In recent years extracorporeal membrane oxygenation (ECMO) has been used to maintain adequate gas exchange in pa-tients with Acute Respiratory Distress Syn-drome (ARDS). The aim of this case report is to share our center’s experience with physiotherapy in patients with ARDS on ECMO, to support the use of physiotherapy and to relate the long-term functional outcomes of the patient at six months after discharge. We present here the case of a 28-year-old female who was referred to our intensive care unit with a diagnosis of ARDS being supported by ECMO. While on ECMO, she received physiotherapy interventions including passive techniques, and participated in an active mobility program following ECMO. Her long-term outcomes, including functional level, exercise capacity, dyspnea, muscle strength, anxiety, depression and quality of life, assessed six months after discharge, were at a very good level. We consider that participation in the early physiotherapy and mobility program may contrib-ute to short- and long-term functional im-provements in an ECMO patient.

Foreign body aspiration into the tracheobronchial system, which is more common in children than adults, can have serious consequences, leading even to mortality and morbidity, and may be diagnosed only after a delay. A foreign body was detected during a flexible bronchoscopy due to stenosis in the left main bronchus in the chest computed tomography of a 59-year-old female patient being followed up for asthma. A cinnamon stick identified in the left main bronchus was removed with rigid bronchoscopy, revealing the asthma to be a misdiagnosis.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a safe procedure with high diagnostic yield. However, complications related to EBUS-TBNA procedures are increasingly being reported. Common complications of EBUS-TBNA include infectious complications, pneumothorax, bleeding, and pneumome-diastinum. Although the frequency of complications varies among studies, complication rates are quite rare (0.15 - 1.44%). One of the rare complications of EBUS-TBNA is the appearance of nodular lesions at the tracheobronchial puncture sites following EBUS-TBNA, namely "tracheobronchial puncture site nodular reaction" (TPNR). Here, we present three cases of TPNR, two of which were diagnosed with granulation tissue and one with malignancy. A biopsy must be taken in cases presenting with nodular lesion after EBUS.

Mediastinal leiomyomas are usually of esophageal origin, among which primary mediastinal leiomyomas are extremely rare. The current approach to the treatment of giant primary mediastinal leiomyoma involves the removal of the mass by thoracic surgery. We present here a case with leio-myoma of the posterior mediastinum that was compressing the trachea, and that was diagnosed via EBUS TBNA.

Vascular anomalies are pathologies that occur in embryonic life that affect the lymphatic and capillary systems, and can be classified as vascular tumors or vascular malformations, according to their histological features. They are rare and are mostly detected in the first years of life. Hemangio-lymphangiomas are benign vascular tumors containing lymphatic and capillary system elements with a reported incidence of 1: 12,000 in newborns. The cases reported to date have been in the head (oral cavity, orbita, etc.), neck and mediastinum regions. We presented here a case of a 17-year-old male patient who was diagnosed with hemangiolymphangioma after a videoassisted lung biopsy (VATS) with accompa-nying interstitial lung disease. The patient, who had no history of chronic disease, pre-sented to the outpatient clinic complaining of cough and shortness of breath for eight months. Interstitial lung features were ob-served in the patient’s thorax computer tomography. After the VATS procedure, the patient developed chylothorax, and the pathology results indicated hemangiolymphangioma.

A pathophysiological link may exist between Birt-Hogg-Dubé syndrome (BHD) and pulmonary sarcoidosis such that the folliculin protein encoded by the FLCN gene may lead to the development of sarcoidosis through the upregulation of T- helper 1 cell activation. We present here a rare case of coexisting BHD and sarcoidosis. Enlarged mediastinal lymphadenopathy may be underdiagnosed in patients with BHD, and so both the mediastinal and lung window of a thoracic CT scan should be evaluated carefully and a biopsy should be performed if pathologic lymphadenopathies are indicated.

Niemann-Pick disease is a rare lysosomal storage disease in which sphingolipids ac-cumulate in reticuloendothelial cells due to acid sphingomyelinase deficiency, three forms of which have been defined to date. Since Niemann-Pick Type B has different clinical findings, the patient presentation and disease progression can differ. Lipid storage is slow and progressive and leads to deterioration in multiple organs. Patients are mostly diagnosed in adulthood and pulmo-nary involvement is common. In our case, a 32-year-old female patient with complaints of cough and dyspnea was on long-term follow-up with a prediagnosis of interstitial lung disease, but with no specific diagnosis as she declined invasive procedures. An open lung biopsy performed due to the progression of symptoms resulted in histiocytes with foamy cytoplasm. A diagnosis of Niemann-Pick Type B was subsequently reached after a large patchy, mild hypocel-lular bone marrow with histiocytic infiltration, compatible with storage disease, was identified from a bone marrow biopsy performed for splenomegaly and thrombocytopenia. Since storage diseases are rare they are not considered in the differential diagnosis of interstitial lung diseases, but should be considered in the presence of systemic symp-toms.

Air embolism refers to the entry of air into the venous or arterial system via direct conduction and pressure difference. The most common causes are iatrogenic, and are observed to be related to surgical and invasive procedures. The consequences of air embolisms depend on the air volume and the velocity of air entry. The clinical presentations may vary from asymptomatic course to shock. Emergency treatments include the provision of hemodynamics, oxygen support and positioning, and hyperbaric oxygen therapy in selected cases. In the present study we investigate the cause of the development of a venous air embolism in a patient on bilevel positive airway pressure (BiPAP) ventilation at home due to chronic respiratory failure and resorption in the short term without hyperbaric oxygen therapy.

Dapson, although generally well tolerated, can lead to hematological side effects. Although methemoglobinemia is a rare clinical condition, it can culminate in death if not treated in a timely and appropriate manner. A 21-year-old male patient presented to our outpatient clinic with shortness of breath, with oxygen saturation in ambient air measured by pulse oximetry at 88%. His initial medical history and physical examination were unremarkable for possible causes of dyspnea, while arterial blood gas measurements revealed methemoglobin elevation (Fmethb: 10.6). Detailed history revealed that dyspnea with subsequent hypoxia had started after dapsone treatment due to IgA dermatitis. We present this case report to highlight the possible role of dapsone as a rare cause of hypoxemia and methemoglobinemia, as exemplified in this young patient undergoing dapsone treatment for IgA dermatitis in which dyspnea was the initial symptom.

Spontaneous pneumomediastinum (SPM) is among the rare complications of Corona-virus Disease-19 (COVID-19) and usually in-volves patients with a severe form of disease who are undergoing treatment with invasive/noninvasive ventilation or high-flow oxygen therapy. A very low percent-age of SPM cases are detected in non-ventilated COVID-patients, the underlying causes of which are still to be understood. We report here on the case of a 65-year-old patient with no clinical history of cardiovascular or pulmonary disease who developed SPM within a few days following hospital admission. SPM was detected on chest CT-angiography, and was unrelated to high-flow oxygen treatment.

Spontaneous pneumomediastinum is a rare and life-threatening complication in patients with COVID-19. Although there are a few reports of spontaneous pneumomediastinum related to COVID-19 in literature, most involve patients who have been followed up in intensive care units (ICUs) or COVID-19 clinics for a period due to mild to severe COVID-19 disease. We present here a case of spontaneous pneumomediastinum that developed in an asymptomatic COVID-19 patient with no medical history.

The declared COVID-19 pandemic has come to affect the entire world. Ever since the first cases were detected, pneumothorax has been considered a rare but possible complication, and may develop in patients under mechanical ventilation due to high pressure. We present here a case of simultaneous bilateral spontaneous pneumothorax with COVID-19 pneumonia with no history of chronic lung disease and no mechanical ventilation.

In the ongoing COVID-19 pandemic, several patients have experienced respiratory failure, for which high-flow nasal oxygen therapy (HFNO) is a frequently preferred treatment modality. In the present study, three COVID-19 patients being followed up with HFNO in the intensive care unit underwent fiberoptic bronchoscopy, and a burned/wounded mucosa with widespread hyperemia, hyperpigmentation and mucosal damage throughout the entire tracheobronchial system mucosa was detected in all cases, the long-term effects of which are unknown. Herein, we aim to draw attention to the possible development of mucosal damage after HFNO, which should be kept in mind during the provision of ventilation support to COVID-19 patients.

As our knowledge and experience of COVID-19 increases, our treatment approaches may change. For patients with respiratory failure due to COVID-19 disease, the disease table can be better controlled with systemic glucocorticoids, and mortality rates and hospitalization periods can also be reduced. Steroid therapy can be applied for the long-term, especially in cases with organized pneumonia, and patients can be discharged from hospital with maintenance treatment. Complications have been noted in patients in the post-COVID period resulting from the use of glucocorticoids. While mostly bacterial and fungal lung infections are seen, another side-effect of glucocorticoids is their negative effect on bone metabolism. We present here a case in which avascular bone necrosis developed as a result of long-term steroid use for the treatment of COVID-19.