Mesalamin, inflamatuvar barsak hastalýklarý tedavisinde kullanýlan bir ilaç olup baþka ilaçlar gibi interstisyel akciðer hastalýðýna sebep olabilmektedir. Ülseratif Kolit (ÜK) nedeni ile mesalamin tedavisi almakta olan 39 yaþýnda kadýn hasta, öksürük, halsizlik, nefes darlýðý yakýnmalarý ile baþvurdu. Akciðer grafisi ve toraks bilgisayarlý tomografisinde bilateral yamalý konsolidasyonlar görüldü. Klinik ve radyolojik bulgularýn, ülseratif kolitin akciðer tutulumuna baðlý olabileceði veya mesalamine baðlý akciðer toksisitesi olabileceði düþünüldü ve mesalamin tedavisi kesildi. Ýzleminde, 10 gün sonraki akciðer grafisinin baþvuru sýrasýndakine göre belirgin düzeldiði görüldü. Hastanýn solunumsal þikâyetleri de geriledi. Sonuç olarak; inflamatuvar barsak hastalýðýnýn akciðer tutulumu yerine mesalamine baðlý akciðer toksisitesi düþünüldü.

Mesalamine, a widely used drug for inflammatory bowel disease, could cause pulmonary interstitial disease, like many other drugs. A 39-year-old woman with ulcerative colitis (UC) admitted with cough, dyspnea, and fatigue. Bilateral patchy alveolar infiltrations were seen on chest x-ray and tomography. Mesalamine was terminated, as the reaction was believed to be potentially caused by CU or due to the pulmonary toxicity of the drug. At the follow-up visit after 10 days, the initial infil-trations on chest radiograph improved. The patient's respiratory complaints had decreased significantly. As a result, mesalamine-induced lung toxicity was considered instead of lung involvement in patients with inflammatory bowel disease.

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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.

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.

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Böcek sokmalarý ve izleyen reaksiyonlar sýk görülmekle beraber, hayatý tehdit eden sistemik reaksiyonlara nadiren yol açarlar. Diffüz alveoler hemoraji (DAH), pek çok sistemik hastalýðýn seyrinde ve nadir durumlarda ortaya çýkabilmektedir. Klinik olarak hemoptizi, anemi, akciðer grafisinde diffüz infiltrasyonlar ve hipoksemik solunum yetmezliði tablosu görülür. Radyolojik görünüm akciðer ödemi, ciddi infeksiyon veya üremi ile benzerlik taþýr. Arý sokmasýný izleyen yarým saat içinde anafilaktik þok ve diffüz alveoler hemoraji tablosu gözlenen 23 yaþýndaki hastayý sunuyoruz.

Insect stings and subsequent reactions are com-mon occurrences, but life-threatening systemic reactions are quite rare. Diffuse alveolar hemor-rhage is a clinical entity seen in many different disease processes and includes hemoptysis, anemia, diffuse radiographic pulmonary infiltrates, and hypoxemic respiratory failure, which can be severe. Radiologic features may mimic cardiogenic pulmonary edema, severe infection or uremia. We describe a 23-year-old girl who developed symptoms of anaphylactic shock and diffuse alveolar hemorrhage within 30 minutes following a bee sting.

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Amiloidoz, amiloid olarak adlandýrýlan özel bir proteinin vücuttaki deðiþik dokularda anormal biçimde depolanmasý sonucunda ortaya çýkan bir grup hastalýktýr. Organize pnömoni, akciðer hastalýklarý içinde ender görülen ama oldukça karakteristik kliniko-patolojik özellikleri olan bir tablodur. Olgumuz nefes darlýðý, öksürük, balgam, yan aðrýsý yakýnmasý ile hastanemize baþvurdu. Postero-anterior akciðer grafisinde sol parakardiak sýnýrda heterojenite, sol sinüs kapalý olarak izlendi. Yüksek çözünürlüklü bilgi-sayarlý tomografide sol akciðer üst lob apikoposterior segmentte ve sol akciðer alt lobda yaygýn buzlu cam dansitesi zemininde retikülonodüler deðiþiklikler, yer yer konsolide alanlar, bronþektazik deðiþiklikler ve hacim kaybý saptandý. Olgunun proteinürisi olmasý üzerine renal amiloidoz açýsýndan böbrek biyopsisi yapýldý. Patoloji sonucu renal amiloidozis ile uyumlu geldi. Fiberoptik bronkoskopide sol alt lob mukozasýnda beyaz plak alanýndan biyopsi yapýldý. Biopsi örneði “organize pnömoni” (interstisyel pnömoni ve interstisyel fibrozis) bulgularý ile uyumlu geldi. Bu yazýda, kistik bronþektaziye baðlý geliþen renal tutulumu olan sekonder amiloidoz ve bronþiolitis obliterans organize pnömoni olgusu sunulmuþtur.

Amyloidosis is group of conditions occurring as a result of abnormal storage of a specific protein, amyloid, in various tissues in the body. Organizing pneumonia, a rarely seen within lung diseases, but rather possessing a characteristic clinicopathologic features is a table. A case applied to our hospital with shortness of breath, cough, sputum, and chest pain. Heterogeneity at the left paracardiac borderline, by closing the left sinus, was observed in the posteroanterior chest x-ray. Reticulonodular changes on the basis of extensive ground-glass density, locally consolidated areas, changes in bronchiectasis, and a loss of volume in the apical-posterior segment of the upper and lower lobes of the left lung were determined by High-resolution computed tomography. Because of proteinuria, renal biopsy was performed on the basis of renal amyloidosis. The pathologic examination was consistent with renal amyloidosis. A biopsy was carried out by fiberoptic bronchoscopy in the lower left lobe mucosa from the area of white plaque. The biopsy specimen was compatible with "organized pneumonia” (interstitial pneumonia and interstitial fibrosis). Secondary amyloidosis and bronchiolitis obliterans organizing pneumonia with renal involvement, progressing due to infected cystic bronchiectasis, are presented in this study.

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Kistik fibrozisli hastalarýn takibinde A vitamini eksikliðine baðlý göz bulgularý görülebilmektedir. Korneal opasite ve geliþme geriliði ile baþvurarak kistik fibrosis tanýsý alan 11 aylýk bir çocuðu sunuyoruz. Korneal opasite bulgusu ile taný alan literatürde bildirilen ilk kistik fibrosis vakasýdýr ve erken yaþta bu hastalarda göz bulgularý nadirdir.

Eye manifestations due to hypovitaminosis A was observed in the follow-up of patients with cystic fibrosis. Herein, we describe an 11-month-old infant with corneal opacity and growth retardation who was diagnosed as cystic fibrosis. To our knowledge, this is the first report in the literature of corneal opacity as a manifestation of cystic fibrosis. Furthermore, it is rare to encounter ophthalmic findings in cystic fibrosis at this age.

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Mediastinit, mediastendeki hayati organlarýn etrafýnda nadir görülen enfeksiyöz bir hastalýktýr. Desendan nekrotizan mediastinite odontojenik, farengeal, servikal enfeksiyonlar, sternotomi veya taný ve tedavi amaçlý giriþimler sebeb olur. Zamanýnda taný konulmaz ve uygun olarak tedavi edilmezse sonuç fatal olur. Tedavideki gecikme enfeksiyonun mediastene yayýlmasýna yol açar. Diþ apsesinden muzdarip 17 yaþýndaki kýzda geliþen desendan nekrotizan mediastinit olgusunu sunuyoruz.

Mediastinitis is a rare infectious disease around the vital organs in the mediastinum. Descending necrotizing mediastinitis (DNM) is caused by odontogenic, pharyngeal, cervical infections, sternotomy or diagnostic and therapeutic instrumentation. Unless it is diagnosed in a timely manner and properly treated, the outcome is fatal. Delay in treatment leads to the spread of the infection down to the mediatinum. We present a case of DNM in 17-year-old girl suffering from a dental abscess.

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Tüberküloz farklý radyolojik görünümlerle ortaya çýkabilen bir hastalýktýr. Sýk olmamakla birlikte kitle görünümünde akciðer tüberkülozu olgularý literatürde mevcuttur. Kitle görünümü ile baþvuran hastalarda tüberküloz tanýsýndan emin olmak ve eþlik eden tümör tanýsýný kesin dýþlamak bazen zor olmaktadýr. Bu yazýda, kliniðimize akciðer grafisinde kitle görünümü ile baþvuran, ailesinde akciðer kanseri öyküsü olan ve sigara içen (25 paket/yýl) 45 yaþýnda erkek hastada taný ve takipte yaþanan güçlükler tartýþýldý. Ülkemiz gibi her iki klinik durumun da sýk görüldüðü toplumlarda ayýrýcý tanýnýn içerdiði güçlükler vurgulanmak istendi.

Tuberculosis can be presented with different radiological forms. Mass lesion with the diagnosis of pulmonary tuberculosis is not rare in literature. Sometimes it is challenging to be sure of the diagnosis of tuberculosis and excludes coexisting cancer in a patient presented with mass lesion. In this paper diagnostic difficulties and follow up of a 45 years old male patient with a family history of lung cancer and a smoking history (25 packs/years) who was presented with a mass lesion on his chest radiography is discussed with review of literature. We would like to emphasize the difficulties of differential diagnosis in communities in which both of the clinical situations were common.

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Karaciðer ve akciðer dýþýnda kist hidatik yerleþimi seyrektir. Kaburgalarýn kemik kýsmý gibi nadir yerle-þimler, alýþýk olmayan semptomlara yol açabilir. Cerrahi öncesi doðru taný önemli olup bazý vakalarda þaþýrtýcý olabilir. Omuz aðrýsý çeken genç bir eriþkin hastada görülen birinci kosta ekinokokoz olgusu sunuldu. Akciðer grafisinde ve toraks bilgisayarlý tomografisinde superior sulkus tümörü þüphesi vardý. Lezyon rezeke edildi ve histopatolojik inceleme sonucu kist hidatik tanýsý kondu.

Hydatid cysts are rarely located outside of the liver and lungs. Exceptional locations, such as the in-traosseous part of the rib can cause unusual symp-toms. An accurate preoperative diagnosis is im-portant, but may be confusing in some cases. The presented case here is an example of echinococcosis of the first rib in a young adult who complained of shoulder pain. Plain chest x-ray and computerized tomography scan were suggestive of a superior sulcus tumor. The lesion was resected and the histopathological examination confirmed hydatid disease.

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Leiomiyosarkom, sýklýkla uterus, retroperitoneum ve intraabdominal bölgeden kaynaklanan, düz has hücrelerinin tümörüdür. Trakeabronþiyal aðaçta düz kas hücrelerinin çokluðuna raðmen primer pulmoner kas tümörleri çok nadirdir. Kýrk sekiz yaþýnda herhangi bir þikayeti olmayan erkek hasta, tesadüfen çekilen akciðer grafisinde lezyon saptanmasý nedeniyle merkezimize yönlendirilmiþti. Bilgisayarlý Toraks tomografisinde sað akciðer alt lobda 4x3 cm çaplý kitlesel lezyon izlendi. Fluorodeoksiglukoz (FDG) iþaretli Bilgisayarlý Tomografi Entegrasyonlu Positron Emisyon Tomografi (PET/CT) taramada lezyonun düþük FDG tutulumu mevcuttu. Tanýsal amaçlý tomografi rehberliðinde iðne aspirasyonlarý yapýldý. Histopatolojik tanýya ulaþýlamayýnca taný ve tedavi amacýyla cerrahi planlandý. Video yardýmlý toraks cerrahisi (VATS) ile alt lob wedge rezeksiyonu uygulanan hastanýn postoperatif patoloji sonucu akciðerin primer leiomiyosarkomu olarak yorumlandý.

Leiomyosarcoma is a tumor of the smooth muscle cells which frequently originates in the uterus, retro-peritoneum, and within the abdomen. Although there are a large number of smooth muscle cells in the tracheobronchial tree, primary pulmonary muscle tumors rarely occur. A 48-year-old male patient with no symptoms was admitted to our department following the inadvertent detection of a lesion in his chest x-ray. Through thoracic computerized tomography, a 4x3 cm diameter mass lesion was located in the lower right lobe. In the positron emission tomography-computed tomography (PET/CT) scan with a fluorodeoxyglucose (FDG) tracer, low FDG uptake was observed in the lesion. Computer tomography-guided needle aspirations were carried out. In the absence of a histopathological diagnosis, surgery was planned for diagnosis and treatment. A lower lobe wedge resection was completed using video-assisted thoracic surgery (VATS). A diagnosis of primary pulmonary leiomyosarcoma was made based on postoperative pathology results.

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Swyer-James/Mac Leod Sendromu (SJMS) pulmoner arter hipoplazisine baðlý unilateral hiperlüsent akciðer görünümü ve bronþektazi ile karakterize nadir görülen bir hastalýktýr. Çocukluk çaðýnda geçirilen viral bronþiolit ve pnömoniler sonrasý akkiz olarak geliþtiði düþünülmektedir. Kýrk sekiz yaþýnda kadýn hasta, nefes darlýðý, öksürük, balgam çýkarma yakýnmalarýyla baþvurdu. Öyküsünden bu þikayetlerinin çocukluk yaþlarýndan beri tekrarladýðý, 10 yýl öncesine kadar kronik bronþit, son 10 yýldýr da bronþektazi ve küçük hava yolu hastalýðý tanýlarýyla takip ve tedavi edildiði öðrenildi. Fizik muayenesinde; solunum seslerinin þiddeti sað alt bölgede sola göre azalmýþ, bilateral orta ve alt bölgede ve anteriorda kaba ralleri mevcuttu. Akciðer grafisinde; sol akciðerde hacim kaybý, radyolusensi artýþý ve alt zonda bronþektazik alanlar izlendi. Bilgisayarlý tomografide; sol pulmoner arter ve dallarýnýn kalibrasyonu saða kýyasla belirgin azalmýþtý. SJMS çocukluk ve genç eriþkin dönemde teþhis edilen bir hastalýk olmasýna karþýn, olgumuzda 48 yaþýna kadar solunum þikayetleri tanýmlamasý nedeniyle birçok kez tetkikler yapýlmasýna raðmen taný konulmamýþtýr. Tek taraflý hiperlüsent akciðer görünümü saptandýðýnda bu sendromun ayýrýcý tanýda düþünülmesi gerektiðini vurgulamak için sunuyoruz.

Swyer-James/MacLeod syndrome (SJMS) is a rare disease, characterized by unilateral hyperlucent lung due to hypoplasia of the pulmonary artery and bronchiectasis. Illnesses such as viral bronchiolitis and pneumonia in childhood are thought to be an acquired form. A 48-year-old woman applied to the hospital with symptoms including shortness of breath, sputum, and cough. Her medical history revealed that these symptoms had been relapsing since her childhood. She had been diagnosed and monitored for chronic bronchitis and bronchiectasis for the past 10 years. A physical examination revealed that the respiratory sounds of the lower left lobe decreased more than the right side, and revealed coarse crackles in the both middle, anterior, and inferior hemithorax. Chest radiography showed a loss of volume of the left lung, hiperlucency, and areas of bronchiectasis in the lower left lobe. Computed tomography showed that calibration of left pulmonary artery and its branches significantly decreased compared to the right side. We present our case simply because the majority of SJMS cases are diagnosed in childhood and young adulthood; however, our patient was examined several times with the same symptoms and not diagnosed until the age of 48. This syndrome should be considered in the differential diagnosis of patients who have hyperlucent lung.

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Scimitar sendromu, nadir bir hastalýktýr ve hipogenetik akciðer sendromu olarak da bilinir. Sendrom sað pulmoner venin, vena kava inferiora drenajý ile karakterizedir. Burada sað pulmoner arter agenezisinin eþlik ettiði Scimitar sendromu sunuldu. Yirmi bir yaþýnda erkek hasta nefes darlýðý, öksürük, balgam çýkarma þikayetleri ile baþvurdu. Akciðer grafisinde sað akciðerde volüm kaybý, kalp ve mediastende saða doðru yer deðiþtirme izlendi. Bronkoskopik incelemede ve toraks BT’de orta lob bronþu izlenmedi. Toraks BT anjiografi görüntülerinde sað akciðer alt loba ait venin sað hepatik vene drene olduðu ve sað pulmoner arter çapýnda azalma izlendi. Akciðer perfüzyon sintigrafisinde sað akciðerde total perfüzyon kaybý izlendi. Scimitar sendromlu hastalarda akciðer grafisinde scimitar (pala) iþaretinin olmasý karakteristiktir. Ancak bu iþaret her zaman görülmeyebilir. Akciðer grafisinde volüm kaybý ve mediastinal þifti olan genç hastalarda diðer hastalýklarýn yanýnda Scimitar Sendromu da akla gelmelidir.

Scimitar syndrome is a very rare disorder and also known as hypogenetic lung syndrome. The syndrome is characterized with anomalous connection of the pulmonary vein with the vena cava inferior. In this text, scimitar syndrome associated with pulmonary artery hypoplasia is presented. A 21-year-old male patient with complaints of cough, shortness of breath and sputum was admitted. Chest X-ray revealed volume loss of right lung and shift to the right of heart and mediastinum. The middle lobe wasn’t observed in bronchoscopy and thorax CT. Thoracic CT angi-ography images revealed that vein of right lung lower lobe drains right hepatic vein and right pulmonary artery diameter is reduced. Lung perfusion scintigraphy revealed total loss of perfusion of right lung. Scimitar sign on chest X ray is characteristics for scimitar syndrome. However, this sign cannot be seen in some patients. If there is volume loss of right lung and shift to the right of heart and mediastinum, scimitar syndrome should be considered in addition to other diseases.

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