cause pulmonary interstitial disease, like many other drugs. A 39-year-old woman with ulcerative colitis (UC) admitted with cough, dyspnea, and fatigue. Bilateral patchy alveolar infiltrations were seen on chest x-ray and tomography. Mesalamine was terminated, as the reaction was believed to be potentially caused by CU or due to the pulmonary toxicity of the drug. At the follow-up visit after 10 days, the initial infil-trations on chest radiograph improved. The patient's respiratory complaints had decreased significantly. As a result, mesalamine-induced lung toxicity was considered instead of lung involvement in patients with inflammatory bowel disease.

4.
Multipl Pulmoner Nodl Etiyolojisi: Mitral Stenoz
Etiology of Multiple Pulmonary Nodules: Mitral Stenosis
Funda Aksu, Alper Yurdasiper, Serdar Akyz
doi: 10.5505/respircase.2013.08208  Sayfalar 6 - 9
Sekiz yl nce mitral kapak replasman operasyonu geirmi olan 36 yanda erkek hasta gs ars ile bavurdu. Fizik muayenesinde gs n duvarda sternotomi skar blgesinde ilik, kzarklk ve hassasiyet dnda patoloji saptanmad. Akcier grafisinde bilateral nodler dansiteler mevcuttu. Bilgisayarl toraks tomografisinde mitral kapak dzeyinde kalsifikasyon ve her iki akcierde dank yerleimli, bazlar kalsifiye ok sayda milimetrik nodller saptand. leri tetkiklerde multipl pul-moner nodl etiyolojisini aklayacak enfeksiyz, granulomatz ya da neoplastik bir patoloji sap-tanmad ve nodller ncelikle mitral stenoza sekonder dnld. Gs arsnn nedeni sternal tel batmas olarak saptand ve operasyonla tel eksize edildi. lk bavurusundan 16 ay sonra hasta hemoptizi ve iddetli gs ars nedeni tekrar bavurdu. Kardiyak deerlendirme ile hemoptizi ve pulmoner nodllerin mitral kapak replasman operasyonu sonras inefektif warfarin kullanmna bal sol atriyum basncnda ykselmelerle seyreden pulmoner konjesyona baland. Romatizmal kalp hastalklar lkemizde halen sk olarak grlmekte olup multipl pulmoner nodl etiyolojilerinde ayrc tanda dnlmelidir.
A 36-year-old male patient, with a history of mitral valve replacement (MVR) operation eight years prior, was admitted with chest pain. A physical examination revealed no pathologies except swelling, redness, and sensitivity on the site of the scar tissue of a sternotomy. Bilateral nodular densities were detected in the chest X-ray. Computed tomography of the thorax revealed calcification at the site of the mitral valve and randomly distributed, multiple millimetric pulmonary nodules, some of which were calcified. Underlying infectious, granulomatous, or neoplastic pathologies were not detected upon further evaluation, and the nodules were accepted as secondary to mitral valve stenosis. Chest pain was due to sternal wire sutures and was completely resolved after removal of the sutures. Patient was readmitted with hemoptysis and severe chest pain 16 months after the first admission. Cardiac evaluation revealed that hemoptysis and the pulmonary nodules were caused by pulmonary congestion together with increases in the left atrial pressure, due to ineffective warfarin treatment after the MVR operation. Rheumatic heart diseases should be a part of the differential diagnosis in researching the etiology of pulmonary nodules, as they continue to be encountered frequently in Turkey.

5.
Ar Sokmasn Takiben Gelien Anafilaksi ve Diffz Alveoler Hemoraji
Anaphylaxis and Diffuse Alveolar Hemorrhage Following Bee Sting
Il Fatma Uzel, Metin Arslan, zkan Demirhan
doi: 10.5505/respircase.2013.00710  Sayfalar 10 - 13
Bcek sokmalar ve izleyen reaksiyonlar sk grlmekle beraber, hayat tehdit eden sistemik reaksiyonlara nadiren yol aarlar. Diffz alveoler hemoraji (DAH), pek ok sistemik hastaln seyrinde ve nadir durumlarda ortaya kabilmektedir. Klinik olarak hemoptizi, anemi, akcier grafisinde diffz infiltrasyonlar ve hipoksemik solunum yetmezlii tablosu grlr. Radyolojik grnm akcier demi, ciddi infeksiyon veya remi ile benzerlik tar. Ar sokmasn izleyen yarm saat iinde anafilaktik ok ve diffz alveoler hemoraji tablosu gzlenen 23 yandaki hastay sunuyoruz.
Insect stings and subsequent reactions are com-mon occurrences, but life-threatening systemic reactions are quite rare. Diffuse alveolar hemor-rhage is a clinical entity seen in many different disease processes and includes hemoptysis, anemia, diffuse radiographic pulmonary infiltrates, and hypoxemic respiratory failure, which can be severe. Radiologic features may mimic cardiogenic pulmonary edema, severe infection or uremia. We describe a 23-year-old girl who developed symptoms of anaphylactic shock and diffuse alveolar hemorrhage within 30 minutes following a bee sting.

6.
Enfekte Kistik Bronektaziye Sekonder Gelien BOOP (Broniolitis Obliterans Organize Pnmoni) ve Renal Amiloidoz
BOOP (Bronchiolitis Obliterans Organizing Pneumonia) and Renal Amyloidosis Secon-dary to Infected Cystic Bronchiectasis
Dilay imen, Mehmet Ekici, Emel Bulcun, Aydanur Ekici
doi: 10.5505/respircase.2013.19480  Sayfalar 14 - 19
Amiloidoz, amiloid olarak adlandrlan zel bir proteinin vcuttaki deiik dokularda anormal biimde depolanmas sonucunda ortaya kan bir grup hastalktr. Organize pnmoni, akcier hastalklar iinde ender grlen ama olduka karakteristik kliniko-patolojik zellikleri olan bir tablodur. Olgumuz nefes darl, ksrk, balgam, yan ars yaknmas ile hastanemize bavurdu. Postero-anterior akcier grafisinde sol parakardiak snrda heterojenite, sol sins kapal olarak izlendi. Yksek znrlkl bilgi-sayarl tomografide sol akcier st lob apikoposterior segmentte ve sol akcier alt lobda yaygn buzlu cam dansitesi zemininde retiklonodler deiiklikler, yer yer konsolide alanlar, bronektazik deiiklikler ve hacim kayb saptand. Olgunun proteinrisi olmas zerine renal amiloidoz asndan bbrek biyopsisi yapld. Patoloji sonucu renal amiloidozis ile uyumlu geldi. Fiberoptik bronkoskopide sol alt lob mukozasnda beyaz plak alanndan biyopsi yapld. Biopsi rnei organize pnmoni (interstisyel pnmoni ve interstisyel fibrozis) bulgular ile uyumlu geldi. Bu yazda, kistik bronektaziye bal gelien renal tutulumu olan sekonder amiloidoz ve broniolitis obliterans organize pnmoni olgusu sunulmutur.
Amyloidosis is group of conditions occurring as a result of abnormal storage of a specific protein, amyloid, in various tissues in the body. Organizing pneumonia, a rarely seen within lung diseases, but rather possessing a characteristic clinicopathologic features is a table. A case applied to our hospital with shortness of breath, cough, sputum, and chest pain. Heterogeneity at the left paracardiac borderline, by closing the left sinus, was observed in the posteroanterior chest x-ray. Reticulonodular changes on the basis of extensive ground-glass density, locally consolidated areas, changes in bronchiectasis, and a loss of volume in the apical-posterior segment of the upper and lower lobes of the left lung were determined by High-resolution computed tomography. Because of proteinuria, renal biopsy was performed on the basis of renal amyloidosis. The pathologic examination was consistent with renal amyloidosis. A biopsy was carried out by fiberoptic bronchoscopy in the lower left lobe mucosa from the area of white plaque. The biopsy specimen was compatible with "organized pneumonia (interstitial pneumonia and interstitial fibrosis). Secondary amyloidosis and bronchiolitis obliterans organizing pneumonia with renal involvement, progressing due to infected cystic bronchiectasis, are presented in this study.

7.
Kistik Fibrozisin Nadir Bir Komplikasyonu: Korneal Opasite
Corneal Opacity: A Rare Manifestation of Cystic Fibrosis
Sevgi Pekcan, Deniz Doru Ersz, Mehmet Kse, Gzin Cinel, Murat rke, Ebru Yaln, Uur zelik, Nural Kiper
doi: 10.5505/respircase.2013.19483  Sayfalar 20 - 22
Kistik fibrozisli hastalarn takibinde A vitamini eksikliine bal gz bulgular grlebilmektedir. Korneal opasite ve gelime gerilii ile bavurarak kistik fibrosis tans alan 11 aylk bir ocuu sunuyoruz. Korneal opasite bulgusu ile tan alan literatrde bildirilen ilk kistik fibrosis vakasdr ve erken yata bu hastalarda gz bulgular nadirdir.
Eye manifestations due to hypovitaminosis A was observed in the follow-up of patients with cystic fibrosis. Herein, we describe an 11-month-old infant with corneal opacity and growth retardation who was diagnosed as cystic fibrosis. To our knowledge, this is the first report in the literature of corneal opacity as a manifestation of cystic fibrosis. Furthermore, it is rare to encounter ophthalmic findings in cystic fibrosis at this age.

8.
lmcl Bir Di Apsesi: Desendan Nekrotizan Mediastinit
Fatal Dental Abscess: Descending Necrotising Mediastinitis
Atalay ahin, Fatih Meteroglu, smet Rezani Toptanci, Tahir evval Eren, Canan Eren
doi: 10.5505/respircase.2013.58066  Sayfalar 23 - 26
Mediastinit, mediastendeki hayati organlarn etrafnda nadir grlen enfeksiyz bir hastalktr. Desendan nekrotizan mediastinite odontojenik, farengeal, servikal enfeksiyonlar, sternotomi veya tan ve tedavi amal giriimler sebeb olur. Zamannda tan konulmaz ve uygun olarak tedavi edilmezse sonu fatal olur. Tedavideki gecikme enfeksiyonun mediastene yaylmasna yol aar. Di apsesinden muzdarip 17 yandaki kzda gelien desendan nekrotizan mediastinit olgusunu sunuyoruz.
Mediastinitis is a rare infectious disease around the vital organs in the mediastinum. Descending necrotizing mediastinitis (DNM) is caused by odontogenic, pharyngeal, cervical infections, sternotomy or diagnostic and therapeutic instrumentation. Unless it is diagnosed in a timely manner and properly treated, the outcome is fatal. Delay in treatment leads to the spread of the infection down to the mediatinum. We present a case of DNM in 17-year-old girl suffering from a dental abscess.

9.
Akcierde Solid Kitle Grnm Veren Tberkloz Olgusu
Tuberculosis Case Presented with a Solid Mass Lesion in the Lung
Sinem Nedime Skc, Levent Dalar, Cengiz zdemir, Songl Bykkale, Ayegl Akba, Sedat Altn
doi: 10.5505/respircase.2013.66376  Sayfalar 27 - 31
Tberkloz farkl radyolojik grnmlerle ortaya kabilen bir hastalktr. Sk olmamakla birlikte kitle grnmnde akcier tberklozu olgular literatrde mevcuttur. Kitle grnm ile bavuran hastalarda tberkloz tansndan emin olmak ve elik eden tmr tansn kesin dlamak bazen zor olmaktadr. Bu yazda, kliniimize akcier grafisinde kitle grnm ile bavuran, ailesinde akcier kanseri yks olan ve sigara ien (25 paket/yl) 45 yanda erkek hastada tan ve takipte yaanan glkler tartld. lkemiz gibi her iki klinik durumun da sk grld toplumlarda ayrc tannn ierdii glkler vurgulanmak istendi.
Tuberculosis can be presented with different radiological forms. Mass lesion with the diagnosis of pulmonary tuberculosis is not rare in literature. Sometimes it is challenging to be sure of the diagnosis of tuberculosis and excludes coexisting cancer in a patient presented with mass lesion. In this paper diagnostic difficulties and follow up of a 45 years old male patient with a family history of lung cancer and a smoking history (25 packs/years) who was presented with a mass lesion on his chest radiography is discussed with review of literature. We would like to emphasize the difficulties of differential diagnosis in communities in which both of the clinical situations were common.

10.
Superior Sulkus Tmrn Taklit Eden Kist Hidatik Olgusu: ntratorasik, Ekstrapul-moner, ntraossz Yerleim
A Case of Hydatid Cyst Mimicking Superior Sulcus Tumor: Intrathoracic, Extrapulmonary, Intraosseous Location
Fatih Meteroglu, Atalay Sahin, Sevval Eren
doi: 10.5505/respircase.2013.68077  Sayfalar 32 - 34
Karacier ve akcier dnda kist hidatik yerleimi seyrektir. Kaburgalarn kemik ksm gibi nadir yerle-imler, alk olmayan semptomlara yol aabilir. Cerrahi ncesi doru tan nemli olup baz vakalarda artc olabilir. Omuz ars eken gen bir erikin hastada grlen birinci kosta ekinokokoz olgusu sunuldu. Akcier grafisinde ve toraks bilgisayarl tomografisinde superior sulkus tmr phesi vard. Lezyon rezeke edildi ve histopatolojik inceleme sonucu kist hidatik tans kondu.
Hydatid cysts are rarely located outside of the liver and lungs. Exceptional locations, such as the in-traosseous part of the rib can cause unusual symp-toms. An accurate preoperative diagnosis is im-portant, but may be confusing in some cases. The presented case here is an example of echinococcosis of the first rib in a young adult who complained of shoulder pain. Plain chest x-ray and computerized tomography scan were suggestive of a superior sulcus tumor. The lesion was resected and the histopathological examination confirmed hydatid disease.

11.
Primer Pulmoner Leiomiyosarkom
Primary Pulmonary Leiomyosarcoma
Nurdan imek Veske, Glah Gnlolu, Adalet Demir, Pelin Karada, Ekrem Cengiz Seyhan, Nur rer, Sedat Altn
doi: 10.5505/respircase.2013.35744  Sayfalar 35 - 38
Leiomiyosarkom, sklkla uterus, retroperitoneum ve intraabdominal blgeden kaynaklanan, dz has hcrelerinin tmrdr. Trakeabroniyal aata dz kas hcrelerinin okluuna ramen primer pulmoner kas tmrleri ok nadirdir. Krk sekiz yanda herhangi bir ikayeti olmayan erkek hasta, tesadfen ekilen akcier grafisinde lezyon saptanmas nedeniyle merkezimize ynlendirilmiti. Bilgisayarl Toraks tomografisinde sa akcier alt lobda 4x3 cm apl kitlesel lezyon izlendi. Fluorodeoksiglukoz (FDG) iaretli Bilgisayarl Tomografi Entegrasyonlu Positron Emisyon Tomografi (PET/CT) taramada lezyonun dk FDG tutulumu mevcuttu. Tansal amal tomografi rehberliinde ine aspirasyonlar yapld. Histopatolojik tanya ulalamaynca tan ve tedavi amacyla cerrahi planland. Video yardml toraks cerrahisi (VATS) ile alt lob wedge rezeksiyonu uygulanan hastann postoperatif patoloji sonucu akcierin primer leiomiyosarkomu olarak yorumland.
Leiomyosarcoma is a tumor of the smooth muscle cells which frequently originates in the uterus, retro-peritoneum, and within the abdomen. Although there are a large number of smooth muscle cells in the tracheobronchial tree, primary pulmonary muscle tumors rarely occur. A 48-year-old male patient with no symptoms was admitted to our department following the inadvertent detection of a lesion in his chest x-ray. Through thoracic computerized tomography, a 4x3 cm diameter mass lesion was located in the lower right lobe. In the positron emission tomography-computed tomography (PET/CT) scan with a fluorodeoxyglucose (FDG) tracer, low FDG uptake was observed in the lesion. Computer tomography-guided needle aspirations were carried out. In the absence of a histopathological diagnosis, surgery was planned for diagnosis and treatment. A lower lobe wedge resection was completed using video-assisted thoracic surgery (VATS). A diagnosis of primary pulmonary leiomyosarcoma was made based on postoperative pathology results.

12.
Bronektazili Bir Hastada Gecikmi Tan: Swyer-James-MacLeod Sendromu
Delayed Diagnosis in a Patient with Bronchiectasis: Swyer-James-MacLeod Syndrome
Dilay Ahat imen, Aydanur Ekici, Emel Bulcun, Mehmet Ekici
doi: 10.5505/respircase.2013.14622  Sayfalar 39 - 43
Swyer-James/Mac Leod Sendromu (SJMS) pulmoner arter hipoplazisine bal unilateral hiperlsent akcier grnm ve bronektazi ile karakterize nadir grlen bir hastalktr. ocukluk anda geirilen viral broniolit ve pnmoniler sonras akkiz olarak gelitii dnlmektedir. Krk sekiz yanda kadn hasta, nefes darl, ksrk, balgam karma yaknmalaryla bavurdu. yksnden bu ikayetlerinin ocukluk yalarndan beri tekrarlad, 10 yl ncesine kadar kronik bronit, son 10 yldr da bronektazi ve kk hava yolu hastal tanlaryla takip ve tedavi edildii renildi. Fizik muayenesinde; solunum seslerinin iddeti sa alt blgede sola gre azalm, bilateral orta ve alt blgede ve anteriorda kaba ralleri mevcuttu. Akcier grafisinde; sol akcierde hacim kayb, radyolusensi art ve alt zonda bronektazik alanlar izlendi. Bilgisayarl tomografide; sol pulmoner arter ve dallarnn kalibrasyonu saa kyasla belirgin azalmt. SJMS ocukluk ve gen erikin dnemde tehis edilen bir hastalk olmasna karn, olgumuzda 48 yana kadar solunum ikayetleri tanmlamas nedeniyle birok kez tetkikler yaplmasna ramen tan konulmamtr. Tek tarafl hiperlsent akcier grnm saptandnda bu sendromun ayrc tanda dnlmesi gerektiini vurgulamak iin sunuyoruz.
Swyer-James/MacLeod syndrome (SJMS) is a rare disease, characterized by unilateral hyperlucent lung due to hypoplasia of the pulmonary artery and bronchiectasis. Illnesses such as viral bronchiolitis and pneumonia in childhood are thought to be an acquired form. A 48-year-old woman applied to the hospital with symptoms including shortness of breath, sputum, and cough. Her medical history revealed that these symptoms had been relapsing since her childhood. She had been diagnosed and monitored for chronic bronchitis and bronchiectasis for the past 10 years. A physical examination revealed that the respiratory sounds of the lower left lobe decreased more than the right side, and revealed coarse crackles in the both middle, anterior, and inferior hemithorax. Chest radiography showed a loss of volume of the left lung, hiperlucency, and areas of bronchiectasis in the lower left lobe. Computed tomography showed that calibration of left pulmonary artery and its branches significantly decreased compared to the right side. We present our case simply because the majority of SJMS cases are diagnosed in childhood and young adulthood; however, our patient was examined several times with the same symptoms and not diagnosed until the age of 48. This syndrome should be considered in the differential diagnosis of patients who have hyperlucent lung.

13.
Sa Pulmoner Arter Agenezisinin Elik Ettii Scimitar (Pala) Sendromu
Scimitar Syndrome Associated with Agenesis of Right Pulmonary Artery
Dilaver Ta, Ouzhan Okutan, Tuncer zksa, mer Ayten, Ersin Demirer, Turgut ztutgan
doi: 10.5505/respircase.2013.96268  Sayfalar 44 - 47
Scimitar sendromu, nadir bir hastalktr ve hipogenetik akcier sendromu olarak da bilinir. Sendrom sa pulmoner venin, vena kava inferiora drenaj ile karakterizedir. Burada sa pulmoner arter agenezisinin elik ettii Scimitar sendromu sunuldu. Yirmi bir yanda erkek hasta nefes darl, ksrk, balgam karma ikayetleri ile bavurdu. Akcier grafisinde sa akcierde volm kayb, kalp ve mediastende saa doru yer deitirme izlendi. Bronkoskopik incelemede ve toraks BTde orta lob bronu izlenmedi. Toraks BT anjiografi grntlerinde sa akcier alt loba ait venin sa hepatik vene drene olduu ve sa pulmoner arter apnda azalma izlendi. Akcier perfzyon sintigrafisinde sa akcierde total perfzyon kayb izlendi. Scimitar sendromlu hastalarda akcier grafisinde scimitar (pala) iaretinin olmas karakteristiktir. Ancak bu iaret her zaman grlmeyebilir. Akcier grafisinde volm kayb ve mediastinal ifti olan gen hastalarda dier hastalklarn yannda Scimitar Sendromu da akla gelmelidir.
Scimitar syndrome is a very rare disorder and also known as hypogenetic lung syndrome. The syndrome is characterized with anomalous connection of the pulmonary vein with the vena cava inferior. In this text, scimitar syndrome associated with pulmonary artery hypoplasia is presented. A 21-year-old male patient with complaints of cough, shortness of breath and sputum was admitted. Chest X-ray revealed volume loss of right lung and shift to the right of heart and mediastinum. The middle lobe wasnt observed in bronchoscopy and thorax CT. Thoracic CT angi-ography images revealed that vein of right lung lower lobe drains right hepatic vein and right pulmonary artery diameter is reduced. Lung perfusion scintigraphy revealed total loss of perfusion of right lung. Scimitar sign on chest X ray is characteristics for scimitar syndrome. However, this sign cannot be seen in some patients. If there is volume loss of right lung and shift to the right of heart and mediastinum, scimitar syndrome should be considered in addition to other diseases.

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