Pnömoni, Hindistan gibi tropikal ülkelerde en sýk görülen solunumsal problemdir. Allerjik bronkopulmoner aspergillozis (ABPA), pnömoni ve tüberküloz gibi solunumsal hastalýklar ile klinik ve radyolojik olarak karýþtýrýldýðý için genellikle tanýda ve incelemelerde atlanmaktadýr. ABPA, uzun süreli atopik astmalý hastalarda Aspergillus antijenine aþýrý duyarlýlýk ile karakterize, aspergillus mantarýna ait en iyi tanýmlanmýþ bir tablodur. ABPA’nýn hastaneye yatýrýlan astmatik hastalarýn %20’sinde ve tüm rinit olgularýnýn %5’inde çeþitli klinik tablolarla ortaya çýktýðý bildirilmiþtir. Burada, öksürük, ateþ, nefes darlýðý gibi yakýnmalarý ile tekrarlayan pnömoni tanýsý ile tedavi edilen, birkaç yýldýr astým olduðu bilinen orta yaþlý erkek olgu sunulmuþtur. Bu olguda, sonuçta ABPA olarak taný konmuþ ve sistemik steroid ve antifungal tedavi ile tam klinik ve radyolojik iyileþme saðlanmýþtýr.

Pneumonia is the most common respiratory problem in tropical countries like India. Allergic bronchopulmonary aspergillosis (ABPA) is routinely underdiagnosed and under evaluated as a result of clinical and radiological overlap with many other respiratory conditions, including pneumonia and tuberculosis. ABPA is the best-recognized manifestation of the fungus Aspergillus, associated with hypersensitivity to Aspergillus antigens in patients with longstanding atopic asthma. ABPA has been reported to occur in 20% of asthmatic patients admitted to hospitals and in 5% of all rhinitis cases, with varied clinical presentations. This report is a description of the case of a middle-aged male with known asthma for several years and constitutional symptoms, such as a cough, fever, and shortness of breath, who was diagnosed and treated for recurrent pneumonia. The case was eventually confirmed as ABPA, and a complete clinical and radiological response to medical treatment with antifungals and systemic corticosteroids was documented.

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Persistan trakeo-kutanöz fistül veya persistan trakeal stoma, trakeostominin geç bir komplikasyonudur. Trakeokutanöz fistül, çocuklarda, kanül çýkarýldýktan sonra trakeostominin spontan kapanmasýnýn baþarýsýz olmasýndan dolayý yaygýn olarak görülmektedir. Ancak yetiþkinlerde, bu nispeten daha az yaygýndýr. Erken ve baþarýlý dekanülasyona raðmen akciðer tüberkülozu nedeniyle kalýcý trakeal stoma ile baþvuran 38 yaþýnda bir erkek hastayý sunuyoruz.

Persistent tracheo-cutaneous fistula, or persistent tracheal stoma, is a potential late complication of a tracheostomy. It commonly occurs in children due to a failure of spontaneous closure after decannulation. In adults, however, this is relatively less common. Described is a case of a 38-year-old man who, despite undergoing early and successful decannulation, presented with a persistent tracheal stoma due to pulmonary tuberculosis.

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Diffüz alveolar hemoraji, etyolojisinde birçok nedenin olduðu, hemoptizi, anemi, diffüz akciðer infiltrasyonlarý ve solunum yetmezliði ile seyreden hayatý tehdit edici bir durumdur. Ýmmün dýþý sebepler arasýnda toksik gaz inhalasyonu da vardýr. Toksik gazlardan, toplumda uçucu madde soluyan kiþiler arasýnda çakmak gazý adýyla da bilinen sýkýþtýrýlmýþ bütan gazý, bunlardan biridir. Yirmi bir yaþýnda adliyede kâtiplik yapan erkek hasta hemoptizi ile baþvurdu. Anamnez derinleþtirildiðinde keyif amaçlý çakmak gazý soluduðu öðrenildi. Hastaya, etyolojisinde bu uçucu maddenin rol oynadýðý diffüz alveolar hemoraji tanýsý konuldu. Çakmak gazý inhalasyonunu terk ettikten sonra hemoptizi olmadý ve iki ay sonraki toraks bilgisayarlý tomografide tama yakýn regresyon mevcuttu. Sosyoekonomik durum ayýrt etmeden her hastaya madde kullanýmý sorgulamasý yapýlmasýnýn önemini vurgulayan bu olguyu sunmak istedik.

Diffuse alveolar hemorrhage is a life-threatening condition with a varied etiology and one which may be seen with hemoptysis, anemia, diffuse pulmonary infiltrates, or respiratory failure. Toxic gas inhalation is also among the non-immune causes of this disorder. Compressed butane gas, also referred to as lighter gas, is one example, and is a volatile substance inhaled by some individuals as a means to experience euphoria. A 21-year-old male patient, who was a clerk at the courthouse, was admitted with hemoptysis. A detailed history revealed experience breathing lighter gas for pleasure. The patient was diagnosed with diffuse alveolar hemorrhage, and it was concluded that this volatile substance played a role in the etiology of the condition. Hemoptysis was not observed after the patient discontinued lighter gas inhalation and near-total regression was observed in a thorax computed tomography image taken 2 months later. This report is presented to emphasize the importance of inquiring about substance use without regard for the socioeconomic status of the patient.

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Bir aydýr nefes darlýðý olan 70 yaþýndaki bayan olgu, nefes darlýðýnda artma yakýnmasý ile acil servise baþvurdu. Fizik muayenesinde bilateral aksiller lenfadenopati saptanan olgunun bir önceki yýl Kronik Lenfositik Lösemi (KLL) nedeniyle kemoterapi aldýðý belirlendi. Bilgisayarlý toraks tomografisinde hipodens lezyon tespit edildi. Yapýlan inceleme sonucunda KLL’nin akciðer tutulumu (Lenfositik infiltrasyon) saptanan olgu, az görülmesi nedeniyle literatür tartýþmasý eþliðinde sunuldu.

A 70-year-old woman who had experienced progressive dyspnea for 1 month was admitted to the emergency department. A physical examination revealed bilateral axillary lymphadenopathy and it was determined that she had undergone chemotherapy due to chronic lymphocytic leukemia (CLL) in the previous year. A hypodense lesion was observed on a thorax computed tomography image. The result of the investigation was a determination of pulmonary involvement (lymphocytic infiltration) of CLL. The case is presented in the context of a literature discussion due to the low incidence.

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Paklitaksel, mikrotübül hiperstabilizasyon yoluyla mitotik duraklamayý baþlatan bir anti-kanser ilacý olup hidrofobikliði ve hücresel seçiciliði olmamasý nedeniyle yan etkilere neden olmaktadýr. Yetmiþ bir yaþýnda erkek hasta göðüs hastalýklarý polikliniðine 2 haftadýr olan nefes darlýðý þikâyeti ile baþvurdu. Kasým 2016 ‘da mesane kaynaklý invazif ürotelyal mesane karsinom tanýsý alan hasta 2 kür Paklitaksel tedavisi almýþtý. Hastanýn posteroanterior akciðer grafisinde bilateral periferik infiltrasyonlarý mevcuttu. Yüksek Rezolüsyonlu Bilgisayarlý Tomografide her iki akciðerde saðda daha belirgin olmak üzere periferal-subplevral interlobüler septal kalýnlaþmalar, retiküler dansiteler, buzlu cam yoðunluk alanlarý, periferal yamasal fokal konsolide alanlar izlendi. Özellikle her iki alt lob posterobazal segmentlerde periferal yerleþimli traksiyon bronþektaziler izlendi. Bronþ lavajýnda; hiperplastik rezerv hücreler, makrofajlar, bakteri kümeleri, PNL izlendi, atipik hücre gözlenmedi. Hastada mevcut bulgularla Paklitaksel toksisitesi düþünüldü, kemoterapisi sonlandýrýldý ve metilprednizolon tedavisi baþlandý. Metilprednizolon tedavisinin birinci ayýnda kontrol akciðer grafisinde regresyon izlendi. Paklitaksel’e baðlý akciðer toksisitesisinin nadir görülmesi nedeniyle bu olguyu sunduk.

Paclitaxel is an anti-cancer drug that induces mitotic arrest via microtubule hyperstabilization, but which also causes side effects due to its hydrophobicity and cellular promiscuity. A 71-year-old male patient presented at the polyclinic with dyspnea present for 2 weeks. In November 2016, the patient had been diagnosed with bladder-derived invasive urothelial bladder carcinoma and received 2 cycles of paclitaxel therapy. High-resolution computed tomography revealed peripheral-subpleural interlobular septal thickening, reticular densities, ground-glass density areas, and peripheral focal consolidation in both lungs, particularly on the right. Peripheral traction bronchiectasis was also observed, especially in the posterobasal segments of both lower lobes. Bronchial lavage revealed hyperplastic reserve cells, macrophages, bacterial clusters, and polymorphonuclear leukocytes, but no atypical cell were observed. The infection was ruled out. Chemotherapy was terminated and methylprednisolone (0.75 mg/kg) was initiated. Regression was observed in a control posteroanterior chest graphy after 1 month of steroid therapy. This case was presented because lung toxicity due to paclitaxel is rare.

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Eozinofilik akciðer hastalýklarý, artmýþ kan veya doku eozinofilisi ile birlikte seyreden hastalýklarýn oluþturduðu geniþ bir gruptur. Ýlaca baðlý eozinofilik pnömoni, pulmoner infiltratlarla birlikte kan veya doku eozinofilisiyle seyreden bir durumdur. Yirmi sekiz yaþýnda kadýn hasta, 3 haftadan beri baþlayan ateþ, üþüme ve öksürük þikâyetiyle polikliniðimize baþvurdu. Daha önce pnömoni tanýsýyla 15 gün antibiyoterapi almýþ ve þikâyetlerinde deðiþiklik olmamýþtý. Özgeçmiþinde sacroileit nedeniyle sülfasalazin kullanýmý mevcuttu. Romatoloji tarafýndan tetkik edilip baþka bir sistemik hastalýk saptanmamýþtý. Akciðer grafisinde bilateral periferik subplevral opasiteler, kan sayýmýnda lökositozu ve eozinofilisi mevcuttu. Toraks bilgisayarlý tomografide bilateral periferik buzlu cam dansitesinde opasiteler, septal kalýnlaþmalar ve retiküler dansiteler saptandý. Eozinofilisi olmasý, antibiyoterapiye yanýt vermemesi, baþka sistemik hastalýðý olmamasý nedeniyle bulgularýnýn sülfasalazin kullanýmýna baðlý olabileceði düþünüldü. Sülfasalazin kesilip prednizolon tedavisi baþlanýldý. Hastanýn semptomlarý dramatik bir þekilde düzeldi. Kan tablosu düzeldi. Radyolojik olarak tam regresyon izlendi. Olgumuz sülfasalazin kullanýmýna baðlý geliþen eozinofilik pnömoni tablosudur. Ýlaç öyküsünün her pulmoner deðerlendirmede dikkatle ele alýnmasý önemlidir.

Eosinophilic lung disease encompasses a large group of diseases caused by increased blood or tissue eosinophilia. Eosinophilic pneumonia due to prescription drug use is a condition in which pulmonary infiltrates with blood or tissue eosinophilia are seen. A 28-year-old female patient admitted to the outpatient clinic with complaints of fever, chills, and a cough of 3 weeks duration. She had been taking antibiotics for 15 days with a diagnosis of pneumonia, but her complaints did not change. Her history revealed the use of sulfasalazine due to sacroiliitis. A rheumatology examination detected no other rheumatic disease. A posteroanterior chest X-ray showed bilateral peripheral opacities. A peripheral blood count revealed leukocytosis and eosinophilia. A thoracic computed tomography image revealed bilateral peripheral ground glass opacities, septal thickening, and reticular densities. Based on the findings of eosinophilia, no response to antibiotics, and no other systemic disease, it was considered that the condition might be related to the use of sulfasalazine. Sulfasalazine was discontinued and prednisolone therapy was started. The patient's symptoms improved dramatically, and the abnormal blood values returned to normal. Radiologically, complete regression was observed. This was a case of eosinophilic pneumonia due to the use of sulfasalazine. It is important that drug history is handled carefully in every pulmonary evaluation.

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Ýnterstisyel akciðer hastalýklarýnýn % 2,5-3’ünün ilaçlarla iliþkili olarak ortaya çýktýðý bildirilmektedir. Ýlaçlar, solunum sisteminin tüm komponentlerinde, yan etkileri gösterebilmektedirler. Altmýþ sekiz yaþýnda kadýn hasta 2 haftadýr olan öksürük ve ateþ yakýnmalarý ile solunum hastalýklarý polikliniðine baþvurdu. Fizik muayenesinde, solunum sisteminde bilateral alt zonlarda raller duyuldu. Özgeçmiþinde depresyon nedeniyle sertralin kullanma öyküsü vardý. Yapýlan klinik deðerlendirme, radyolojik görüntüleme ve laboratuvar neticelerin sonunda hastaya ilaçlara baðlý interstisyel akciðer hastalýðý tanýsý kondu. Ýlaçlara baðlý interstisyel akciðer hastalýklarý nadir görüldüðünden literatüre katký saðlamak amacýyla olguyu sunuyoruz.

It has been reported that 2.5% to 3% of interstitial lung diseases are related to prescription drugs. Drugs can demonstrate side effects in all components of the respiratory system. A 68-year-old woman was admitted to the department of respiratory diseases with a history of a cough and fever present for 2 weeks. A physical examination revealed crackles in the bilateral lower zones of the respiratory system. She had a history of using sertraline for depression. Based on the results of the clinical evaluation, radiological imaging, and laboratory findings, the patient was diagnosed with interstitial pulmonary disease emerging as a side effect of prescription drug use. As drug-related interstitial lung disease is rare, this case is presented as a contribution to the literature.

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Kalýtsal faktör VII eksikliði, nadir görülmesine raðmen, kalýtsal faktör eksiklikleri içinde en fazla otozomal resesif geçiþ gösteren bir hastalýktýr. Asemptomatik olabildiði gibi, çoðunlukla mukoza kanamasý, eklem ve kas içi kanama, intrakraniyal kanama gibi kanama diatezi bulgularý ile seyredebilir. Öte yandan çok ender olarak bu hastalarda arteriyel veya venöz tromboz bildirilmiþtir. Kliniðimizde pulmoner tromboemboli tanýsý alan bir kalýtsal faktör VII eksikliði tanýlý olguyu sunuyoruz.

Hereditary factor VII deficiency is rare recessive autosomal disorder. It may be asymptomatic and typically presents with signs of bleeding diathesis, such as mucosal bleeding, joint and muscle hemorrhage, or intracranial hemorrhage; arterial and venous thrombosis is rare in the literature. Presently described is a case of a patient who had hereditary factor VII deficiency diagnosed with pulmonary thromboembolism.

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Konjenital lober amfizem; akciðerin bir veya daha fazla lobunun hiperekspansiyonu, bunun çevredeki normal akciðer dokusuna basýsý ve mediastinal kayma ile karakterli bir respiratuvar distres nedenidir. Yeni doðan döneminde solunum sýkýntýsýna yol açmakla birlikte, ender olarak semptomlarýn ortaya çýkýþý altýncý aya kadar gecikebilir. Nadir görülen bir hastalýktýr. Spontan pnömotoraks ile karýþtýrýlmasý ve ciddi olgularda uygulanan acil cerrahi müdahale ile klinik tablonun dramatik olarak düzelmesi nedeniyle önem taþýmaktadýr. Kliniðimizde solunum sýkýntýsý, sýk sýk enfeksiyon nedeniyle medikal tedavi alan 4 ve 27 aylýk iki erkek olgu yatýrýldý. Her iki olguya da lober amfizem nedeniyle sol üst lobektomi yapýldý. Cerrahi iþlem sonrasý takiplerinde genel durumlarýnda ve solunum düzeylerinde ciddi düzelmeler olan iki olguyu sunmayý amaçladýk.

Congenital lobar emphysema is a cause of respiratory distress characterized by hyperexpansion of 1 or more lobes of the lung, compression onto the ipsilateral or contralateral functional pulmonary parenchymas, and a resultant mediastinal shift. The onset of symptoms may be delayed until the age of 6 months, although the disease causes dyspnea in newborns or infancy. It is a rarely seen disease. Awareness is important due to confusion with pneumothorax and the possibility of considerable clinical improvement with early surgical intervention, even in severe cases. Two male patients with failed conservative treatment, 4 and 27 months of age, were hospitalized in this clinic because of respiratory distress and repeated infections. A left upper lobectomy was performed due to lobar emphysema in both patients. The goal of this report was to present the improvement in respiratory function and general condition of 2 patients observed after surgical management.

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