e-ISSN 2147-2475

Hzl Arama




RESPIRATORY CASE REPORTS - Respir Case Rep: 8 (1)
Cilt: 8  Say: 1 - ubat 2019

OLGU SUNUMU
1.
Akcier Kanseri Olarak Yanl Tan Alan mmn Sistemi Salkl EBUS-TBA ile nvazif Pulmoner Aspergillozis Tansnn Konan Bir Olgu
A Case of Invasive Pulmonary Aspergillosis in an Immunocompetent Patient Diagnosed by EBUS-TBNA, Misdiagnosed as Lung Cancer.
Taeyun Kim, Hyunji Choi, Jinyoung Lee, Jehun Kim
doi: 10.5505/respircase.2019.49140  Sayfalar 1 - 5
Aspergillozis rnekleri doada yaygn olarak bulunmaktadr. Aspergillus, immn sistemi bozulmu hastalarda hayat tehdit eden invazif pulmoner aspergillozise (IPA) neden olabilmektedir. IPA semptomlar nonspesifik ve radyolojik bulgular eitli olduu iin tans zor bir hastalktr. Gs st ksmnda iki haftadr devam ar nedeniyle, 68 yandaki kadn hasta Gs Hastalklar blmne ynlendirilmiti. Bilgisayarl tomografide akcier kanserinden phe edildi. Endobronial ultrason rehberliinde transbronial ine aspirasyonu (EBUS-TBA) yapld ve IPA tans histolojik olarak kondu. Bu, Korede EBUS-TBA ile IPA tans konan ilk olgu sunumudur. Kitlesel akcier lezyonlarnn tansnda EBUS-TBAnn rolnn artmas beklenmektedir.
Aspergillus species are widely distributed in nature. Aspergillus can cause life-threatening invasive pulmonary aspergillosis (IPA) in patients with impaired immune function. IPA is difficult to diagnose because the symptoms are nonspecific and the radiologic findings can be various. A 68-year-old female was referred to the department of pulmonology for right upper chest pain for two weeks. Computed-tomography (CT) scan showed suspicion of lung cancer, then endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed. IPA was diagnosed histologically. In Korea, this is the first report of IPA diagnosed through EBUS-TBNA. The role of EBUS-TBNA in the histological diagnosis of mass like lung lesions is expected to expand.

2.
Mesleksel Eksojen Lipoid Pnmoni: Genellikle Gecikmi Tan
Occupational Exogenous Lipoid Pneumonia: A Commonly Delayed Diagnosis
Feriel Dhouib, Mounira Hajjaji, Kaouthar Jmal Hammami, Mohamed Larbi Masmoudi
doi: 10.5505/respircase.2019.19971  Sayfalar 6 - 9
Exogenous lipoid pnmoni seyrek grlen bir hastalktr ve mesleksel etyoloji de nadirdir. Mesleki maruziyete bal olgular, genellikle sifonerler ve ate yutanlar gibi lipid maddelerin aspirasyonundan kaynaklanrlar. Biz, makinalar onaran ve yalama iin ya spreyi kullanan bir hastada, eksojen lipoid pnmoni olgusunu sunuyoruz. Hastann mesleki maruziyetlerinin ihmal edilmesi nedeniyle tans iki yl gecikmiti. Ana tedavi, nedensel ajana maruz kalmann nlenmesidir. zlemlerinde klinik ve radyolojik iyileme grld.
Exogenous lipoid pneumonia is an uncommon disease and an occupational etiology is rare. Occupational cases are usually related to aspiration of lipid substances, such as in cases of those who siphon fuel and fire-eaters. Presented here is a rare case of exogenous lipoid pneumonia in a mechanic using a grease spray for lubrication in whom diagnosis was delayed for 2 years because physicians initially neglected to consider his occupational history. Avoidance of occupational exposure to the causal agent was the main treatment and subsequent monitoring confirmed clinical and radiological improvement.

3.
Soliter Pulmoner Nodl ile Karan Pulmoner Arteriovenz Malformasyon Olgusu
A Case of Pulmonary Arteriovenous Malformation Mimicking Solitary Pulmonary Nodule
Fatmanur elik Baaran, Canan Doan, Mine Gayaf, Ahmet Emin Erbaycu
doi: 10.5505/respircase.2019.54771  Sayfalar 10 - 13
Pulmoner arteriyovenz malformasyonlar (PAVMs) pulmoner arter ve venler arasndaki anormal balantlardr. Sklkla izole anomali eklinde grlrler ancak multiple olarak Herediter Hemorajik Telenjiektaziye elik edebilirler. Genelde asemptomatik olmakla birlikte hemoptizi ve hipoksemi klinii ile de karmza kabilmektedir. PAVMler ou zaman radyolojik olarak soliter pulmoner nodl veya multipl nodller ile karabilmektedir. Bizim olgumuzda da radyolojik olarak soliter pulmoner nodl ile karan bir radyolojik grnm mevcuttu.
Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between the pulmonary arteries and veins. They are frequently seen as isolated anomalies, but they may also occur as multiple malformations, as in cases of hereditary hemorrhagic telangiectasia. Although PAVMs are generally asymptomatic, hemoptysis and hypoxemia may also be present. Radiologically, PAVMs often mimic solitary or multiple pulmonary nodules. The present case report is a description of the radiological appearance of PAVMs mimicking a solitary pulmonary nodule.

4.
Nadir Grlen Semptomatik ntrapulmoner Bronkojenik Kist
A Rarely Seen Symptomatic Intrapulmonary Bronchogenic Cyst
Cenk Balta, amil Gnay
doi: 10.5505/respircase.2019.98700  Sayfalar 14 - 16
Bronkojenik kistler embriyonal dnemde trakeobronial aacn anormal geliimine bal olarak oluan, nadir grlen benign, kistik oluumlardr. Normal broniyal sistem gibi mukus salgs yapan hcreler, kkrdak, elastik doku ve dz kaslar ierir. ounlukla asemptomatik olmakla birlikte nadiren ksrk, ate ve hemoptizi izlenebilir. Radyolojik olarak homojen kitle ve enfektif olduunda hava - sv seviyesi ieren kistik kitleler olarak karmza kar. Bu yazda nadir grlen intrapulmoner semptomatik bronkojenik kist olgusu literatr eliinde sunulmutur.
A bronchogenic cyst (BC) is a rarely seen benign congenital malformation of the bronchial tree. These cysts are lined with secretory respiratory epithelium, and are similar to a normal bronchial tree, including cartilage, elastic tissues, mucous glands and smooth muscle. They are usually asymptomatic, but a cough, fever, and hemoptysis may be seen. On plain radiographies, cysts are homogenous lesions, but if there is additional infection, an air-fluid level can be seen. This is a description of a rarely seen symptomatic intrapulmonary bronchogenic cyst and a review of the published literature.

5.
Pulmoner Emboli Tans Hala Bir kilem mi? Hangi Skorlama Sistemi Bizi Tanya Gtrr?: Olgu Sunumu
Is the Diagnosis of Pulmonary Embolism Using Scoring Systems Still a Dilemma?: A Case Report
Alten Oskay, Cihangir elik, Kvan Karaman, Hamit Hakan Armaan, nder Tomruk
doi: 10.5505/respircase.2019.35762  Sayfalar 17 - 20
Pulmoner emboli (PE) tansn kolaylatrmak, hastalarn acil servisten gvenle taburculuunu salayabilmek, hastalar iyonizan radyasyon ve opak maddelerin komplikasyonlarndan koruyabilmek iin eitli skorlama sistemleri kullanlmaktadr. Altm alt yanda aktif erkek hasta acil servise geirmi olduu senkop nedeniyle getirildi. Hasta batc tarzdaki gs arsndan, hemoptizi ve hafif bir retrosternal sknt hissinden ikayetiydi. Vital bulgularnda hipoksemisi (SpO2=88%) mevcuttu. D-dimer deeri 165ng/mL (normal snrlar: 69-243) olarak saptand. PE olasl 2 kategorili Wellste dk, D-dimer negatiflii ile birlikte deerlendirilen rGeneva skorlama sistemlerinde %2 olarak ngrlmesine ve YEARS skalasnda tamamen dlanmasna ramen hastaya pulmoner bilgisayarl tomografi anjiografi ekildi. Her iki ana pulmoner arterde pulmoner emboli saptand. Sklkla kullanlan skorlama sistemlerinin tedavi gerektiren PEyi tanmakta yetersiz kalabildikleri grlmektedir. Klinik algnn stn olduu baz noktalar hala vardr.
Various scoring systems are used to facilitate the diagnosis of pulmonary embolism (PE), provide for the safe discharge of patients from emergency departments (EDs), and protect patients from complications caused by ionizing radiation and iodinated contrast media. A 66-year-old active male patient was brought to the ED due to syncope. He complained of a stinging type of chest pain, hemoptysis, and a mild feeling of retrosternal distress. He had hypoxemia (SpO2=88%). The D-dimer level determined was 165ng/mL (normal range: 69243 ng/mL). He was evaluated to be at low risk using the Wells Criteria, to have a 2% probability of PE according to the Geneva scoring system when viewed in combination with D-dimer negativity, and PE was excluded using the YEARS algorithm. However, computerized tomography pulmonary angiography revealed PE in 2 main pulmonary arteries. The common scoring systems may fail to recognize PE, which requires treatment. Clinical perception may still be superior.

6.
Plevral Mezotelyomal Bir Hastada Bilateral Non-arteritik skemik Optik Nropati ve Minimal Deiiklik Hastal
Minimal change disease and bilateral non-arteritic ischemic optic neuropathy in a patient with pleural mesothelioma
Senyo Tagboto
doi: 10.5505/respircase.2019.14471  Sayfalar 21 - 25
Malign mezotelyoma tipik olarak yava ilerleyen dispne ve gs ars ile kendini gstermektedir. Toraks d semptomlar ve paraneoplastik tablolar ok nadirdir. Bu maliginite ile glomerler hastalk birliktelii literatrde nadiren bildirilmitir. Bu olgu sunumunda, 26 yl nce mesleksel asbest maruziyeti olan son bir aydr yava ilerleyen grme kayb, hafif kilo kayb ve ayaklarda dem yaknmalar olan 65 yanda erkek hasta sunulmutur. Gz hastalklar uzmanlar tarafndan non-arteritik iskemik optik nropati gelitii belirlendi. leri nefrolojik incelemelerde renal biyopsi ile dorulanan minimal deiiklik hastalna bal nefrotik sendrom olduu gsterildi. Steroid tedavisi ile klinik semptomlar hzla dzeldi. Nefrotik sendrom ve ilerleyici grme kayb klinik olarak remisyona girdi ve kilo kayb dzeldi. Balang akcier grafisi yalnzca kronik deiiklikler gsteriyordu. Sekiz ay sonra nefes darl ve gs ars semptomlar ortaya kt ve sa da youn plevral sv saptand. leri incelemelerde plevral mezotelyoma tespit edildi.
Malignant mesothelioma typically presents with slowly progressive dyspnea and chest pain. Extra-thoracic symptoms and paraneoplastic presentations are very rare. The association of this malignancy with glomerular disorders has been only rarely reported in the literature. The present report describes the case of a 65-year-old man with a remote occupational exposure to asbestos more than 26 years prior who presented with a months history of slowly progressive visual loss, minimal weight loss, and pedal edema. Assessments by several ophthalmologists concluded that he had developed non-arteritic ischemic optic neuropathy. Further nephrological work-up demonstrated that he had developed nephrotic syndrome due to minimal change disease, which was confirmed with a renal biopsy. His clinical symptoms rapidly improved with steroid treatment. The nephrotic syndrome went into clinical remission, his progressive visual loss improved, and there was no further weight loss. The initial chest X-ray performed when he first presented was reported as showing only chronic changes. He reported the symptoms of shortness of breath and chest pain 8 months later and was found to have a large right pleural effusion. Further investigation revealed pleural mesothelioma.

7.
Fluorourasil, Leucoverin ve Oxaliplatin Tedavisine Sekonder Akcier Toksistesi: Olgu Sunumu
Pulmonary Toxicity Secondary to Fluorouracil, Leucoverin and Oxaliplatin Treatment: A Case Report
Fatma Tokgz Akyl, Mustafa Akyil, Erdem en, Meltem Aca, Tlin Sevim
doi: 10.5505/respircase.2019.43433  Sayfalar 26 - 30
Gnmzde, FOLFOX (5-fluorourasil, leucoverin ve oxaliplatin) ileri evre veya metastatik
gastrointestinal sistem tmrlerinde ilk srada kullanlan kemoteraptik rejimdir. Bu rejimin
hematolojik, gastrointestinal ve sensrinral sistem ile ilgili yan etkileri bilinmesine karn pulmoner
toksisitesi snrl sayda olgu bildirimleri dzeyindedir. Hzla ilerleyerek mortal seyredebileceinden
akcier toksisitesinin erken farkndal ve tedavisi nemlidir. Bu yazda, metastatik zofagus kanseri
nedeniyle kullanlan FOLFOX tedavisine sekonder gelien interstisyel akcier hastal olgusu nadir
olmas nedeniyle sunulmutur.
To date, 5-fluorourasil, leucovorin, and oxaliplatin (FOLFOX) continues to be used as a first-line treatment for advanced or metastatic gastrointestinal system tumors. Though associated hematological, gastrointestinal, and neurosensory toxicities are widely known, pulmonary toxicity has solely been described in case reports. Early diagnosis and treatment is extremely important, since the toxicity may lead to rapid deterioration and mortality. Presently described is the case of a female patient with interstitial lung disease secondary to undergoing a FOLFOX regimen for metastatic esophagus cancer.

8.
Tc-99m DTPA Klirens Ynteminin Amiodaron'un ndkledii Akcier Hasarnn Uzun Dnem Takibinde Tansal Gc
The Diagnostic Facility of Tc-99m DTPA Clearance Method in the Long Term Follow-up of Improvement of Amiodarone-Induced Lung Damage
Zehra Pnar Ko, Pelin zcan Kara, Mukadder alkolu
doi: 10.5505/respircase.2019.59251  Sayfalar 31 - 34
Amiodaronun tetikledii akcier hasar (ATAH) bu ilacn doz kstlayc nemli bir yan etkisi olup tans klasik morfolojik yntemlerle zordur. Amiodaron nemli bir antiaritmik ila olsa da ciddi yan etkileri olup bunlardan birisi de akcier hasardr. Daha nceki gzlemler, Tc-99m DTPA klirensi hesaplanmasnn bu akcier hasarn gstermede doru bir yntem olduunu gstermitir. Elli sekiz yanda erkek hasta, antiaritmik ila olarak amiodaron kullanmaktayd. Hasta dispne yaknmas ile geldi ancak konvansiyonel BT sonucu tansal bir bulgu vermedi. ATAH tans ve ilacn kesilmesinden sonra uzun dnem takibinde Tc-99m DTPA grntleme yntemi kullanld. Bu olgu sunumu, Tc-99m DTPA klirensinin ATAH tans ve uzun dnem tedavi takibinde yeterli bir metod olduunu gstermektedir.
Amiodarone-induced lung damage (AILD) is a well-defined and important side effect of this drug which is challenging to diagnose with the classic morphological imaging methods. Although amiodarone is an efficient antiarrhythmic agent, there can be severe side effects, including lung damage. Previous observations have demonstrated that the technetium-labeled diethylenetriamine pentaacetate (Tc-99m DTPA) clearance method is an accurate imaging modality in AILD. A 58-year-old male patient who used amiodarone as an antiarrhythmic agent presented with severe dyspnea but conventional computed tomography imaging revealed nothing diagnostic. Tc-99m DTPA clearance imaging was performed for the diagnosis and long-term follow-up of AILD after cessation of treatment. This case report describes the presence of AILD and long-term follow-up results of improvement using the Tc-99m DTPA clearance method.

9.
Hiperkapnik Solunum Yetmezlii ve Yksek Akm Nazal Oksijen Tedavisi
Hypercapnic Respiratory Failure and High Flow Nasal Oxygen Therapy
Fatma rem Yeiler, Deniz Kosoval, mit Gkhan endur, Abdlhamit Sutukolu, Mustafa Kemal Bayar
doi: 10.5505/respircase.2019.47113  Sayfalar 35 - 39
Akut hipoksemik solunum yetmezlikli hastalarda, konvansiyonel oksijen tedavisi yerine son yllarda stlm ve nemlendirilmi yksek akmda oksijenin nasal kanlle (HFNC) uygulanmas poplarite kazanmtr. Bu uygulama ile anatomik l boluk, nazofaringeal diren azalmas, pozitif ekspiratuar basn etki ve alveoler rekrtment salanr. Hastalarn konforu ve toleransn arttrd, solunum iini ve saysn azaltt ve deiik etyolojilere bal solunum yetersizliklerinde solunum desteini arttrma gereksinimini azaltt saptanmtr. Hiperkapnik solunum yetmezlikli hastalarda da solunum iini, solunum saysn azalttn, ventilasyon etkinliini, tidal volm ve egzersiz toleransn arttrdn gsteren almalar mevcuttur. ki olgumuzu da kronik obstrktif akcier hastalna bal hiperkapnik solunum yetmezliinde noninvaziv mekanik ventilasyon tedavisinin etkin olmad durumlarda yksek akmda oksijenin nasal kanlle uygulanmasnn etkinliini gstermek ve kullanmna ynelik farkndal arttrmak amacyla sunuyoruz.
The use of heated and humidified high-flow nasal cannula oxygen (HFNC) is increasingly popular in place of conventional oxygen therapy for patients with acute hypoxemic respiratory failure. HFNC oxygen rapidly alleviates symptoms of respiratory distress and the effort to breathe through several mechanisms, including dead space washout, reduction in inspiratory nasopharyngeal resistance, and a positive airway pressure effect that may generate alveolar recruitment. HFNC oxygen increases the comfort and tolerance of patients and reduces the requirement for respiratory support in patients with respiratory failure. Several studies have shown that HFNC oxygen may also reduce breathing effort and respiratory rate, and increase alveolar ventilation, tidal volume, and exercise tolerance in patients with hypercapnic respiratory failure. Presently described are 2 cases in which a HFNC system was used to successfully manage hypercapnic respiratory failure secondary to chronic obstructive pulmonary disease in 2 patients unable to tolerate conventional noninvasive mechanical ventilation. This report is presented in order to draw attention to the use of HFNC oxygen in patients with hypercapnic respiratory failure.

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