Respir Case Rep. 2013; 2(1): 6-9 | DOI: 10.5505/respircase.2013.08208

Etiology of Multiple Pulmonary Nodules: Mitral Stenosis

Funda Aksu¹, Alper Yurdasiper², Serdar Akyüz^3
1Eskiþehir Yunus Emre Hospital, Deparment Of Chest Diseases
²Eskiþehir Yunus Emre Hospital, Deparment Of Radiology
³Eskiþehir Yunus Emre Hospital, Deparment Of Cardiology

A 36-year-old male patient, with a history of mitral valve replacement (MVR) operation eight years prior, was admitted with chest pain. A physical examination revealed no pathologies except swelling, redness, and sensitivity on the site of the scar tissue of a sternotomy. Bilateral nodular densities were detected in the chest X-ray. Computed tomography of the thorax revealed calcification at the site of the mitral valve and randomly distributed, multiple millimetric pulmonary nodules, some of which were calcified. Underlying infectious, granulomatous, or neoplastic pathologies were not detected upon further evaluation, and the nodules were accepted as secondary to mitral valve stenosis. Chest pain was due to sternal wire sutures and was completely resolved after removal of the sutures. Patient was readmitted with hemoptysis and severe chest pain 16 months after the first admission. Cardiac evaluation revealed that hemoptysis and the pulmonary nodules were caused by pulmonary congestion together with increases in the left atrial pressure, due to ineffective warfarin treatment after the MVR operation. Rheumatic heart diseases should be a part of the differential diagnosis in researching the etiology of pulmonary nodules, as they continue to be encountered frequently in Turkey.

Keywords: Mitral Valve Stenosis, Multiple Pulmonary Nodules, Idiopathic pulmonary hemosiderosis.

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Multipl Pulmoner Nodül Etiyolojisi: Mitral Stenoz

Funda Aksu¹, Alper Yurdasiper², Serdar Akyüz^3
1Eskiþehir Yunus Emre Devlet Hastanesi, Göðüs Hastalýklarý Kliniði
²Eskiþehir Yunus Emre Devlet Hastanesi, Radyoloji Kliniði
³Eskiþehir Yunus Emre Devlet Hastanesi, Kardiyoloji Kliniði

Sekiz yýl önce mitral kapak replasman operasyonu geçirmiþ olan 36 yaþýnda erkek hasta göðüs aðrýsý ile baþvurdu. Fizik muayenesinde göðüs ön duvarda sternotomi skarý bölgesinde þiþlik, kýzarýklýk ve hassasiyet dýþýnda patoloji saptanmadý. Akciðer grafisinde bilateral nodüler dansiteler mevcuttu. Bilgisayarlý toraks tomografisinde mitral kapak düzeyinde kalsifikasyon ve her iki akciðerde daðýnýk yerleþimli, bazýlarý kalsifiye çok sayýda milimetrik nodüller saptandý. Ýleri tetkiklerde multipl pul-moner nodül etiyolojisini açýklayacak enfeksiyöz, granulomatöz ya da neoplastik bir patoloji sap-tanmadý ve nodüller öncelikle mitral stenoza sekonder düþünüldü. Göðüs aðrýsýnýn nedeni sternal tel batmasý olarak saptandý ve operasyonla tel eksize edildi. Ýlk baþvurusundan 16 ay sonra hasta hemoptizi ve þiddetli göðüs aðrýsý nedeni tekrar baþvurdu. Kardiyak deðerlendirme ile hemoptizi ve pulmoner nodüllerin mitral kapak replasmaný operasyonu sonrasý inefektif warfarin kullanýmýna baðlý sol atriyum basýncýnda yükselmelerle seyreden pulmoner konjesyona baðlandý. Romatizmal kalp hastalýklarý ülkemizde halen sýk olarak görülmekte olup multipl pulmoner nodül etiyolojilerinde ayýrýcý tanýda düþünülmelidir.

Anahtar Kelimeler: Mitral kapak darlýðý, Çoklu akciðer nodülleri, Ýdiopatik pulmoner hemosiderozis.

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