Aspergillozis örnekleri doðada yaygýn olarak bulunmaktadýr. Aspergillus, immün sistemi bozulmuþ hastalarda hayatý tehdit eden invazif pulmoner aspergillozise (IPA) neden olabilmektedir. IPA semptomlarý nonspesifik ve radyolojik bulgularý çeþitli olduðu için tanýsý zor bir hastalýktýr. Göðüs üst kýsmýnda iki haftadýr devam aðrý nedeniyle, 68 yaþýndaki kadýn hasta Göðüs Hastalýklarý bölümüne yönlendirilmiþti. Bilgisayarlý tomografide akciðer kanserinden þüphe edildi. Endobronþial ultrason rehberliðinde transbronþial iðne aspirasyonu (EBUS-TBÝA) yapýldý ve IPA tanýsý histolojik olarak kondu. Bu, Kore’de EBUS-TBÝA ile IPA tanýsý konan ilk olgu sunumudur. Kitlesel akciðer lezyonlarýnýn tanýsýnda EBUS-TBÝA’nýn rolünün artmasý 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.

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Exogenous lipoid pnömoni seyrek görülen bir hastalýktýr ve mesleksel etyoloji de nadirdir. Mesleki maruziyete baðlý olgular, genellikle sifonerler ve ateþ yutanlar gibi lipid maddelerin aspirasyonundan kaynaklanýrlar. Biz, makinalarý onaran ve yaðlama için yað spreyi kullanan bir hastada, eksojen lipoid pnömoni olgusunu sunuyoruz. Hastanýn mesleki maruziyetlerinin ihmal edilmesi nedeniyle tanýsý iki yýl gecikmiþti. Ana tedavi, nedensel ajana maruz kalmanýn önlenmesidir. Ýzlemlerinde klinik ve radyolojik iyileþme görüldü.

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.

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Pulmoner arteriyovenöz malformasyonlar (PAVMs) pulmoner arter ve venler arasýndaki anormal baðlantýlardýr. Sýklýkla izole anomali þeklinde görülürler ancak multiple olarak Herediter Hemorajik Telenjiektazi’ye eþlik edebilirler. Genelde asemptomatik olmakla birlikte hemoptizi ve hipoksemi kliniði ile de karþýmýza çýkabilmektedir. PAVM’ler çoðu zaman radyolojik olarak soliter pulmoner nodül veya multipl nodüller ile karýþabilmektedir. Bizim olgumuzda da radyolojik olarak soliter pulmoner nodül ile karýþan bir radyolojik görünüm 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.

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Bronkojenik kistler embriyonal dönemde trakeobronþial aðacýn anormal geliþimine baðlý olarak oluþan, nadir görülen benign, kistik oluþumlardýr. Normal bronþiyal sistem gibi mukus salgýsý yapan hücreler, kýkýrdak, elastik doku ve düz kaslar içerir. Çoðunlukla asemptomatik olmakla birlikte nadiren öksürük, ateþ ve hemoptizi izlenebilir. Radyolojik olarak homojen kitle ve enfektif olduðunda hava - sývý seviyesi içeren kistik kitleler olarak karþýmýza çýkar. Bu yazýda nadir görülen intrapulmoner semptomatik bronkojenik kist olgusu literatür eþliðinde sunulmuþtur.

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.

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Pulmoner emboli (PE) tanýsýný kolaylaþtýrmak, hastalarýn acil servisten güvenle taburculuðunu saðlayabilmek, hastalarý iyonizan radyasyon ve opak maddelerin komplikasyonlarýndan koruyabilmek için çeþitli skorlama sistemleri kullanýlmaktadýr. Altmýþ altý yaþýnda aktif erkek hasta acil servise geçirmiþ olduðu senkop nedeniyle getirildi. Hasta batýcý tarzdaki göðüs aðrýsýndan, hemoptizi ve hafif bir retrosternal sýkýntý hissinden þikayetçiydi. Vital bulgularýnda hipoksemisi (SpO2=88%) mevcuttu. D-dimer deðeri 165ng/mL (normal sýnýrlar: 69-243) olarak saptandý. PE olasýlýðý 2 kategorili Wells’te düþük, D-dimer negatifliði ile birlikte deðerlendirilen rGeneva skorlama sistemlerinde %2 olarak öngörülmesine ve YEARS skalasýnda tamamen dýþlanmasýna raðmen hastaya pulmoner bilgisayarlý tomografi anjiografi çekildi. Her iki ana pulmoner arterde pulmoner emboli saptandý. Sýklýkla kullanýlan skorlama sistemlerinin tedavi gerektiren PE’yi tanýmakta yetersiz kalabildikleri görülmektedir. Klinik algýnýn üstün olduðu bazý noktalar hala vardýr.

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: 69–243 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.

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Malign mezotelyoma tipik olarak yavaþ ilerleyen dispne ve göðüs aðrýsý ile kendini göstermektedir. Toraks dýþý semptomlar ve paraneoplastik tablolar çok nadirdir. Bu maliginite ile glomerüler hastalýk birlikteliði literatürde nadiren bildirilmiþtir. Bu olgu sunumunda, 26 yýl önce mesleksel asbest maruziyeti olan son bir aydýr yavaþ ilerleyen görme kaybý, hafif kilo kaybý ve ayaklarda ödem yakýnmalarý olan 65 yaþýnda erkek hasta sunulmuþtur. Göz hastalýklarý uzmanlarý tarafýndan non-arteritik iskemik optik nöropati geliþtiði belirlendi. Ýleri nefrolojik incelemelerde renal biyopsi ile doðrulanan minimal deðiþiklik hastalýðýna baðlý nefrotik sendrom olduðu gösterildi. Steroid tedavisi ile klinik semptomlar hýzla düzeldi. Nefrotik sendrom ve ilerleyici görme kaybý klinik olarak remisyona girdi ve kilo kaybý düzeldi. Baþlangýç akciðer grafisi yalnýzca kronik deðiþiklikler gösteriyordu. Sekiz ay sonra nefes darlýðý ve göðüs aðrýsý semptomlarý ortaya çýktý ve sað da yoðun plevral sývý saptandý. Ýleri 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 month’s 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.

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Günümüzde, FOLFOX (5-fluorourasil, leucoverin ve oxaliplatin) ileri evre veya metastatik
gastrointestinal sistem tümörlerinde ilk sýrada kullanýlan kemoterapötik rejimdir. Bu rejimin
hematolojik, gastrointestinal ve sensörinöral sistem ile ilgili yan etkileri bilinmesine karþýn pulmoner
toksisitesi sýnýrlý sayýda olgu bildirimleri düzeyindedir. Hýzla ilerleyerek mortal seyredebileceðinden
akciðer toksisitesinin erken farkýndalýðý ve tedavisi önemlidir. Bu yazýda, metastatik özofagus kanseri
nedeniyle kullanýlan FOLFOX tedavisine sekonder geliþen interstisyel akciðer hastalýðý olgusu nadir
olmasý nedeniyle sunulmuþtur.

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.

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Amiodaronun tetiklediði akciðer hasarý (ATAH) bu ilacýn doz kýsýtlayýcý önemli bir yan etkisi olup tanýsý klasik morfolojik yöntemlerle zordur. Amiodaron önemli bir antiaritmik ilaç olsa da ciddi yan etkileri olup bunlardan birisi de akciðer hasarýdýr. Daha önceki gözlemler, Tc-99m DTPA klirensi hesaplanmasýnýn bu akciðer hasarýný göstermede doðru bir yöntem olduðunu göstermiþtir. Elli sekiz yaþýnda erkek hasta, antiaritmik ilaç olarak amiodaron kullanmaktaydý. Hasta dispne yakýnmasý ile geldi ancak konvansiyonel BT sonucu tanýsal bir bulgu vermedi. ATAH tanýsý ve ilacýn kesilmesinden sonra uzun dönem takibinde Tc-99m DTPA görüntüleme yöntemi kullanýldý. Bu olgu sunumu, Tc-99m DTPA klirensinin ATAH tanýsý ve uzun dönem tedavi takibinde yeterli bir metod olduðunu göstermektedir.

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.

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Akut hipoksemik solunum yetmezlikli hastalarda, konvansiyonel oksijen tedavisi yerine son yýllarda ýsýtýlmýþ ve nemlendirilmiþ yüksek akýmda oksijenin nasal kanülle (HFNC) uygulanmasý popülarite kazanmýþtýr. Bu uygulama ile anatomik ölü boþluk, nazofaringeal direnç azalmasý, pozitif ekspiratuar basýnç etki ve alveoler rekrütment saðlanýr. Hastalarýn konforu ve toleransýný arttýrdýðý, solunum iþini ve sayýsýný azalttýðý ve deðiþik etyolojilere baðlý solunum yetersizliklerinde solunum desteðini arttýrma gereksinimini azalttýðý saptanmýþtýr. Hiperkapnik solunum yetmezlikli hastalarda da solunum iþini, solunum sayýsýný azalttýðýný, ventilasyon etkinliðini, tidal volümü ve egzersiz toleransýný arttýrdýðýný gösteren çalýþmalar mevcuttur. Ýki olgumuzu da kronik obstrüktif akciðer hastalýðýna baðlý hiperkapnik solunum yetmezliðinde noninvaziv mekanik ventilasyon tedavisinin etkin olmadýðý durumlarda yüksek akýmda oksijenin nasal kanülle uygulanmasýnýn etkinliðini göstermek ve kullanýmýna yönelik farkýndalýðý arttýrmak amacýyla 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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