Medikal torakoskopi (MT), açýklanamayan plevral efüzyonlarý olan hastalar için eþ zamanlý tanýsal ve terapötik çözümler sunan minimal invazif bir araç olarak dünya çapýnda giderek daha fazla kullanýl-maktadýr. Re-ekspansiyon pulmoner ödem (REPO), MT'yi takiben meydana gelebilecek, drene olan plevral efüzyonlarýn nadir fakat potansiyel olarak yaþamý tehdit eden bir komplikasyonudur. MT son-rasý REPO insidansý, risk faktörleri ve tedavi strateji-leri hakkýnda az þey bilinmektedir. MT sonrasý REPO geliþen tüberküloz plevral efüzyonlu (TPE) 3 hastayý içeren bugüne kadarki en büyük olgu serisini sunu-yoruz. Hastalarýn her üçü de oksijen tedavisi, diüre-tik ve hidrokortizon içeren destek tedavisine iyi ce-vap vermiþtir. Literatür taramasý ile birlikte bu olgu serisinin MT'nin nadir fakat tehlikeli bir komplikasyo-nunu aydýnlatmak için bir fýrsat saðlayabileceðini umuyoruz. Erken taný ve ardýndan REPO'nun hýzlý tedavisi daha iyi bir klinik sonuç saðlayabilir.

Medical thoracoscopy (MT) procedures are witnessing increased use worldwide as a minimally-invasive modality offering simultaneous diagnostic and therapeutic benefits to patients with unexplained pleural effusions. Re-expansion pulmonary edema (REPE) is a rare but potentially life-threatening complication associated with pleural effusion drainage that can happen following MT. Little is known about the incidence, risk factors or management strategies of REPE post-MT. We report here on the largest case series to date involving three patients with tuberculous pleural effusion (TPE) who developed REPE after MT. All three patients responded well to supportive measures, including oxygen therapy, intravenous diuretics and hydrocortisone. We believe this case series and literature review serve to highlight an uncommon but dan-gerous complication of MT. Early recognition, fol-lowed by prompt treatment of REPE can ensure a better clinical outcome.

Nokardiya enfeksiyonlarý, baðýþýklýðý baskýlanmýþ ve organ nakli olan hastalarda sýk görülür, ayrýca, Nokardiya türleri immünokompetan hastalarda nadiren enfeksiyona neden olur. Pulmoner nokardiozis, Nokardiya türlerinin en sýk görülen klinik manifestasyonudur ve Türkiye gibi pulmoner tüberküloz (TB) için yüksek riskli bölgelerde sýklýkla pulmoner tüberküloz gibi birçok pulmoner hastalýðý taklid edebilir. Anamnez, klinik semptomlar ve radyolojik bulgulara göre pulmoner tüberkülozu taklit eden pulmoner nokardiozis tanýsý alan nadir bir immünokompetan olguyu sunuyoruz. Bronkoskopik lavajýn aside dirençli boyamasý ve real-time polimeraz zincir reaksiyonu TB için negatifti ve kültürde hiçbir Mikobakteri türü üremedi. Ýki benzer hastalýðýn ayýrýcý tanýsý lavaj sitolojisi ile yapýldý. Ýki aylýk kýsa süreli bir tedavi ile dramatik bir iyileþme gözlendi.

Nocardia infections are common in immunocompromised and organ transplant patients, although Nocardia species only rarely cause infections in immunocompetent patients. Pulmonary nocardiosis is the most common clinical manifestation of Nocardia species, and may imitate several pulmonary diseases, such as pulmonary tuberculosis (TB) in such high-risk settings for TB as Türkiye. We present here a rare case of an immunocompetent patient with pulmonary nocardiosis mimicking tuberculosis in terms of the history, clinical symptoms and radiological findings. Acid-fast staining and real-time polymerase chain reaction testing of the bronchoscopic lavage were negative for TB, and no Mycobacterium species proliferated in the culture. Two similar diseases were differentiated by lavage cytology. The patient improved dramatically following a short course of treatment over two months.

Tromboangiitis obliterans (Buerger hastalýðý), üst ve alt ekstemitenin küçük ve orta çaplý damarlarýný etkileyen inflamatuar bir hastalýktýr. Sýklýkla sigara içen genç erkeklerde görülür. Vasküler inflamasyon ve tromboza baðlý olarak, distal ekstemitelerde iskemi, nekroz, parmak ülserleri ve aðrý ile karakterizedir. Kýrk yedi yaþýnda Beurger Hastalýðý tanýlý, medikal tedaviye raðmen geçmeyen distal ekstemite de ülser ve aðrý þikayeti bulunan hastaya vaskülarizasyonu saðlamak amacýyla torakal sempatektomi uyguladýk. Beurger Hastalýðýnýn tedavisinde nadir uygulanan bir yöntem olmasý nedeniyle deneyimlerimizi literatür eþliðinde sunmak istedik.

Thromboangiitis obliterans (Buerger's disease) is an inflammatory disease that affects small and medium-sized vessels in the upper and lower extremities, and is frequently seen in young smokers. It is character-ized by ischemia, necrosis, finger ulcers and pain in the distal extremities due to vascular inflammation and thrombosis. A thoracic sympathectomy was per-formed to provide vascularization to a 47-year-old patient with a diagnosis of Buerger's Disease who had ulcers and pain in a distal extremity that did not resolve despite medical treatment. Since it is a rarely used method in the treatment of Buerger's Disease, we wanted to present our experience in the light of the literature.

Pulmoner emboli (PE), çeþitli etiyolojilere baðlý olarak pulmoner arter yataðýnda týkanma olarak tanýmlanýr. Çoðu durumda PE bacaklardaki derin venlerden veya nadiren vücudun diðer bölgelerindeki damar pýhtýlarýndan kaynaklanýr. Günümüzde yeni nesil oral antikoagülanlar güvenilirlik ve kullaným kolaylýðýndan dolayý tercih edilmektedir. Yeni oral antikoagülanlar trombin veya faktör Xa gibi koagülasyon faktörlerine selektif olup direkt etkili yeni ilaçlarý temsil eder. Rivaroksaban birçok ülkede kullanýlan yeni nesil oral antikoagülanlardan biridir. Rivaroksaban kullanan hastalarda yanlýþ pozitif olarak sonuçlanabilen lupus antikoagülan antikorlarý altta yatan risk faktörü olmayan pulmoner embolide ortak bir suçlu olarak kabul edilir. Rivaroksaban kullanýmýna baðlý lupus antikoagülan otoantikor pozitifliði olan bir olgu konuya dikkat çekmek için sunulmuþtur.

Pulmonary embolism refers to obstructions of the pulmonary arterial bed due to various etiologies. In most cases, pulmonary embolisms are caused by blood clots that travel to the lungs from the deep veins in the legs or, more rarely, from veins in other parts of the body. Today, the new generation oral anticoagulants are preferred for the treatment of pulmonary embolism due to their ease of use and greater reliability. The new oral anticoagulants are novel direct-acting medications that are selective for a specific coagulation factor, either thrombin or activated factor Xa, among which Rivaroxaban has been used in many countries. Lupus anticoagulant autoantibodies are considered a common culprit in the etiology of pulmonary embolisms with no underlying risk factor, which may lead to false positives in patients using Rivaroxaban. A case with lupus anticoagulant autoantibody positivity due to rivaroxaban usage is presented here to draw attention to this issue.

Pirfenidon, Ýdiopatik pulmoner fibrozis (IPF) için onaylanmýþ iki tedaviden biridir. Pirfenidonun en yaygýn yan etkileri cilt ve gastrointestinal sistem ile ilgilidir. Yan etkiler iyi tolere edilse de zaman zaman ilacýn kesilmesi gerekebilir. Bu olgu sunumunda pirfenidon tedavisinin nadir görülen bir yan etkisi olan likenoid aktinik mukozit ve likenoid aktinik keratoz bildirilmiþtir. Nefes darlýðý ve kuru öksürük þikayetleri ile baþvuran 72 yaþýndaki erkek hasta, tipik radyolojik bulgularla ÝPF tanýsý almýþ ve 3 yýldýr takip edilmektedir. Pirfenidon tedavisi altýnda stabil olarak deðerlendirilen hastanýn üçüncü yýl kontrolünde saçlý deri ve dudakta deri lezyonlarý görüldü. Bu lezyonlarýn biyopsisi likenoid aktinik mukozit ve likenoid aktinik keratoz varlýðýný ortaya koydu. Bu lezyonlar, pirfenidonun kesilmesi üzerine gerileme gösterdi; ancak tedavinin yeniden baþlatýlmasýndan sonra lezyonlar tekrarladý ve lezyonlarýn premalign doðasý nedeniyle tedaviye nintedanib olarak devam edildi.

Pirfenidone is one of two approved treatments for Idiopathic pulmonary fibrosis (IPF), the most common side effects of which are related to the skin and the gastrointestinal tract. Although these side effects are well tolerated, it may at times be necessary to discontinue the drug. We present here a case with rare side effects of pirfenidone treatment, lichenoid actinic mucositis and lichenoid actinic keratosis. A 72-year-old male patient with complaints of dyspnea and dry cough was diagnosed with IPF with typical radiological findings, and was followed up for three years. The patient was considered stable under pirfenidone treatment, however, skin lesions were observed on the scalp and lip at the third-year follow-up, a biopsy of which revealed the presence of lichenoid actinic mucositis and lichenoid actinic keratosis. The lesions regressed upon the cessation of pirfenidone, but returned after the reinitiation of treatment, and the precancerous nature of the lesions spurred a change of treatment to nintedanib.

Dünyada kansere baðlý ölümlerin ilk nedeni olan akciðer kanserlerinde taný aþamasýnda akciðer, karaciðer, adrenal bezler, iskelet sistemi ve kraniyal metastazlar sýklýkla saptanabilirken, orbital metastazlar ise nadiren görülmektedir. Metastatik orbital kitleler, orbital tümörlerin %3-7'sini oluþturur. Orbitaya en sýk metastaz yapan tümörler prostat, meme ve akciðer tümörleridir. Yýllar içerisinde tanýsal metodlardaki geliþmelere raðmen orbital metastaz tanýsýnýn konulmasý zor olabilir ve gözden kaçabilmektedir. Radyolojik görüntüleme yöntemleri metastaz deðerlendirmesinde oldukça önemlidir. Primer akciðer kanseri tanýsý konulan ve görme bozukluðu geliþen iki olgumuzda magnetic resonance imaging (MRI) ile orbita metastazý saptandý ve primer hastalýk göz önünde bulundurulduðunda tanýsal amaçlý invazif giriþim düþünülmedi. Görme bozukluklarýnýn ayýrýcý tanýsýnda altta yatan neoplastik hastalýklar da düþünülmelidir.

While metastases of the lung, liver, adrenal glands, skeletal system and cranium can frequently be detected at the diagnosis stage of lung cancer, as the primary cause of cancer-related death around the world, orbital metastases are less frequently observed. Metastatic orbital masses account for 3–7% of all orbital tumors, while the most common tumors that metasta-size to the orbit are those affecting the prostate, breast and lung. Despite advances in diagnostic methods over the years, orbital metastases are often overlooked, and diagnosis can be difficult. Radiological imaging methods are highly important for the evaluation of metastasis. Orbital metastases were identified on magnetic resonance imaging (MRI) in both patients in the present study, both of whom developed visual impairment after being diagnosed with primary lung cancer, and were not considered for diagnostic invasive interventions due to the primary disease. Underlying neoplastic diseases should be considered during differential diagnoses of visual disturbances.

Akciðerin berrak hücreli tümörü, literatürde þimdiye kadar bildirilen sýnýrlý sayýda vaka ile son derece nadir bir neoplazmdýr. Perivasküler epiteloid hücre tümörleri ailesinin atipik ve çoðunlukla iyi huylu periferik primer akciðer tümörüdür. Ýntrasitoplazmik glikojen içeren berrak hücrelerden oluþtuðu için “þeker tümörü” olarak adlandýrýlýr. Pandemi döneminde akciðerin berrak hücreli þeker tümörü tanýsý alan olgumuz COVÝD-19 pnömonisi nedeniyle operasyon þansýný kullanamadan hayatýný kaybetmiþtir.

Clear cell tumors of the lung are extremely rare neoplasms, and only a limited number of cases have been reported in literature to date. It is an atypical and mostly benign peripheral primary lung tumor belonging to the family of perivascular epithelioid cell tumors, and is referred to also as a “sugar tumor” since it consists of clear cells containing intracytoplasmic glycogen. The case presented here was diagnosed with a clear cell sugar tumor of the lung during the pandemic, but died due to COVID-19 pneumonia before surgery.

Mucormycosis is a fungal infection that is common worldwide and has a high mortality rate after COVID-19 disease. We present here the case of a 55-year-old male who developed cerebral-pulmonary mucormycosis during voriconazole treatment. The pa-tient presented with hemoptysis, and had a history of uncontrolled diabetes due to high-dose and longterm use of corticosteroids for the treatment of COVID-19. He was treated medically with liposomal amphotericin-B and oral posaconazole, and the lung lesion was subsequently removed surgically.

Mukormikoz COVID-19 hastalýðý sonrasý tüm dünyada yaygýn olarak gözlenen ve yüksek ölüm oranýna sahip fungal bir enfeksiyondur. Olgumuz 55 yaþýnda hemoptizi þikayeti olan, özgeçmiþinde COVID 19 nedeni ile yüksek doz ve uzun süreli kortikosteroid kullanýmýna baðlý kontrolsüz diyabet öyküsü olan ve vorikanazol tedavisi kullanýrken geliþen, lipozomal Amfoterisin-B ve oral posakonazol ile medikal tedavi uygulanan, sonrasýnda cerrahi olarak çýkarýlan ilk serebro-pulmoner mukormikoz olgusudur.

COVID-19 patolojisi; akciðer ve diðer organlarda mikrovasküler seviyede tromboinflamatuvar olaylar ile karakterizedir. Yoðun bakým gerektiren aðýr COVID-19 pnömonili hastalara kýlavuzlara göre terapötik/profilaktik dozda düþük moleküler aðýrlýklý heparin uygulamasýndan sonra karþýlaþýlan hayatý tehdit eden kanama olgularýný derledik. Olgularýn üçü erkek, ikisi kadýndý ve hepsine antikoagülasyon uygulandý. Ka-nama þüphenilen hastalarýn hepsinde ciddi hemoglobin düþüklüðü mevcuttu. Biri klinik þüphe ile taný konulan, diðerleri görüntüleme yöntemleri ile kesinleþen 5 hastanýn dördünde retroperitoneal, birinde iliopsoas kasý içinde hematom tespit edildi. Bir hasta hemoraji nedeniyle kaybedilirken, diðer hastalarýn hemorajileri antikoagülan tedavinin sonlandýrýlmasý, uygun kan ürünü transfüzyonlarý ile kontrol altýna alýndý. Yoðun bakým ünitesinde takip edilen COVID-19 pnömonili olgularda antikoagülan tedavi verilirken kanama açýsýndan dikkatli olunmalý ve hastalar vital bulgular ve laboratuvar bulgularý ile sýk monitorize edilmeli, retroperitoneal hematom gibi nadir ancak hayatý tehdit edebilecek komplikasyonlar akýlda tutulmalýdýr.

The COVID-19 pathology is characterized by thromboinflammatory events at a microvascular level in the lung and other organs. In an assessment of patients with severe COVID-19 pneumonia requiring intensive care, we identified cases in which life-threatening hemorrhage was encountered after the administration of therapeutic/prophylactic-dosage low molecular weight heparin according to guidelines. Among the identified cases, three were male, two female and all patients were administered anticoagulation admin-istrations. All patients with suspected bleeding were identified with severely low hemoglobin levels. Retroperitoneal hematomas were detected in four of the five patients, one of whom was diagnosed based on clinical suspicion, while others were confirmed via imaging. One patient died due to hemorrhage, while the hemorrhages of other patients were controlled through the discontinuation of anticoagulant therapy and appropriate blood product transfusions. While administering anticoagulant therapy for COVID-19 pneumonia in patients followed in the intensive care unit, attention should be paid to the issue of bleeding, and the potential for such rare but life-threatening complications as retroperitoneal hematoma.