Bu görsel aðýrlýklý sunuda, mediastinal lenf bezi çalýþmalarý sýrasýnda, endobronþial ultrasonda anekoik görüntü saptanan dört farklý olguyu sunuyoruz. Herbir anekoik görüntü, lenf bezinde koagülatif nekroz iþareti vermekteydi. Tüm olgularda anekoik görüntüler benzer karakteristik özelliklere sahip olmasýna raðmen, patoloji rapor sonuçlarý farklýdýr. Ýki olguda maliginte pozitif idi, bir olguda tiroidden orijin alan benign tümör ve bir olguda da tüberküloz saptandý. Tüm hastalardan EBUS iþlemi için yazýlý onamlar alýndý. Mediastinal patolojilerin tanýsýnda gerekli genel incelemeleri takiben hastanemiz kurallarýna göre iþlemler yapýldý.

In the present pictorial study, we report on four different cases with Endobronchial Ultrasound anechoic images, taken during a mediastinal lymph node study. Each anechoic image had a nodal coagulative necrosis sign. Although the anechoic images had similar characteristics in all cases, the final pathology report was different, with two cases positive for malignancy, one case showing a benign tumor of thyroid gland origin, and one case with tuberculosis. All patients signed informed consent for investigation with the EBUS technique. The procedure was performed in accordance with the regulations of our hospital, and following the usual technique followed in diagnostic mediastinal pathology studies.

Yabancý cisim aspirasyonu, hava yolu obstrüksiyonuna neden olduðu için acil bir týbbi durumdur ve bu nedenle, bu tür durumlarda yabancý cismin hemen çýkarýlmasý çok önemlidir. Rijit bronkoskopi, yabancý cisimlerin çýkarýlmasýnda ilk tercih edilen yöntemdir, ancak bazý çalýþmalar flexible bronkoskopinin de yüksek baþarý oraný saðlayabildiðini göstermiþtir. Son zamanlarda, eriþkinlerde, yabancý cisimlerin çýkarýlmasýnda, kriyoprobun kullanýmýyla ilgili bazý bildirimler vardýr. Fakat pediatrik grupta, özellikle yeni doðan ve infant dönemde, nadiren karþýlaþýlan bir durum olduðu için kullanýmý konusunda çok az deneyim vardýr. Biz de infant dönemde yabancý cisim aspirasyonu olan olgumuzda, flexible bronkoskopi ile kriyoprob kullanmanýn da etkinliðini vurgulamak ve bu konudaki deneyimlere katkýda bulunmak için olgumuzu sunmayý amaçladýk.

Foreign body (FB) aspiration is a true medical emergency that occurs due to airway obstruction in which immediate removal is crucial. Rigid bronchoscopy is the preferred method for the removal of foreign bodies lodged in the airways, however studies have found that a flexible bronchoscopy can achieve greater success rates. Recently, although there have been reports of a cryoprobe being used for the removal of FBs in adults, in pediatrics, and especially in infancy, there is little experience about its use, in that tracheobronchial FB aspiration is an infrequently encountered event among neonates and in early infancy. This report highlights the efficacy of using a cryoprobe for a flexible bronchoscopy for the management of a retained FB in a young infant.

Kardiyak tamponad ve ciddi hiponatremi hayatý tehdit edebilen önemli klinik bulgulardýr. Küçük hücreli dýþý akciðer kanserinin baþlangýç bulgularýnýn ciddi hiponatremi, 1000 ng/mL’nin üzerinde karsinoembriyonik antijen (CEA) düzeyi ve kardiyak tamponad olmasý nadirdir. Bu makalede, öksürük, nefes darlýðý, bulantý ve kilo kaybý þikayetleriyle baþvuran 60 yaþýnda bir erkek hastayý sunduk. Hastanýn CEA deðeri 1041 ng/mL idi. Ayný zamanda hastada ciddi hiponatremi ve kardiyak tamponad vardý. Araþtýrma sonucu metastatik akciðer adenokarsinomu tanýsý konuldu. Hastaya kemoterapi verildi ve kanser tanýsýndan 4 ay sonra eksitus oldu. Akciðer adenokarsinomunun baþlangýç bulgularýnýn ciddi hiponatremi, çok yüksek CEA düzeyi ve kardiyak tamponad olmasý ileri evre hastalýk ve kötü prognoz göstergesi olabilir.

Cardiac tamponade and severe hyponatremia are life-threatening and significant clinical findings. Severe hyponatremia, carcinoembryonic antigen (CEA) levels above 1000 ng/mL and cardiac tamponade are rare conditions as initial findings of non-small cell lung cancer. We report a 60-year-old man who presented with a cough, shortness of breath, nausea and loss of weight. The CEA level of the patient was 1041 ng/mL. He also had severe hyponatremia and cardiac tamponade. The patient was diagnosed with metastatic lung adenocarcinoma following an evaluation. The patient underwent chemotherapy treatment, but died 4 months after the cancer diagnosis. Severe hyponatremia, very high levels of CEA, and cardiac tamponade as initial findings of lung adenocarcinoma may be predictors of higher stage disease and poor prognosis.

Elli yaþýnda kadýn hasta vajinal kanama nedeniyle Kadýn Hastalýklarý ve Doðum servisine baþvurmuþ. Hastaya miyoma uteri tanýsý konarak operasyon kararý verilmiþ. Hastanýn preoperatif deðerlendirme sýrasýnda akciðer grafisinde bilateral þüpheli nodül saptanmasý üzerine çekilen Toraks Bilgisayarlý Tomografisin’ de sað alt lob süperior segment ve sol alt lob posterobazal segmentte nodüler lezyonlar saptandý. Sað akciðer tru-cut biyopside ‘interstisyel ve perivasküler alanlarda granülom formasyonu, nötrofil ve lenfosit infiltrasyonu, fibrinoid nekroz’ izlendi. Otoantikor tetkiklerinde c-ANCA pozitifliði saptandý. Hastanýn Göz, K.B.B. ve nefrolojik muayenesinde patoloji saptanmadý. Mevcut bulgularla hastaya 'Akciðere Sýnýrlý Granülomatöz Polianjitis' tanýsý kondu. Düþük doz haftalýk oral metotreksat, prednizon ve folik asit tedavisi baþlandý. Hasta komplikasyonsuz total abdominal histerektomi ve bilateral salpingo ooferektomi operasyonu oldu. Hastanýn asemptomatik olmasý ve hastalýðýn nadir görülmesi nedeniyle, literatür tartýþmasý eþliðinde sunuldu.

A 50-year-old female patient was admitted to the Obstetrics and Gynecology Department with vaginal bleeding. The patient was diagnosed with uterine myoma, and an operation was scheduled. A chest radiography revealed suspicious bilateral nodules during the preoperative evaluation of the patient. A thoracic computed tomography revealed bilateral nodular lesions in the superior segment of the right lower lobe and the posterobasal segment of the left lower lobe. A core needle biopsy of the right lung revealed a granuloma formation, neutrophil and lymphocyte infiltration, and fibrinoid necrosis in the interstitial and perivascular area. c-ANCA positivity was detected in autoantibody tests. Eyes, ears, nose, mouth and nephrological examinations of the patient revealed no pathology. The patient was diagnosed with Pulmonary Limited Granulomatosis with Polyangiitis, based on the present findings. Treatment with low dose weekly oral methotrexate, prednisone and folic acid was planned. The patient underwent a total abdominal hysterectomy and a bilateral salpingo oophorectomy without complications. The case is presented with a literature review given the asymptomatic status of the patient and the rarity of the disease.

Göðüs duvarý tümörleri çok nadirdir ve tüm torasik neoplazmlarýn %3,26 – 5’ ini oluþtururlar. Göðüs duvarý tümörleri yüzeyel veya derin yumuþak dokulardan, kemik ve kýkýrdak yapýlardan köken alabilir. Lipom en sýk görülen benign yumuþak doku tümörüdür. Göðüs duvarýndaki lipomlar genellikle yüzeyel olanlara göre daha iyi sýnýrlý ve geniþ olan derin lipomlardýr. Lipom eðer kemik ile temas halinde ise parosteal olarak isimlendirilmektedir. Osteokondrom, kemik dokunun sýk görülen, iyi huylu ve genellikle 10-30 yaþlarýnda görülen primer tümörüdür. Çoðunlukla uzun kemiklerde görülürken, kostal yerleþimleri nadirdir. Biz interkostal uzanýmlý bir parosteal lipom ve iliþkide olduðu kemikte osteokondrom olan 28 yaþýndaki bayan hastayý sunduk.

Chest wall tumors are very rare, accounting for 3.26–5% of all thoracic neoplasms. Chest wall tumors may originate from superficial or deep soft tissues, and from bone and cartilage structures. Lipoma is the most frequent benign tumor of the soft tissue, and those localized on the chest wall are often well-demarcated and larger than those that are superficial. A lipoma that is in contact with the bone is referred to as a parosteal lipoma. Osteochondroma (OC) is a common benign primary tumor of the bone that generally occurs between the ages of 10 and 30 years. It is often seen in the long bones, and costal localization is rare. We present here the case of a 28 year-old female patient who developed a parosteal lipoma with intercostal extension together with osteochondroma in the neighboring bone.

Mediastinal Granüler Hücreli Tümör (GHT) oldukça nadirdir. Ýlk kez 1972 yýlýnda Harrer tarafýndan bildirildiði tarihten beri literatürdeki toplam olgu sayýsý 21’dir. GHT’nin hem benign hem de malign formlarý bildirilmiþ, malignite kriterleri de tanýmlanmýþtýr. Oldukça nadir bir tümör olmasý nedeniyle ayýrýcý tanýda düþünülmediðinden preoperatif tanýsý zordur. Histopatolojik incelemeler mutlaka immünhistokimyasal çalýþmalarý da içermelidir. Mediastende nadir görülen bir tümörü olduðundan, tanýda PET/BT’nin etkinliði de henüz belirlenmemiþtir. Sunulan olguda, sýrt aðrýsý ile baþvuran 50 yaþýnda bir kadýn hastaya, toraks tomografisi ve takiben PET/BT çekilmiþ, posterior mediastinal bölgede saptanan lezyona yönelik VATS ile total eksizyon yapýlmýþtýr. Histopatolojik taný “granüler hücreli tümör” olarak raporlanmýþtýr.

Granular cell tumors (GCT) of mediastinal origin are extremely rare. To the best of our knowledge there have been a total of 21 cases reported since the first case was reported by Harrer in 1972. Both benign and malign forms of GCTs have been reported, and some criteria for malign forms have been described. Preoperative diagnoses are challenging due to the rareness of the condition. Histopathological studies should include immunhistochemistry. Given the rareness of such tumors in the mediastinum, the findings and the diagnostic yield of PET-CT are still unclear. Herein we present the case of a 50-year-old woman suffering from back pain whose diagnosis was based on a thorax computed tomography followed by PET-CT, and who was treated with a video-assisted thoracic surgical excision, with a final pathologic diagnosis of a “granular cell tumor” of the posterior mediastinum.

Sternum tüberkülozu tüm kemik-eklem tüberküloz olgularýn %1-3 oluþtur ve oldukça nadir görülmektedir. Taný konulmasý, atipik prezantasyon nedeni ile sýklýkla gecikmektedir. Toraks MR, erken dönem ve atipik prezantasyonlarda taný koydurucu olmaktadýr. Yirmi üç yaþýnda kadýn hasta, altý aydýr göðüs aðrýsý ve göðüs duvarýnda þiþlik þikâyeti ile merkezimize baþvurdu. Toraks BT ve MR 'ýnda 33x28x42 mm büyüklüðünde sternum korpusunu eroze eden kitle görüldü. Sternum rezeksiyon biyopsinin histopatolojik incelemesi tüberküloz ile uyumlu bulundu. Ülkemiz gibi tüberkülozun sýk görüldüðü bölgelerde genç yaþ grubunda sternum tüberkülozu göðüs duvarý kitlerinin ayýrýcý tanýsýnda düþünülmelidir. Göðüs duvarý tümörünü taklit eden ve sternal tüberküloz tanýsý koyduðumuz bu olguyu sunduk.

Sternal osteomyelitis resulting from tuberculosis (TB) is a clinical rarity, occurring in only 1–3% of all cases of osteoarticular TB. Diagnosis is difficult and is often delayed due to atypical presentation and a lack of awareness. Magnetic resonance imaging (MRI) may be useful in the early stages and in atypical presentations. A 23-year-old female admitted with a 6-month history of chest pain and a mass on middle sternal part of her chest. A computerized tomography (CT) of the thorax and MRI showed a 33x28x42 mm soft tissue mass that was eroding the corpus sternum. Deep biopsy samples from lesions were obtained, and pathology revealed multiple granulomatous and necrotic lesions that were consistent with tuberculous osteomyelitis. The possibility of sternal TB should be kept in mind in the differential diagnosis of masses involving the chest wall, particularly in endemic areas. Herein, we report a case in which a sternal mass mimicked a chest wall tumor that was finally diagnosed as primary sternal tuberculosis.

Ortak embriyojenik köken, otoimmünite, sigara ve kolondan bakteri translokasyonu gibi nedenlerden dolayý akciðer ve baðýrsak hastalýklarý bir arada bulunabilir. Ýnflamatuvar baðýrsak hastalýklarýnda (ÝBH) da Ülseratif kolitli hastalarda, Crohn hastalarýna (CH) göre akciðer tutulumu daha sýk olmaktadýr. Elli üç yaþýndaki kadýn olgumuz, plöretik aðrý, kuru öksürük ve efor dispnesi ile baþvurdu. Antibiyoterapiye yanýt vermeyen pnömonisi olmasý üzerine yapýlan video yardýmlý torakoskopi materyali biyopsi sonucunda organize pnömoni tanýsý aldý. Kortikostreoid tedavisi ile klinik ve radyolojik iyileþme gösteren olgumuz, takibinin 18. ayýnda Crohn hastalýðý tanýsý aldý. ÝBH’de hem hastalýk ile iliþkili hem de kullanýlan ilaç tedavilerine baðlý olarak interstisyel akciðer hastalýklarý görülebilmektedir. Akciðer patolojileri ÝBH tanýsýndan önce de olabilmektedir. Organize pnömoni, CH’da nadir görülmekle beraber bizim hastamýzda olduðu gibi CH tanýsý sonradan da konabilmektedir.

Lung and intestinal diseases may coexist as a result of their common embryonic origin, autoimmunity, smoking and colon translocation. In patients with inflammatory bowel disease (IBD), pulmonary involvement is more common in patients with ulcerative colitis than in patients with Crohn's disease (CH). A 53-year-old female patient presented with pleuritic pain, dry cough and exertional dyspnea. Antibiotic therapy was initiated, but after the patient did not respond to treatment, a video-assisted thoracoscopy was performed, and a diagnosis of organizing pneumonia was made following the examination of the biopsy material. The radiological and clinical condition of the patient improved with corticosteroid treatment, and a diagnosis of Crohn's disease was made in the 18th month of follow-up. Interstitial lung diseases can be seen in IBD, related either to the disease itself or to the drugs used. Pulmonary pathologies may also occur prior to a diagnosis of IBD. Although organizing pneumonia is rare in CH, as in our patient, a subsequent diagnosis of CH may be made.

Plazma hücresi granülomu (PCG), maligniteden ayýrt edilmesi güç olan nadir görülen, iyi huylu bir tümördür. PCG ile iliþkili terminoloji ve literatürde tutarsýzlýk vardýr ve bu tümörlere ayrýca enflamatuar psödotümör, fibröz histiyositoma veya fibroksantoma da denir. Taný, klinik özellikler, serum IgG4 düzeyi, radyoloji ve histopatolojik bulgularýn birlikte deðerlendirilmesi ile konmaktadýr. Çok nadir görülen ve literatürde yeni tanýmlanmýþ, kliniðimize hemoptizi þikayeti ile baþvuran ve akciðerdeki bir lezyon nedeniyle rezeksiyon sonrasý IgG4 ile iliþkili hastalýk tanýsý konulan bu olgumuzu sunduk.

Plasma cell granuloma (PCG) is a rare benign tumor that is difficult to distinguish from malignancy. The terminology associated with PCG is inconsistent, with tumors referred to in literature also as inflammatory pseudotumor, fibrous histiocytoma or fibroxanthoma. Diagnosis: clinical features, serum IgG4 level, radiology and histopathological findings should be evaluated together. We present a case here that is very rare and newly described in literature in which a male patient presented to our clinic with a complaint of hemoptysis, resection due to a lesion on the lung who was subsequently diagnosed with IgG4-related disease.