Otuzbir yaþýnda erkek hasta nefes darlýðý, öksürük þikayetleri ile baþvurdu. Hasta 1 ay önce mesleksel astým tanýsýyla inhaler tedavi kullanmýþtý. Özgeçmiþinde 5 paket yýl sigara hikayesi (8 yýldýr sigara içmiyor) vardý. Hasta 3 yýldýr mobilya fabrikasýnda çalýþýyor ve çalýþma ortamýnda maske kullanmadýðýný ve yapýþtýrýcý inhalasyonu olduðunu tarifliyordu. Fizik muayenesinde vital bulgularý normaldi. Oksijen saturasyonu %95, sað akciðer bazalinde raller vardý. Difüzyon kapasitesi ise çok düþüktü. Toraks BT'de sað alt lobda buzlu cam densitesi, sol akciðerde hava hapsi mevcuttu. Fiberoptik bronkoskopi yapýldý ve transbronþiyal biyopsi alýndý. Ancak biyopsi materyali kesin taný için yeterli deðildi. Sað torakotomi yapýlan hastadan wedge biyopsi alýndý. Histopatolojik taný ise hipersensitivite pnömonisi (HP) olarak raporlandý. Hastaya 6 ay metilprednizon (1mg/kg/gün) tedavisi verildi. Tedavi sonrasý ve antijen maruziyetinin kesilmesi ile belirgin klinik ve radyolojik düzelme saðlandý. Sonuç olarak detaylý meslek anamnezinin mesleksel HP þüphesi durumunda önemli olduðunu vurgulamak istiyoruz.

A 31-year-old male patient was admitted to the hospital with coughing and dyspnea. One month ago he was treated with inhaler drugs with the diagnosis of occupational asthma. His history revealed that he smoked five packets of cigarettes per year (he was an ex-smoker for 8 years) and worked in the furniture industry for 3 years. He also added that he was exposed to glue inhalation in the work place; he did not use a mask. The physical examination revealed normal vital signs, and oxygen saturation was 95%. Rales in the base of right lung were also noted. Diffusion capacity was found to be very low. The thoracic CT revealed ground-glass densities in the right lower lobe and air trapping in the left lung. Fiber optic bronchoscopy and transbronchial biopsy were performed. The transbronchial biopsy specimen was insufficient for a specific diagnosis. Right thoracotomy and wedge resection were performed for the specific diagnosis. The pathological diagnosis was reported to be hypersensitivity pneumonitis (HP). The patient was treated with methylprednisolone (1mg/kg/day) for six months. After the treatment and removal from the antigen exposure, clinical and radiological improvements were obtained. In conclusion, detailed working anamnesis is important in the patients with suspicion of occupational HP.

Abstract | Full Text PDF

Pulmoner alveoler mikrolitiazis (PAM), her iki akciðerde intraalveolar mikrolitlerin birikimi ile karakterize az rastlanan kronik bir akciðer hastalýðýdýr. Taný genellikle spesifik radyolojik bulgularla konmakla birlikte kesin taný için patolojik inceleme yapmak gerekebilir. Kemik sintigrafisi tanýya yardýmcý olan diðer bir görüntüleme yöntemidir. Kemik sintigrafisinde birçok vakada akciðerlerde diffüz Tc-99m metilen difosfonat (MDP) tutulumu rapor edilmiþtir. Çalýþmamzda kemik sintigrafisinde bilateral akciðerlerde diffüz artmýþ Tc-99m MDP tutulumu gösteren PAM tanýlý bir olguyu sunduk.

Pulmonary alveolar microlithiasis (PAM) is a rare chronic lung disease characterized by the deposition of intra-alveolar microliths in both lungs. Although diagnosis is usually based on specific radiological findings, pathological examination may be necessary for final diagnosis. Bone scintigraphy is another imaging method that aids in the diagnosis. Diffuse Tc-99m methylene diphosphonate (MDP) uptake was reported in the lungs on bone scintigraphy in many cases. The current study presents a case diagnosed with PAM who had diffuse increased Tc-99m MDP uptake in both lungs on bone scintigraphy.

Abstract | Full Text PDF | DICOM

Pulmoner Langerhans hücreli histiositozis daha çok genç, sigara içen eriþkinlerde görülen etiyolojisi bilinmeyen nadir bir hastalýktýr. Otuz altý yaþýnda bayan hasta 4 aydýr devam eden öksürük ve balgam çýkarma yakýnmasý ile polikliniðimize baþvurdu. Yedi yýl günde 1 paket sigara anamnezi olan hastanýn çekilen Yüksek rezolüsyonlu toraks bilgisayarlý tomografisinde her iki akciðer parankim alanlarýnda üst ve orta zonlarda daha belirgin olarak, alt zonlarda ise daha hafif derecede ve küçük olarak izlenen kaviter lezyonlar, çevresinde buzlu cam dansitesinde infiltratif tutulumlar ve milimetrik buzlu cam dansitesinde nodüler görünümler mevcuttu. Taný açýk akciðer biyopsisinde immunohistokimyasal boyama ile CD1a yüzey antijeni pozitifliði gösteren Langerhans hücrelerin görülmesiyle konuldu.

Pulmonary Langerhans cell histiocytosis is a rare idiopathic disorder mostly seen in young adult smokers. A 36-year-old female patient referred to our clinic with the complaints of cough and sputum production for the last four months. She had a smoking history of 7 packets per year (current smoker). In high resolution computed tomography, cystic appearances, which were more marked in upper lobes, ground glass opacities near the cystic lesions, and millimetric nodules around them were observed. A surgical biopsy showed a lymphocytic lung infiltrate with Langerhans cells immune staining with CD1a antigen positivity.

Abstract | Full Text PDF | DICOM

Pulmoner alveoler mikrolitiyazis (PAM) alveollerde kalsiyum birikmesi ile karakterize nadir görülen bir akciðer hastalýðýdýr. Her iki akciðerde yaygýn simetrik mikronodüler radyolojik pattern mevcuttur. Bu yazýda 48 yaþýnda PAM tanýsý alan bayan hasta sunulmuþtur. Hasta 5 yýldýr eforla geliþen nefes darlýðý ile baþvurdu. Fizik muayene ve solunum sesleri normaldi. Akciðer grafisinde orta ve alt alanlarda bilateral yaygýn mikronodüler patern saptandý. Bilgisayarlý toraks tomografisinde parankim penceresinde bilateral alt loblarda daha belirgin olmak üzere yaygýn milimetrik kalsifiye nodüller izlenmekteydi. Teknesyum-99m ile yapýlan tüm vücut kemik sintigrafisinde her iki hemitoraksta yumuþak doku alanlarýnýnda heterojen tarzda diffüz artmýþ aktivite tutulumu saptandý. Mevcut radyolojik bulgularýn uyumlu olmasý ile ileri giriþimsel tetkik yapýlmadý, hasta PAM tanýsý ile tedavisiz takibe alýndý.

Pulmonary alveolar microlithiasis (PAM) is a rare lung disease characterized by the deposition of calcium in the alveolar spaces and bilateral diffuse micronodular ‘‘sandstorm’’ radiographic pattern. The current report presents the case of a 48-year-old woman with pulmonary alveolar microlithiasis. The patient presented with exertional dyspnea for the past five years. The physical examination was within normal limits and respiratory sounds were normal. The chest x-ray revealed a bilateral diffuse micronodular pattern in the middle and the lower areas of both lungs. On the parenchymal window of thorax computed tomography (CT), bilateral diffuse widespread millimetric calcified nodules that were more prominent in the lower lobes were observed. Whole body bone scintigraphy with technetium-99m revealed bilateral, diffuse, heterogeneous, increased uptake in the pulmonary parenchyma. Regarding the current special radiological findings, further invasive diagnostic examination was not performed, the patient was diagnosed with PAM and continues to be followed-up on without treatment.

Abstract | Full Text PDF

Plastik bronþit kronik öksürük, dispne hava yolu obstrüksiyonu ve lastik kývamýnda sekresyon ekspektorasyonu ile karakterize nadir bir hastalýktýr. Bu antite sýklýkla siyanotik konjenital kalp hastalýðý olan çocuklarda görülmektedir. Bu yazýda 2 yýldýr astým tanýsý ile tedavi gören ve bronkoskopi ile plastik bronþit tanýsý konulan eriþkin hastayý sunmaktayýz.

Plastic bronchitis is a rare disease characterized by chronic cough, dyspnea, airway obstruction, and expectorating rubber-like secretions. This entity is mostly seen in children predominantly in association with an underlying congenital heart disease. We present an adult case who was treated for asthma for two years and finally diagnosed with plastic bronchitis via bronchoscopy.

Abstract | Full Text PDF

Bilateral spontan pnömotoraks çok nadir rastlanýlan bir durumdur. Biz burada ayný seansta yarý oturur pozisyonda tek lümen entübasyon VATS ile opere ettiðimiz primer senkronize bilateral spontan pnömotoraks hastamýzý sunmak istedik.

Bilateral spontaneous pneumothorax is an extremely rare condition. The current study presents a primary synchronized bilateral spontaneous pneumothorax patient who was operated on by VATS in a semi-seated position with single lumen intubation and bilaterally, simultaneously.

Abstract | Full Text PDF

Solunum yetmezliði ve hemodinamik anstabilite, obstetrik yoðun bakým yatýþlarýnýn %80’ninden sorumludur. Biz burada çok nadir karþýlaþýlan multigravid hastada hamileliðin geç döneminde tansiyon hidropnömotoraksý taklit eden rüptüre akciðer kist hidatiði sunduk.

Respiratory failure and hemodynamic instability are responsible for up to 80% of the obstetric admissions to the intensive care unit. We report an unusual case of a multigravida with ruptured pulmonary hydatid cyst that mimics tension hydropneumothorax.

Abstract | Full Text PDF

Akciðer absesi, piyojenik mikroorganizmalarýn doku nekrozuna yol açmasý sonucu akciðer parankiminde oluþan kaviter, düzgün sýnýrlý, lokalize ve süpüratif bir lezyondur. Radyolojik olarak hava-sývý düzeyi gösteren kavite görünümü ile tanýnýr ve bu olgularýn %10-15’i antibiyotik tedavisine raðmen iyileþmemektedir. Giriþimsel tedavi yöntemleri arasýnda transtorasik tüp drenajý, bronkoskopi veya bilgisayarlý tomografi eþliðinde aspirasyon ve cerrahi rezeksiyon bulunmaktadýr. Burada diyabeti olan 70 yaþýndaki bir kadýn hastayý sunmaktayýz. Hastanýn sað akciðer alt lobunda periferik yerleþimli bir apse saptandý. Ýlk olarak medikal tedavi yapýldý. Yanýt alýnamamasý üzerine ultrasonografi eþliðinde ince iðne aspirasyonu ile apse drenajý yapýldý. Yaptýðýmýz literatür araþtýrmasýnda, ultrasonografi eþliðinde ince iðne aspirasyonuyla tam olarak iyileþen baþka bir akciðer absesi olgusuna rastlamadýk. Sonuç olarak toraks duvarýna komþu periferik akciðer abselerinin tedavisinde; kolay ulaþýlabilirliði, ucuz bir yöntem olmasý ve radyasyon maruziyetine yol açmamasý nedeniyle ultrasonografi eþliðinde transtorasik abse drenajý, ilk tercih olarak düþünülmelidir

Lung abscess is a well-circumscribed and localized suppurative lesion in the lung parenchyma as a result of pyogenic microorganisms, which usually leads to tissue necrosis and cavitation. The lung abscess radiologically appears as an air-fluid level and despite the antibiotic treatments, up to 10%-15% of these lesions do not heal. In these cases, drainage by the transthoracic catheters and aspiration by the guidance of bronchoscopy or computed tomography and surgical resection are the choices of treatment modalities. Herein, we report a 70-year-old female patient with diabetes mellitus. A lung abscess was detected in the right lower lobe with peripheral localization. The patient did not recover by medical therapy and the content of abscess was aspirated by ultrasonography guidance. No cases with lung abscess that was treated completely with the fine needle aspiration by the guidance of ultrasonography were found in the literature. As a result, we recommend that transthoracic drainage of peripheral lung abscesses by the guidance of ultrasonography should be considered as a first choice treatment modality with the advantages of being affordable, convenient, and with no exposure to radiation.

Abstract | Full Text PDF

Keratozis Likenozis Kronika (KLK), simetrik daðýlým gösteren, eritemli, likenoid, keratotik papüllerle karakterize, nadir görülen kronik bir dermatozdur. Histopatolojik incelemede hiperkeratoz ve parakeratozun eþlik ettiði likenoid dermatit bulgusu görülür. Etyolojisi tam olarak bilinmemekle birlikte liken planus veya likenoid ilaç reaksiyonlarýnýn bir varyantý olduðu düþünülür. Tedavinin kesilmesiyle dramatik bir düzelme gösteren, isoniyazid, rifampisin, etambutol ve pirazinamidli antitüberküloz tedavi sýrasýnda oluþan Jeneralize KLK olgusunu, tüberküloz tedavisi sýrasýnda görülebilecek yan etkilere dikkat çekmek amacýyla sunuyoruz.

Keratosis lichenoides chronica (KLC) is a rare and chronic skin disease characterized by erythema, keratotic and lichenoid papules are distributed symmetrically. The histological examination of KLC reveals lichenoid dermatitis with hyper and parakeratosis. Although the etiology and pathogenesis of KLC are unknown, it is suggested that KLC is a variant of lichen planus or lichenoid drug eruptions. We present a case of generalized KLC that occurred during antituberculosis therapy including isoniazid, rifampicin, ethambutol, and pyrazinamide and dramatically improved after cessation of therapy. We report this generalized KLC case in order to draw attention to the side effects that can be seen during tuberculosis treatment.

Abstract | Full Text PDF

Akciðer kanseri, nadir olarak kalbin iç ventrikül duvarýna metastaz yapar ve sonrasýnda buradan kaynaklanan emboli sistemik dolaþýma girerek atar damar týkanýklýðýna yol açar. Burada, periferik atar damarýnda emboliye yol açan bir akciðer kanseri olgusunu sunmaktayýz. Bu olgunun ilginç tarafý, hospitalize edilip ilk deðerlendirme aþamasýnda, periferik arter embolektomi materyalinden akciðer kanseri tanýsý konulmuþ olmasýdýr. Periferik arter dolaþýmýnýn ani olarak durmasýnda, ayýrýcý tanýda tümör embolisi de akýlda tutulmalýdýr.

Lung cancers rarely metastasize to intracardiac ventricular wall and subsequently embolizes to systemic circulation, causing arterial occlusion. The current study reports a case of lung cancer with peripheral arterial embolism. This is unique case report because the first diagnostic tool of bronchogenic carcinoma was embolectomy material during hospitalization and the initial evaluation stage of the patient. Tumor embolization should be considered in the differential diagnosis in an abrupt cessation of peripheral arterial circulation.

Abstract | Full Text PDF

Sað arkus anomalisi eriþkin çaðda nadir görülen, genellikle asemptomatik bir durumdur. Trakea veya özefagusa basý durumunda hastalar bazen nefes darlýðý veya disfaji gibi þikayetlerle de baþvurabilirler. Bu olgu sunumunda sað arkus aorta anomalisi bulunan, yýllardýr astým tanýsý ile takip edilen 59 yaþýnda kadýn hasta sunulmaktadýr. Hastalarda astým ayýrýcý tanýsýnda vasküler ring gibi hava yolu basýsýna yol açan patolojilerin de düþünülmesi önemlidir.

Right aortic arch is a rare condition that is usually asymptomatic in adulthood. Patients may present with dyspnea and dysphagia. This report presents a 59-year-old woman with a right aortic arch anomaly who had been followed-up with asthma for many years. The current report emphasizes the importance of the consideration of aortic arch anomaly in the differential diagnosis of asthma.

Abstract | Full Text PDF

Hipersensitivite pnömonisi (HP); duyarlýlaþmýþ kiþilerde çeþitli allerjenlerin tekrarlayan inhalasyonu sonucu meydana gelen IGE aracýlý olmayan bir hipersensitivite reaksiyonudur. Tanýda en önemli nokta HP düþünmek ve buna yönelik maruziyeti hem çevresel hem de mesleksel olarak ayrýntýlý sorgulamaktýr. Elli dört yaþýnda kadýn ve 2 yýldýr nefes darlýðý, halsizlik ve miyalji þikayeti olan hastanýn Fizik muayenesinde fibrotik ralleri mevcuttu. Posteroanterior akciðer grafisinde retiküler ve mikronodüler görünümleri vardý. Difüzyon testi düþüktü. Yüksek çözünürlüklü bilgisayar tomografisinde interlobuler septalarý kalýn, buzlu cam dansitesinde alanlar ve mozaik atenüasyon görüldü. Hikayesinde güvercin maruziyeti bulunan hastaya HP tanýsý kondu. Uygun tedavi ve etkenden uzaklaþtýrýlmasý ile bulgularýnda regresyon izlendi. Biz olgumuzu nadir görülmesi nedeniyle sunduk.

Hypersensitivity pneumonitis (HP) is a non-IgE-mediated hypersensitivity reaction which is caused by repeated inhalation of allergens in the patient has been previously sensitized. The most important point in the diagnosis is to consider HP and to profoundly question the environmental and occupational exposure. A 54-year-old, female suffering from shortness of breath, fatigue, myalgia for two years admitted to our hospital. Fine crackles were auscultated. Reticular and micronodular opacities were observed at chest X-ray. Diffusion capacity of the patient was low. High resolution computed tomography revealed ground glass opacities, interlobular septal thickening, and mosaic attenuation areas in the lung field. As the patient had contact history with pigeon she was diagnosed with HP. With proper treatment and removal of influential factors, such findings of regression were observed. The current case is presented due to its rarity.

Abstract | Full Text PDF | DICOM

Mounier-Kuhn sendromu (MKS) trakea ve ana bronþ duvarýndaki muskuloelastik fibrillerin kaybolmasý veya atrofisi sonucu oluþan ve trakeobronkomegali ile karakterize nadir bir sendromdur. Bu sendromun tanýsý daha çok hayatýn 3. veya 4. dekatýnda konulmaktadýr. Taný genellikle trakea ve ana bronþlarýn çaplarýnýn radyolojik olarak ölçülmesi ile konur. Elli iki yaþýnda bir erkek hasta kronik prodüktif öksürük ve tekrarlayan solunum yolu infeksiyonlarý nedenleri ile polikliniðimize sevk edilmiþ. Bilgisayarlý tomografi incelemesinde trakeobronkomegali, trakeal ve bronþiyal divertiküller ve bronþektazik alanlar saptadýk. Bu nadir olguyu beklenenden daha geç baþlangýçlý olmasý ve çok eðitici radyolojik bulgular nedeniyle sunduk.

Mounier-Kuhn syndrome is a rare syndrome characterized by tracheobronchomegaly resulting from the loss or atrophy of musculo-elastic fibers within the trachea and main bronchi wall. This syndrome is more common in the third or fourth decades of life. The diagnosis can usually be made by measuring the diameters of trachea and main bronchi radiologically. A 52-year-old male patient was referred to our outpatient clinic with chronic productive cough and recurrent respiratory tract infections. We detected tracheobronchomegaly, tracheal diverticula, and bronchiectasis in the chest CT scans. This rare case is presented due to later onset than expected and very demonstrative radiological findings.

Abstract | Full Text PDF