Kýrk dokuz yaþýnda erkek hasta tekrarlayan pnömoni nedeniyle göðüs hastalýklarý yoðun bakým ünitesine yatýrýldý. Hasta beþ yýl önce bir trafik kazasý geçirmiþti. Bu nedenle kuadriplejikti ve trakeostomi tüpü vardý. Fizik muayenede yaygýn ekspiratuvar ronküsler ve interkostal çekilmeleri mevcuttu. Posteroanterior akciðer grafisinde ve toraks bilgisayarlý tomografisinde sað alt lob atelektazisi ve ayný zamanda sað alt lob giriþinde yabancý cisim saptandý. Yabancý cismin kazadan hemen sonra çekilen akciðer grafisinde de mevcuttu. Dental travma muhtemelen entübasyon sýrasýnda oluþmuþtu. Fiberoptik bronkoskopi ile bakýldýðýnda sað alt lob giriþinde yabancý cisim olduðu görüldü. Segment düzeylere bakýldýðýnda ikinci bir yabancý cisim fark edildi. Yabancý cisimler çevre dokulara zarar vermeden timsah biyopsi forsepsi ile çýkarýldý. Herhangi bir komplikasyon olmadý. Yabancý cisimlerin diþ ve protez olduðu görüldü. Sonuç olarak, travmatik entübasyon dâhil olmak üzere, yüz ya da diþ travmasý geçiren hastalarda aðýz içi gözden geçirilmeli, özellikle eksik diþ varlýðýnda aspirasyon ihtimali gözönünde bulundurulmalý ve radyolojik deðerlendirme yapýlmalýdýr.

A 49-year-old male patient was hospitalized to our chest intensive care unit with the diagnosis of recurrent pneumonia. Following a traffic accident five years previously the patient was quadriplegic and had a tracheostomy tube. His physical examination revealed widespread expiratory rhonchi and intercostal retractions. Right lower lobe atelectasis, and also a foreign body at the entrance of the right lower lobe, was seen with a posteroanterior chest x-ray and thoracic computed tomography. We saw that the foreign body was present at the chest x-ray performed immediately after the accident. It is probable that dental trauma occurred during intubation. In a fiberoptic bronchoscopy, a foreign body was identified in the proximal part of the right lower bronchus; a second foreign body was seen at the segment level. The foreign bodies were removed using an alligator biopsy forceps without damaging the surrounding tissue; there were no complications. The foreign bodies were teeth and a dental prosthesis. In conclusion, in patients who have sustained facial or dental trauma, including traumatic intubations, and who have a missing tooth, it must be presumed that the tooth has been aspirated, and radiographic evaluation is needed.

Birt-Hogg-Dubé Sendromu (BHDS) deride fibrofolikülomalar, renal tümörler ve akciðer kistleri ile karakterizedir. Bu olgu serisinde, Birt-Hogg-Dubé sendromlu iki olgu ve aile üyelerinin BT bulgularý sunulmaktadýr. Diðer kistik akciðer hastalýklarý ile ayýrýcý taný tartýþýlmaktadýr. Olasý malignitelerin tespit edilebilmesi açýsýndan takip ve tarama ile multidisipliner yaklaþýmýn önemi vurgulanmaktadýr. BHDS seyri sýrasýnda yýllýk hasta takibi yaný sýra pnömotoraks riski açýsýndan özen gerekmektedir.

Birt-Hogg-Dubé Syndrome (BHDS) is characterized by hair follicle hamartomas, renal tumors, and pulmonary cysts. In this case series, CT findings of two index patients with BHDS, and their family members, are presented. Differential diagnosis with other cystic lung diseases is discussed. The importance of follow-up and screening for the early detection of possible malignancies, as well as multidisciplinary approach, is emphasized. The course of BHDS requires not only annual patient follow-up but also care due to the risk of pneumothorax.

Organize pnömoni (OP) küçük havayollarý ve etrafýndaki dokularda hasara yol açabilen bronþiollerin inflamatuvar bir sürecidir. Antikanser ilaçlar ve radyoterapiye baðlý sekonder OP daha önce bildirilmiþtir. Bu makalede, remisyonda evre 4 mide kanseri nedeniyle idame düþük doz kapesitabin kullanýrken OP geliþen 60 yaþýnda bir kadýn hasta sunulmuþtur. On sekiz ay süresine kapesitabin tedavisi altýnda iken rutin bilgisayarlý tomografi tetkikinde sað akciðer üst lob posterior segmentte 9 mm subplevral nodül saptanmýþ ve kama rezeksiyon uygulanmýþtýr. Histopatolojik incelemede OP tanýsý koyulmuþtur. Bu durum ilaç iliþkili akciðer toksisitesi olarak düþünülmüþtür. Bu hasta uzun süreli kapesitabin monoterapisi altýnda OP geliþen literatürdeki ilk olgudur.

Organizing pneumonia (OP) is an inflammatory process of the bronchioles that can lead to destruction of small airways and surrounding lung tissue. Secondary OP, caused by anti-cancer drugs and radiotherapy, has previously been reported. In this study, we report the case of a 60-year-old female patient presented with OP, while using low dose capecitabine maintenance for stage IV gastric cancer under remission. After 18 months of routine follow-up with computed tomography (CT), a 9 mm subpleural nodule was presented at the right lung upper lobe posterior segment. Wedge resection was performed. Based on histopathologic examination, a diagnosis of OP was confirmed. In this instance, capecitabine was implicated as the likely cause of this drug-induced lung toxicity. This patient is the first case associated with development of OP during capecitabine monotherapy.

Akut promiyelositik lösemi (APL), all-trans-retinoik asit (ATRA) tedavisinin bulunmasýndan sonra akut miyeloid lösemilerin en iyileþtirilebilir formu olmuþtur. Bununla birlikte, ATRA tedavisi sýrasýnda ateþ, solunum sýkýntýsý, pulmoner infiltrasyonlar, plevral ve perikardiyal efüzyon, hipotansiyon ve akut böbrek yetmezliði ile karakterize ATRA sendromu geliþebilmektedir. Burada, ATRA tedavisi sýrasýnda nefes darlýðý, ödem ve plevral efüzyon geliþen ve deksametazon 2x8mg iv tedavi ile kýsa sürede düzelen olgu sunulmaktadýr.

Following the advent of all-trans retinoic acid (ATRA), acute promyelocytic leukemia (APL) is the most curable form of acute myeloid leukemia. However, all trans-retinoic acid (ATRA) syndromes can occur during the treatment by ATRA. ATRA syndrome is characterized by fever, respiratory distress, pulmonary infiltrations, pleural and pericardial effusion, hypotension, and acute renal failure. Here, we presented a patient with ATRA syndrome, admitted with dyspnea, pretibial edema and pleural effusion, who fully recovered in a short time following dexamethasone 2x8mg IV treatment.

Biz burada T hücreden zengin diffüz büyük B hücreli lenfoma (DBBL) tanýsý alan kadýn olguyu, tüberküloz ile ayýrýcý tanýda güçlük yaþanmasý nedeniyle klinik, radyolojik özellikleri göz önünde bulundurularak sunuyoruz. Kýrk üç yaþýnda kadýn hasta, 3 aydýr devam eden öksürük, nefes darlýðý, terleme, iþtahsýzlýk þikâyetleriyle baþvurdu. Toraks BT’de anterior mediastende kitle lezyonu, sað plevral ve perikardial efüzyonu mevcuttu. Hastanýn bilateral supraklaviküler lenfadenopatisi vardý. Sývý sitolojisi malignite açýsýndan negatifti. Lenf bezi biyopsisi kazeifiye granülom görünümü olup tüberkülozla uyumluydu. Hastanýn kliniði tüberküloz ile uyumlu olmadýðý için mediastendeki kitlesinden biyopsi alýndý. Sonuç yine tüberküloz ile uyumlu olarak deðerlendirildi. Hastaya standart 4’lü antitüberküloz tedavi baþlandý. Tedavisinin 2. ayýnda Toraks BT’de regresyon izlenmedi. Hastanýn mevcut biyopsi preparatlarý tekrar incelendi ve T hücreden zengin DBBL olarak deðerlendirildi. Sonuç olarak, diðer malignitelerde olduðu gibi lenfomalarda da granülomatöz reaksiyon görülebilmektedir. Bu nedenle, tüberküloz ile ayýrýcý tanýsýný yapmak güç olabilmektedir.

We present here the case of a female patient with T cell rich diffuse large B cell lymphoma (DLBL), since it is hard to differentiate from tuberculosis, both clinical and radiological features were considered. A 43- year-old female patient had complaints of dyspnea, cough, sweating, and anorexia for the previous three months. In the thorax CT, there were anterior mediastinal mass lesions, and right pleural, pericardial effusion. She had bilateral supraclavicular lymphadenopathy. Fluid cytology was negative for malignancy. The pathology of the lymph node was caseified granuloma in appearance, compatible with tuberculosis. Since her clinical findings were not compatible with tuberculosis, multibiopsy was performed in mediastinal mass. According to the biopsy, the disease was compatible with tuberculosis. Standard antituberculosis treatment was initiated. By the second month of treatment, no regression was observed with thorax CT. Her biopsy preparations were reevaluated. The patient had T cell rich DLBL. In conclusion, as with other malignancies, lymphomas also cause granulomatous reaction. Therefore, it may be hard to differentiate from tuberculosis.

Yabancý cisim aspirasyonu çok ciddi ve yaþamsal bir sorundur. Akciðerlerde geriye dönüþümsüz - kronik hastalýklara hatta bazen ani ölümlere neden olabilir. Erken taný komplikasyonlarýn önlenmesinde anahtardýr. Diþ ve aðýz içi tedavi süreçlerine baðlý aspirasyon bilinen ancak, literatürde çok sýk bildirimi yapýlmayan durumlardýr. Aspirasyonlarýn esas nedenleri maksillofasiyal travmalar, aðýz içi tedavi süreçleri veya alkol/ etanol zehirlenmesi ile demansa baðlýdýr. Bu makalede geç taný konulan ve komplikasyona yol açan, aðýz içi tedavi esnasýnda geliþen dörtlü diþ protezi aspirasyonu olgusu sunulmuþtur.

Foreign body aspiration is a very serious and critical problem. It may cause chronic and irreversible lung injury and occasionally lead to sudden death. Early diagnosis is key to the prevention of complications. Although the aspiration of teeth and dental repairs is a recognized event, it is only rarely reported in the literature. The main reasons for aspiration are maxillofacial trauma, dental treatment procedures or alcohol/ ethanol intoxication and dementia. We report a case of dental treatment the lead to aspiration of a quad dental prosthesis, with delayed diagnosis and complications.

Havayolu darlýðý olan birçok hasta uzun süre yanlýþ tanýlarla takip edilmektedir. Bu hastalarda havayolu darlýðýnýn nedeni benign patolojilere baðlý olabileceði gibi malign hastalýklara sekonder de olabilir ve erken fark edilmezse hayatý tehdit eden boyutlara ulaþabilir. Beþ senedir astým tanýsý ile takip edilen 50 yaþýnda bayan hasta, progresif nefes darlýðý þikâyeti ile baþvurdu. Bronkoskopik deðerlendirmesinde, vokal kordlardan 2 cm sonra sað anterolateral duvara geniþ taban ile oturan üzeri düzgün yüzeyli vasküler yapýdan zengin kitle ile lümenin %90 oranýnda obstrükte olduðu izlendi. Trakea proksimalindeki kitleye diyot lazer ile fotokoagulasyonun ardýndan core out uygulandý ve 16x14x16 stenotik silikon stent yerleþtirildi. Hastanýn trakeal biyopsi patoloji sonucu tiroid karsinomu olarak raporlandý. Cerrahi operasyon planlanan hastada distale migre olan stent çýkartýldý. Hastaya, tiroidektomi sonucu papiller tiroid karsinom tanýsý kondu. Tiroidektomi sonrasý komplikasyonsuz takibe alýndý. Uzun süre obstrüktif havayolu hastalýðý nedeniyle bronkodilatör tedavi almasýna raðmen klinik rahatlamasý olmayan hastalarda ileri tetkiklerle ayýrýcý tanýya gidilmesi önemlidir.

Many patients with airway stenosis are misdiagnosed for a long period. The reason for the airway obstruction in these patient can be due to benign pathology as well as secondary malignant disease. If not recognized early, it can reach life-threatening dimensions. A 50-year-old female patient was admitted with a five-year following the diagnosis of asthma with progressive shortness of breath. Bronchoscopic evaluation revealed a smooth surface structure with rich vascularity 2 cm distal to the vocal cords sitting with a large base of over the right anterolateral wall and obstructing the lumen by 90%. Core out was applied following diode laser photocoagulation of the proximal mass and afterwards a 16x14x16 stenotic stent was positioned. The tracheal biopsy pathology was established a thyroid carcinoma. The distally migrated stent was removed with scheduled surgery. The patient’s thyroidectomy pathology identified a papillary thyroid carcinoma. Following thyroidectomy, the patient was observed without any complication. It is important to underwent differential diagnosis with advanced techniques in patients without clinical relief, despite prolonged bronchodilator treatment for obstructive airway disease.

Þilotoraks plevral boþlukta lenfatik sývýnýn birikmesiyle oluþan nadir bir klinik tablodur. Lenfatik sývý birikimi ciddi metabolik ve immünolojik bozukluklara yol açabilir. Þilotoraks çoðunlukla toraks travmasý ve malign obstrüksiyon (Non-Hodgkin lenfoma) sonucu ortaya çýkar. Daha nadir sebepleri lenfanjiyomiyomatosiz, tüberküloz, venöz tromboz, konjenital lenfatik malformasyon, nefrotik sendrom, hipotroidizm, siroz ve idiopatik þilotorakstýr. Elli altý yaþýndan kadýn hasta nefes darlýðý, kilo kaybý ve iþtah azalmasý þikâyeti baþvurdu. Akciðer grafisinde sol hemitoraksta homojen dansite artýþý ve sað kostovertebral açýda kapanma izlendi. Torasentezde beyaz sütümsü renkli plevral mayi aspire edildi. Plevral mayi biyokimyasal analizi ile þilotoraks tanýsý doðrulandý. Þilotoraks nedenleri araþtýrýldý, etiyolojik patoloji saptanamadý. Konservatif tedavi ile þilotoraksta gerileme izlendi. Bu yazýda, konservatif tedavi ile gerileyen idiyopatik ve bilateral þilotoraks olgumuzu sunduk.

Chylothorax is the collection of lymphatic fluid in the pleural space. Lymphatic fluid in the pleural space may cause metabolic and immunologic disorders. Trauma to the thoracic duct and malignant disease (non-Hodgkin’s lymphoma) are the common mechanisms of chylothorax. Other rare causes are lymphangiomyomatosis, tuberculosis, venous thrombosis, congenital lymphatic malformations, nephrotic syndrome, hypothyroidism, cirrhosis and idiopathic chylothorax. A 56-year-old woman presented with dyspnea, reduced appetite and weight loss. A chest x-ray showed left homogenoeus density with a concave interface toward the lung and blunting of right costophrenic angle. Thoracentesis was performed. Milky off-white fluid was aspirated. Analysis of the fluid confirmed the diagnosis of chylothorax. Etiology was not determined. Chylothorax was regressed with conservative treatment. We present a case of rare bilateral-idiopathic chylothorax with regression following conservative therapy.

Sarkoidoz ve Sjögren sendromu kronik multisistemik hastalýklardýr. Bu iki hastalýðýn birlikteliði sadece Sjögren sendromlu hastalarýn %1’inde bildirilmiþtir. Sarkoidoz ve Sjögren sendromu birlikteliði olan bu olguyu nadir görülmesi ve bu ayrýmýn prognostik öneme sahip olduðuna dikkat çekmek için bildiriyoruz. Altmýþ iki yaþýnda kadýn hasta, nefes darlýðý ve kuru öksürük þikâyeti ile hastanemize baþvurdu. Göz ve aðýzda kuruma mevcuttu. Laboratuvar incelemesinde serum anti SS-A (Ro) (+++) antikoru pozitifliði gösterildi. Toraks bilgisayarlý tomografisinde lenfadenopati ve retiküler- mikronodüler görünüm saptandý. Lenf bezlerinden 10R ve 7 nolu istasyondan endobronþiyal ultrason eþliðinde transbronþiyal iðne aspirasyonu yapýldý. Patoloji sarkoidoz ile uyumlu bulundu. Karbonmonoksit difüzyon kapasitesi %40 olarak saptandý. Sjögren sendromunu taklit eden sarkoidozu, sarkoidoz- sjögren sendromu birlikteliðinden ayýrt etmek prognostik öneme sahiptir, çünkü sarkoidoz çoðunlukla kendini sýnýrlayýp, fonksiyonel kýsýtlama olmaksýzýn kendiliðinden iyileþebilirken, Sjögren sendromunun pulmoner tutulumu kalýcý defektlere yol açmaktadýr.

Sarcoidosis and Sjögren’s syndrome are chronic multi-systemic diseases. The association of these two diseases was reported only in 1% of patients with Sjögren’s syndrome. We present this rare case in order to draw the attention to the prognostic importance of this difference. A 62-year-old female patient presented to our hospital with the complaints of dyspnea and a dry cough. Dry eye and dry mouth were present. Laboratory analyses revealed serum anti SS-A (Ro) (+++) antibody positivity. Chest computerized tomography revealed lymphadenopathy and reticular-micronodular appearance evident. Transbronchial needle aspiration guided with endobronchial ultrasound was conducted through 10R and 7 lymph nodes. Pathology was compatible with sarcoidosis. Pulmonary function test revealed 40% carbon monoxide diffusion capacity. It is of prognostic importance to distinguish sarcoidosis imitating Sjögren’s syndrome from the association of sarcoidosis- Sjögren’s syndrome, since sarcoidosis mostly limits itself and recover by itself without any functional restrictions, but the pulmonary involvement of Sjögren’s syndrome causes permanent defects.

Pulmoner Langerhans hücreli histiositoz (PLHH) nadir görülen bir hastalýktýr. Kliniðe baþvuru anýndan kesin tanýya ulaþýlana dek metastatik akciðer kanserini düþündüren olgu, nodüler akciðer lezyonlarýnýn ayýrýcý tanýsýnda histiositozun da düþünülmesini hatýrlattýðýndan sunmayý uygun bulduk. Kýrk yaþýnda erkek hasta bel aðrýsý ile baþvurdu. Toraks tomografisinde her iki akciðerde solda orta ve alt zonda ve en büyüðü yaklaþýk 2 cm çapýnda olan 5-6 adet düzgün sýnýrlý yuvarlak lezyonlar izlenmekteydi. Bronkoskopisinde sol alt lob apikal segmentte vejetan tümöral kitle saptandý. Biyopsisinde psödostratifiye solunum epiteli ile döþeli mukozal doku örnekleri, submukozal alanda serömüköz bez yapýlarý çevrede eozinofil lökosit, lenfoplazmositer iltihabi hücre infiltrasyonu saptandý. PET-CT’sinde sol akciðer alt lob bronþu komþuluðunda posteromedial plevral tabanlý kitlede belirgin artmýþ FDG tutulumu izlenmekteydi (SUVmax: 14,9). Yapýlan bronkoskopilerin sonucunda taný gelmemesi üzerine hastaya sað akciðerden wedge rezeksiyon uygulandý. Patolojik taný PLHH ile uyumlu geldi. Olgumuzu yaygýn tutulumun eriþkin yaþta nadir görülmesi ve özellikle akciðer karsinomunu taklit edici klinik tablo nedeniyle yayýnlamayý uygun gördük.

Pulmonary Langerhans cell histiocytosis (PLCH) is a rarely seen disease. We think our case is worthy of publication due to its presentation with anamnesis and clinical findings very similar to metastatic pulmonary carcinoma, from the patient’s admittance to the clinic until the thoracosopic evaluation. A 40-year-old male patient was admitted with a compliant of lower back pain. Five or six round lesions with regular contours in both lungs on the left and lower zone, the largest with dimension of 2cm, were observed on the patient’s thoracic CT examination. During bronchoscopy, a vegetant tumoral mass was detected in left lower lobe apical segment. Mucosal tissue samples containing pseudostratified respiratory epithelium, seromucous glandular structures in the submucosa, surrounding eosinophilic leukocytes and lymphoplasmocytic inflammatory infiltration were detected in the transbronchial biopsy. Significantly increased FDG enhancement was observed in the posteromedial pleural based mass located in the left lung lower lobe bronchus contiguity in the PET-CT examination (SUVmax: 14.9). Wedge resection was performed, as the diagnosis was not established following bronchoscopy examinations. Pathological diagnosis was compatible with PLCH. We thought our case worthy publication as the disease is seen rarely in adulthood and furthermore the clinical presentation imitated pulmonary carcinoma.

Pulmoner kapillerit akciðerin küçük damarlarýnýn vaskülitidir. Kollajen vasküler hastalýk ya da ANCA iliþkili vaskülitlerin parçasý olarak, izole pauci-immün kapillerit veya akciðer transplant rejeksiyonunda görülebilir. Biz, ANCA iliþkili olmayan ve sistemik tutulum göstermeyen, diffüz alveoler hemoraji (DAH) tablosu ile prezente olan “Ýzole Pulmoner Kapillerit (ÝPK)” olgusunu sunuyoruz. Miyomektomi operasyonu sonrasý geliþen nefes darlýðýyla konsülte edilen hastaya, operasyonda genel anestezik olarak sevofluran
kullanýlmýþtý. Derin hipoksik hastanýn toraks HRCT’sinde her iki akciðerde yaygýn buzlu cam alanlarý, sað akciðer alt lobda konsolidasyon izlendi. BAL materyalinin hemorajik ve aspire ettikçe renginin koyulaþmasý nedeniyle alveoler hemoraji olarak deðerlendirildi.
Metilprednizolon tedavisine iyi yanýt alýndý. Transbronþial akciðer biyopsileri vaskülit olarak raporlandý. ANCA’lar, diðer romatolojik belirteçler negatifti. Olgumuzun sistemik bulgularý olmadýðý için, ANCA negatif Ýzole Pulmoner Kapillerit olarak deðerlendirildi. Hýzlý taný ve pulse steroid baþlanmasý bu hastalarda hayati öneme sahiptir, gecikmeler hayati riskli olabilir. Literatürde yeterli kanýt yoksa da inhalasyon anesteziklerinin postoperatif dönemde oluþabilecek DAH ve ÝPK olgularýndan sorumlu olabileceði akýlda tutulmalýdýr.

Pulmonary capillaritis is the small-vessel vasculitis of the lungs. We report a case of isolated pulmonary capillaritis presenting with diffuse alveolar hemorrhage, which is not associated with ANCA. The patient had shortness of breath that developed after myomectomy surgery: sevoflurane was used as a general anesthetic in the operation. The thorax HRCT scans showed ground glass opacities in both lungs and consolidation in the right lower lobe. Due to hemorrhagic and darkening of the BAL fluid as aspirated, it was thought that the diagnosis was in accordance with alveolar hemorrhage. The patient responded well to methylprednisolone therapy. The transbronchial lung biopsies revealed vasculitis. ANCA and other rheumatologic markers were negative. Due to the absence of systemic symptoms, we diagnosed ANCA negative isolated pulmonary capillaritis. Rapid diagnosis and pulse steroid therapy are of vital importance in these patients. It should be kept in mind that inhalation anesthetics could be responsible for cases of DAH and SPC.

Diffüz alveoler hemoraji (DAH), immün ve immün olmayan etyolojik faktörlere baðlý olarak geliþen, akciðerlerde alveolokapiller membranýn hasarý sonucu nefes darlýðý, hemoptizi, anemi, diffüz alveolar konsolidasyon ile karakterize bir hastalýktýr. Burada, kontrolsüz oral antikoagülan (varfarin) kullanýmýna baðlý kanamalar arasýnda nadir görülen bir komplikasyon olan DAH nedeni ile kliniðimizde takip edilen 65 yaþ üstü dört olguyu sunmayý amaçladýk.

Diffuse alveolar hemorrhage (DAH) caused by immune and non-immune etiological factors, characterized by diffuse alveolar consolidation, often presents with the clinical triad of dyspnea, hemoptysis and, anemia, as a result of the disruption of the alveolocapillary membrane of the lung. We present four cases, when the patients are over 65 years of age, followed up at our clinic with diffuse alveolar hemorrhage as a rare complication of the uncontrolled use of anticoagulant (Warfarin) therapy.

Romatoid artrit (RA) toplumda %1’e yakýn sýklýðý ile en fazla karþýlaþýlan inflamatuar bað doku hastalýklarýndandýr. RA derin ven trombozu ve pulmoner emboli için genellikle risk faktörü olarak görülmemesine raðmen RA’lý hastalarda venöz tromboemboli (VTE) riskinin arttýðý saptanmýþtýr. RA’sý olan ve pulmoner emboli saptanan 3 olgumuzu bu konuya dikkat çekmek amacýyla sunuyoruz.

Rheumatoid arthritis (RA) is the most commonly encountered inflammatory joint disease, affecting nearly 1% of the adult population. RA is not generally viewed as a risk factor for deep venous thrombosis and pulmonary embolism, although patients with RA are at an increased risk of venous thromboembolism. We present three cases of RA with the diagnosis to draw attention in this issue.

Akciðer herniasyonlarý nadiren gözlenir. Plevra ile çevrili akciðer dokusunun göðüs duvarýndan protrüze olmasýyla meydana gelir. Akkiz veya konjenital orjinli olarak görülebilirler. Burada aðýr kaldýrma sonrasýnda meydana gelen akciðer herniasyon olgusu sunuldu.

Lung hernias are seen rare. It is defined as the protrusion of lung tissue covered by pleurae through in the thoracic wall. They can be either congenital or acquired in origin. Here we report a case of lung hernia due to heavy lifting.

Pulmoner hamartom, akciðerin en sýk görülen iyi huylu tümörüdür. Boyutu genellikle 4 cm’den küçüktür ve 10 cm’den büyük pulmoner hamartom nadirdir. Hava dolu kistik alanlar içeren pulmoner hamartom nadir görülen bir formdur. Bu yazýda, nadir görülmesi nedeniyle, öksürük ve nefes darlýðý þikâyeti ile baþvuran 56 yaþýndaki pulmoner kistik hamartom olgusu sunulmuþtur.

Pulmonary hamartoma is the most common benign neoplasm of the lung. Its size is usually smaller than 4 cm, and a pulmonary hamartoma larger than 10 cm is rare. Pulmonary hamartoma with air-filled cystic areas is also an unusual form. Since it is a rare condition, in this article, we reported a case of pulmonary cystic hamartoma in a 56-year-old patient admitted with a cough and breathing difficulties.

Desmoid tümörler histolojik olarak benign karakterde fakat lokal agresif tümörlerdir. Fibrositler, konnektif doku fasyasý ve muskuloaponörotik fibroz dokulardan geliþen nadir tümörlerdir. Toraks duvarýnda ender olarak rastlanýr ve malign tümörler gibi tedavi edilirler. En etkili ve seçkin tedavi cerrahidir. Elli yedi yaþýnda bayan hastanýn, þiddetli omuz ve sýrt aðrýsý þikâyetleri nedeni ile akciðer grafisi çektirildiðinde, sað akciðer üst zonda normal dýþý görüntü izlenmiþtir. Kitlesi total eksize edilen olgunun postoperatif bir sorunu olmamýþ ve yedinci günde taburcu edilmiþtir. Kitlenin patolojik incelemesi sonucunda tanýsý desmoid tümör olarak rapor edilmiþtir.

Desmoid tumors are histologically benign, however locally aggressive, tumors. They are rare tumors that develop from fibrocytes, connective tissue fascia and musculoaponeurotic fibrous tissues. They are rarely found in thoracic wall and are treated like malignant tumors. Surgery is the most effective and foremost treatment. The chest x-ray of a 57-year-old female patient, who complained of severe shoulder and back pain showed an abnormality in right lung upper zone. The mass was totally excised. The patient had no post-operative problem and was discharged on the post-operative seventh day. Based on pathologic analysis, the diagnosis was reported to be a desmoid tumor.

Castleman hastalýðý, etiyolojisi tam olarak bilinmeyen ve nadir görülen benign bir hastalýktýr. Eriþkinlerde sýk olmasýna karþýlýk çocukluktan itibaren her yaþta görülebilmektedir. Sýklýkla toraksa yerleþmekle beraber tüm vücutta bulunabilir. Genellikle orta ve ön mediastende
lokalizedir. Burada, teratom ön tanýsýyla eksize ettiðimiz bir Castleman hastalýðý olgusunu, literatür bilgileri eþliðinde sunmaktayýz.

Castleman’s disease is a rare benign disease with an unknown etiology. Although it is more common in adults, it can be seen at any age starting from childhood. Although more commonly observed in the thorax, it can be found anywhere in the body. It is usually localized in the middle or anterior mediastinum. With a review of the literature, we hereby introduce a case of Castleman’s disease, excised in prediagnosis as a teratoma.

Akondroplazi; otozomal dominant geçiþ gösteren, servikomedüller kompresyon, spinal kord enfarktlarý, sinir kök kompresyonlarý ve uykuda solunum bozukluklarý gibi birçok nörolojik semptomun görüldüðü, konjenital kemik displazilerinin en sýk görülen formudur. On iki yaþýnda akondroplazi tanýsý alan olgu, horlama, uykuda nefes durmasý ve uykululuk hali yakýnmalarýyla baþvurdu. Polisomnografi tetkikinde aðýr obstrüktif uyku apne sendromu saptanmasý üzerine iki seviyeli pozitif hava yolu basýncý desteði ile titrasyona alýndý ve apne-hipopne indeksi geriledi. Hasta pozisyon ve iki seviyeli pozitif hava yolu basýncý desteði tedavisi ile taburcu edildi.

Achondroplasia is the most common form of congenital bone dysplasia, which is inherited, autosomal dominantly and characterized by cervicomedullary compression, infarction of the spinal cord, nerve root compression, and respiratory disorders during sleep. A 12-year-old patient with a diagnosis of achondroplasia was presented with complaints of snoring, sleep apnea, and lethargy. Upon finding severe obstructive sleep-apnea syndrome with polysomnography, the patient received titration with the support of two-level positive airway pressure and apneahypopnea index regressed. The patient was discharged with position and support from two-level positive airway pressure.