Yenidoðanlarda potansiyel intauterin bulaþ ve özellikleri hakkýnda çok az veri olmasýnda karþýn, COVID-19’un klinik özellikleri, eriþkinlerde ve bir yaþýndan küçük çocuklarda tanýmlanmýþtýr. Epideminin baþýnda Cancun Quintana Roo’da bölgesel bir hastanede yeni doðan bir bebekte enfeksiyon saptandý. Hastada ciddi bir komplikasyon yoktu ve yoðun bakým ihtiyacý da olmadý. SARS-Cov-2 ile enfekte olan anne hafif solunumsal semptomlar gösteriyordu. Bu tarihte SARS-CoV-2 semptomlarý olan 10 tane anne görülmesine raðmen, hastanede sadece bir yenidoðan pozitif olarak saptandý. Kýsaca, yenidoðanlarda da SARS-CoV-2 enfeksiyonu düþünülmelidir. SARS-CoV-2 PCR pozitif yenidoðanlarda semptom olmayabilir ve SARS-CoV-2’nin yenidoðanlarda eriþkinlerden daha hafif seyrettiði düþünülebilir. Dünya’da ve Latin Amerika’da henüz bir kanýt olmamasýna karþýn, COVID pnömonisi geliþen bir kadýnda vertikal intrauterin bulaþ mümkün olabilir.

The clinical features of Covid-19 have been described in adults and infants younger than 1 year of age, although there is little data on the characteristics and the potential of intrauterine transmission in newborns. A case of infection was identified in a baby born in Cancún Quintana Roo, in a regional hospital at the beginning of the epidemic. The patient did not require intensive care, nor were there any serious complications. The mother was infected with SARS-CoV-2, showing mild respiratory symptoms. Although 10 mothers with symptoms of SARS-CoV-2 have been observed to date, only one case of a positive newborn has been identified in the hospital. In summary, newborns are susceptible to SARS-CoV-2 infection. The SARS-CoV-2 PCR-positive newborn had no symptoms, and so SARS-Cov2 may be considered less severe in neonates than in adults. Vertical intrauterine transmission in women who develop COVID-19 pneumonia is possible, although evidence is still lacking in Latin America and around the world.

Aðýr Akut Solunum Sendromu Corona Virüs 2 (SARS-CoV2) veya Corona Virüs Hastalýðý 2019 (COVID-19), yüksek bulaþýcýlýðý olan ve hýzla yayýlan bir hastalýktýr. Pnömoni sýk görülürken, pnömotoraks gibi plevral boþluðun tutulumu nadir olarak meydana gelir. Pnömotoraks hemen bir toraks tüpü takýlmasýný gerektirir. Torakostomi iþlemleri hassas ve hýzlý bir yönetim gerektir, ancak bulaþma riskinden kaçýnmak için dikkat edilmelidir. Acil servise nefes darlýðý ve oksijen desatürasyonu ile gelen 49 yaþýndaki bir erkek hastayý sunuyoruz. Fizik muayene ve portabl akciðer grafisinde solda pnömotoraks saptandý. Hastaya trakeal entübasyonu takiben toraks tüpü takýldý ve iþlem sonrasý iki saatte akciðerler ekspanse oldu. N95 maskeleri, tam göz korumasý, yüz siperi ve sývýya dayanýklý önlük dahil kiþisel koruyucu ekipman (PPE) giyen iki cerrah iþlemi yaptý. Toraks tüpü takýlmasýndan iki hafta sonar cerrahlarýn SARS-Cov2 PCR testleri negatif olarak geldi. Bu yazýda, konu ile ilgili güncel literatürlerle mevcut bulgular tartýþýldý.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2), or Coronavirus disease 2019 (COVID-19), is a highly contagious and rapidly-spreading disease. While pneumonia is a common finding, pleural space involvement, such as pneumothorax, occurs only in rare cases. Pneumothorax requires the immediate insertion of a chest tube. Thoracostomy procedures require prompt and precise management, but with caution to avoid the risk of transmission. We report here on a 49-year-old male patient who was admitted to the emergency ward with shortness of breath and oxygen desaturation. A physical examination and portable chest X-ray indicated a left pneumothorax. The patient underwent tracheal intubation followed by chest tube insertion, and the lungs inflated two hours after the procedure. The operators included two people, wearing personal protective equipment (PPE), including N95 masks, full eye protection, a face shield and a fluid-resistant gown. Two weeks following chest tube insertion, the operators underwent a SARS-CoV2 PCR examination, with negative results. This report discusses relevant findings in literature related to the current issue.

Bleomisin testis kanseri, lenfoma ve bazý skuamöz hücreli kanserlerin tedavisinde tercih edilen kemoterapotik bir ajandýr. Bleomisine baðlý akciðer toksisitesi sýk karþýlaþýlmakla birlikte nadiren fatal yan etkiye neden olmaktadýr. Ayrýca bleomisine baðlý akciðer hasarýnýn radyolojik görüntüleri diðer organize pnömoni paterni yapan nedenler karýþabilmektedir. Bu olgu sunumunda bilinen testis kanseri tanýsý olan 40 yaþýnda erkek hastanýn, Covid 19 pnömonisi ile karýþan bleomisin baðlý fatal akciðer hasarý sunulmaktadýr. Hasta bu zeminde spontan fatal pnömotoraks, pnömomediasten ve pulmoner intersisyal ve subkütan amfizem geliþimi nedeniyle respiratuar arrest kaynaklý kaybedilmiþtir..

Bleomycin is a chemotherapeutic agent that is preferred for the treatment of testicular cancer, lymphoma and some squamous cell carcinomas. Bleomycin-induced lung toxicity is a common, but rarely fatal side-effect, and the radiological image of which can be confused with other reasons which makes organizing pneumonia pattern. We report here on the case of a 40-year-old male patient with testicular cancer with bleomycin-induced fatal lung toxicity that was misdiagnosed as Covid-19 pneumonia. The patient suffered subsequent fatal spontaneous pneumomediastinum, pneumothorax, and pulmonary interstitial and subcutaneous emphysema, and died from respiratory failure.

Kronik eozinofilik pnömoninin (KEP) etiyolojisi tam olarak bilinmemektedir. KEPi, alveollerde ya da kanda eozinofili ile seyreden,subakut veya kronik solunumsal ya da genel semptomlarý olan ve akciðer radyolojisinde periferik tutulumla karekterize bir hastalýktýr. Yeni koronavirüs (2019-nCoV) ile enfekte olmuþ birçok pnömoni olgusu, Aralýk 2019'dan beri Çin'in Wuhan þehrinde tespit edildi. HRCT, 2019-nCoV için çok hassas ve kullanýþlý bir tarama aracýdýr. Yeni koronavirüs pnömonisinin radyolojik görünümü kendine has özellikleri olmakla birlikte yaygýn viral pnömoniden çok farklý deðildir. Genellikle buzlu cam (% 85.7) ve düzensiz konsolidasyona (% 19.0) benzeyen yamalý ya da bölgesel opasiteler ile kendini gösterir. Lezyonlar esas olarak subplevral bölgede bulunur. Burada nefes darlýðý, öksürük, ateþ ve COVID-19'a benzer klinik ve radyolojik tablo ile baþvuran bir KEP olgusu sunulmaktadýr.

The etiology of chronic eosinophilic pneumonia (CEP) is not precisely known, although its characteristic features include eosinophilia, involving alveoli or blood; subacute or chronic respiratory and general symptoms; while chest radiological imaging shows peripheral pulmonary infiltrates. Many cases of pneumonia associated with the new coronavirus (2019-nCoV) were detected in Wuhan, China starting in December 2019. HRCT is a highly sensitive and convenient screening tool for 2019-nCoV. The radiological appearance of the new coronavirus pneumonia is not very different from that of the common viral pneumonia, but it has some unique features. It usually manifests with patchy or punctuate opacities resembling ground glass (85.7%), and patchy consolidation (19.0%), and the lesions are mainly located in the subpleural area. Here we present a case of CEP who presented with shortness of breath, cough, fever, and a clinical and radiological picture similar to COVID-19.

Pulmoner aktinomikozis, aktinomiçes türlerinin neden olduðu, nonspesifik klinik ve radyolojik bulgularý olmasý nedeni ile taný konulmasýnda güçlük yaþanan bakteriyel bir hastalýktýr. Elli dokuz yaþýnda kadýn hasta, son bir yýldýr devam eden öksürük ve beyaz renkli balgam þikâyeti ile baþvurdu. Burada, fiberoptik bronkoskopide sað alt lob bazal segmentleri obstrükte eden, endobronþial lezyon görülen ve transbronþiyal biyopsi ile taný konulan endobronþiyal aktinomikoz olgusu, nadir görülmesi nedeniyle sunuldu.

Pulmonary actinomycosis is a bacterial disease that can be difficult to diagnose due to its nonspecific clinical and radiological findings caused by actinomyces. A 59-year-old female patient presented with a history of coughing and white sputum for the last one year. Here, we present a rare case of endobronchial actinomycosis with an endobronchial lesion obstructing the basal segments of the right lower lobe, diagnosed from a transbronchial biopsy taken during a fiberoptic bronchoscopy.

Eriþkinlerde infuenza A ile iliþkili spontan pnömomediastinum ve spontan pnömotoraks olgularý oldukça nadirdir. Olgumuz acil servise yüksek ateþ, ciddi dispne, öksürük ve bilinç deðiþikliði ile baþvuran 33 yaþýnda bir kadýndý. Akciðer grafisi ve bilgisayarlý toraks tomografisinde pnömomediastinum ve bilateral pnömotoraks tespit edildi. Nazal sürüntü ve trakeal aspirasyon örneklerinde H1N1 virüsü tespit edildi. Klinisyenler literatürde görülmeye baþlayan Influenza A’nýn bu nadir komplikasyonu hakkýnda dikkatli olmalýdýrlar.

Cases of spontaneous pneumomediastinum and spontaneous pneumothorax related with influenza A (H1N1) infection in adults are quite rare. The case presented here was a 33-year old female patient admitted to the emergency room with high fever, severe dyspnea, cough and altered consciousness. Pneumomediastinum and bilateral pneumothorax were detected on a chest roentgenogram and thoracic computerized tomography imaging. The H1N1 virus was identified in a nasal smear and in tracheal aspirate samples. Clinicians should be aware of this rare complication of the Influenza A virus that has started to be seen in literature.

Obsesif-kompulsif bozukluk tanýsý olan 33 yaþýnda erkek hasta acil servise, ateþ, öksürük, balgam ve giderek artan nefes darlýðý ile baþvurdu. Fizik muayenesinde dispneik ve ortopneik idi. Dinlemekle bilateral akciðer orta ve basallerde ralleri mevcuttu. Oda havasýnda oksijen saturasyonu %84 idi. Direkt akciðer grafisi ve toraks bilgisayarlý tomografisinde her iki akciðerde yaygýn parankimal infiltrasyon ve konsolidasyon alanlarý mevcuttu. Hikayesinde obstrüktif uyku apne sendromu için CPAP ve obsessif –kompulsif bozukluk nedeniyle de aripipirazol kullandýðý öðrenildi. Hasta pnömoni ön tanýsýyla yoðun bakýma yatýrýlarak seftriakson 2 gr/gün, klaritromisin 2x500 mg ve oseltamivir 2x75 mg tedavisi baþlandý. Yapýlan kan ve balgam kültüründe üreme olmadý. Viral markýrlarý ve procalsitonin negatif geldi. Bunun üzerine metil prednisolon 40 mg/gün baþlandý. Steroid tedavisinden sonra kliniði hýzla düzeldi. Yatýþýnýn 8. günü hasta ayaktan takip edilmek üzere önerilerle taburcu edildi. Obsessif- kompulsif bozukluk için tedavisine 1 ay önce aripipirazol eklenmiþ ve þikayetleri bu ilaç deðiþikliðinden 20 gün sonra baþlayarak giderek þiddetlenmiþ olduðu öðrenildi. Bu nedenle klinik tablo aripiprazole baðlý akciðer toksisitesi olarak deðerlendirildi.

A 33-year-old male patient with a diagnosis of obsessive-compulsive disorder applied to the emergency department with fever, cough, sputum and increasing shortness of breath. A physical examination revealed the patient to be dyspneic and orthopneic. Bilateral rales were present in middle and basal lung areas. Oxygen saturation in room air was 84%. Diffuse parenchymal infiltration and consolidation areas were noted in a posteroanterior chest X-ray and a thorax computerized tomography. The patient’s history revealed that the patient used a CPAP machine due to obstructive sleep apnea syndrome and aripiprazole, related to his obsessive-compulsive disorder. The patient was hospitalized in the intensive care unit with a preliminary diagnosis of pneumonia and treated with ceftriaxone 2 gr/day, clarithromycin 2x500 mg and oseltamivir 2x75 mg. Blood and sputum cultures, viral markers and procalcitonin were negative, and so methylprednisolone 40mg/day was started. The patient’s clinical condition improved rapidly after treatment with steroids, and he was discharged on the 8th day after admission, with recommendations for ambulatory care. It was learnt that aripiprazole had been added to his treatment for obsessive-compulsive disorder 1 month earlier, and that his complaints had started and gradually intensified 20 days after this change in medication. The patient’s clinical picture was assessed as lung toxicity caused by aripiprazole.

Masif pulmoner emboli (PE) hayatý tehdit eden medikal bir durumdur. Bazen, masif PE geçiren hastalarda, eþlik eden bir trombositopeni görülebilir. Sol femurda aðrý ve hareket kýsýtlýðýna neden olan subperiostal apseli osteomiyeliti bulunan 64 yaþýndaki kadýn hasta yatýrýldý. Altta yatan trombofili veya maligniteyi düþündüren bir bulgusu yoktu. Yatýþýn beþinci gününde, vasopresör desteði ve entübasyon gerektiren akut bir solunum sýkýntýsý ortaya çýktý. Pulmoner tomografik angiografide, sol inen pulmoner arter ve sol ana pulmoner arterde masif bir pulmoner emboli görüldü. Öncesinde heparin kullanmamasýna raðmen açýklanamayan trombositopeni geliþti. Trombolitik tedavi ihtiyacý olmasýna raðmen, bu tedavi kontrendike idi. Multidisipliner bir toplantýda cerrahi embolektomi öncesi trombosit sayýsýný düzeltme kararý alýndý. Ancak hasta iki gün içinde kaybedildi. Açýklanamayan bir trombositopeni masif PE için tek ipucu olabilir. Klinisyenlerin, erken taný ve daha iyi sonuçlar elde etmeleri için dikkatli olmalarý gerekir.

Massive acute pulmonary embolism (PE) is a life-threatening medical condition. Occasionally, patients experiencing a massive PE may develop concurrent thrombocytopenia. A 64-year-old female was admitted for left femur osteomyelitis with a sub-periosteal abscess that was causing pain and immobility. There were no indications suggesting underlying thrombophilia or malignancy. On day 5 of admission, the patient developed acute onset respiratory distress, necessitating intubation and vasopressor support. A computed tomography pulmonary angiogram revealed a massive PE involving the left main trunk and left ascending pulmonary artery. The patient had experienced an unexplained worsening thrombocytopenia that despite without heparin use previously. There was clear indication for thrombolysis, but the treatment was contraindicated. After a multidisciplinary meeting it was decided to optimize platelet counts prior to the performance of a surgical embolectomy, however the patient succumbed 2 days later. The unexplained thrombocytopenia could be the only clue for massive PE. Clinicians should remain vigilant to ensure early diagnosis and improved outcomes.

Günümüzde çalýþan nüfusun, yaklaþýk %25’inde en az bir kronik hastalýk vardýr. Bu nedenle “iþe uygunluk kavramý” oldukça önem taþýmaktadýr. Bu yazýda kronik obsrüktif akciðer hastalýðý (KOAH) tanýsý ile iþ ve meslek hastalýklarý kliniðimize baþvuran bir çalýþanýn, iþe uygunluk süreci; detaylý iþ analizi ve ileri fonksiyonel inceleme ile birlikte deðerlendirilmiþtir. Ýki yýldýr KOAH tanýsý olan 39 yaþýnda erkek, jant fabrikasýnda çalýþmaktaydý. Yapýlan kardiyopulmoner egzersiz testi ve iþ analizi sonucunda yaptýðý iþin enerji gereksiniminin, olgunun kabul edilebilir limit deðerlerinin üzerinde olduðu belirlendi. Ortamdaki toz ve metal dumanýnýn da KOAH alevlenmesine ve progresyonuna katkýsý olabileceði düþünüldü. Tanýmlanan risklerden uzak kalacak ve kardiopulmoner kapasitesine uygun þekilde iþ modifikasyonu yapýlmasý önerildi. Ýþe uygunluk deðerlendirmesi, iþ ve meslek hastalýklarý uzmanlarý baþta olmak üzere pek çok disiplinin bir arada çalýþmasýnýn gerektiði, çalýþanýn saðlýðý ve iþin devamýný korumayý amaçlayan önemli bir alandýr.

Today, approximately 25% of the working populations have at least one chronic disease, and so the delineation “fitness for work” is quite important. The process for the evaluation of fitness for work is evaluated in this paper, alongside a detailed work analysis and a further functional evaluation of an employee who presented to our work and occupational illnesses clinic with a diagnosis of chronic obstructive pulmonary disease (COPD). A 39-year-old male with the diagnosis of COPD, who was employed at a rim factory, was subjected to a cardiopulmonary exercise test, and a work analysis revealed that the energy requirement of the work was above the acceptable limits for the case. The smoke, dust and metal identified in the environment were thought to contribute to the exacerbation and progression of COPD. Modifications to the patients work to suit his cardiopulmonary capacity, and reducing the defined risks was suggested. Evaluating work compatibility is an important area of study requiring the collaboration of many disciplines, and occupational disease specialists in particular, with the am being to protect the health of the workforce and the continuity of works.

Akciðerin konjenital anomalileri bronkopulmoner sistemin tüm bileþenlerinden kaynaklanabilir. Konjenital lober amfizem, bronkojenik kist, konjenital kistik adenoid malformasyon (KKAM) veya pulmoner sekestrasyon (PS) bronkopulmoner malformasyonlardýr. KKAM ve PS birlikte çok nadir görülmektedir. Solunum sýkýntýsý, tekrarlayan enfeksiyonlar gibi komplikasyonlar nedeniyle çoðu antenatal veya postnatal dönemde taný almaktadýr. Eriþkin yaþa kadar taný ve tedavisinde sorunlar yaþanan bir olgu, ileri taný ve tedavi amaçlý kliniðimize yönlendirildi. Tetkik ve deðerlendirmeler sonrasýnda kliniðimizde ikinci kez operasyon yapýldý. Çok nadir görülen KKAM ve PS birlikteliði (hibrid konjenital malformasyon) saptanan olguyu literatür eþliðinde sunmayý amaçladýk.

Congenital abnormalities of the lung can manifest in any component of the bronchopulmonary system. Congenital lobar emphysema, bronchogenic cyst, congenital cystic adenoid malformation (CCAM) or pulmonary sequestration (PS) are just some of the many kinds of malformations of the lung. The co-existence of CCAM and PS is a very rare condition. Due to such complications as dyspnea or recurrent infection, most malformations are diagnosed antenatally or in the immediate postnatal period. The present case was not diagnosed until late adolescence, and the patient was subsequently referred to our clinic after undergoing a previous operation. After examinations and a preoperative evaluation, a second operation was performed. We present to literature a very rare case of co-existing CCAM and PS (hybrid lung malformation).

Langerhans Hücreli Histiyositoz (LCH), Langerhans hücrelerinin neoplastik olmayan bir proliferasyonudur. Eriþkinlerde insidansý milyonda 1-2 'dir. Pediatrik bir hastalýk olarak kabul edilir. Kot tutulumu çok nadirdir. Çalýþmamýzda, kotta yerleþim gösteren 33 yaþýndaki LCH olgusunu sunuyoruz.

Langerhans Cell Histiocytosis (LCH) refers to a non-neoplastic proliferation of Langerhans cells with an incidence in the adult population of 1–2 per million. It is considered a pediatric disease, and while rib involvement is very rare, we report here on a 33-year-old patient with LCH located in the rib.

Pnömomediastinum mediastende hava bulunmasýyla karakterize bir durumdur. Non-travmatik pnömomediastinum çocuklarda nadir olarak görülmektedir ve en sýk sebebi, astým olmakla beraber, özellikle 3 yaþ altý çocuklarda yabancý cisim aspirasyonu akýlda tutulmalýdýr. Bu tür olgularda kliniði belirleyen dispnenin derecesidir. Dispne kliniði belirginse rijit bronkoskopi öncesi fasiotomi açýlmalý ve mediastinal kompresyon azaltýlmalýdýr. Burda, 2 yaþýnda yabancý cisim aspirasyonuna baðlý pnömomediastinumla gelen bir olguda, neler yapýlmasý gerektiðini literatür eþliðinde sunuyoruz.

Pneumomediastinum is characterized by the presence of air in the mediastinum. Non-traumatic pneumomediastinum is rarely seen in children, and while the most common cause is asthma, foreign body aspiration should be considered in children younger than 3 years of age. The determinant of the clinical picture in these cases is the severity of dyspnea. Fasciotomy should be performed prior to rigid bronchoscopy, and mediastinal compression should be decreased in the presence of a marked dyspnea. Here, we present the case of a 2-year-old patient with pneumomediastinum secondary to foreign body aspiration, and discuss the alternative approaches to such cases in the light of literature findings.

Malign periferik sinir kýlýfý tümörü yumuþak doku tümörlerinin %5-10’unu oluþturur. Bu tümörler Nörofibromatozis tip 1 ile yakýndan iliþkilidir. Farklý lokalizasyonlarda birçok olgu bildirilmiþ olsa da göðüs duvarý yerleþimli diffüz nörofibroma zemininde geliþen malign periferik sinir kýlýfý tümörü son derece nadirdir. Bu çalýþmada, göðüs duvarý yerleþimli diffüz nörofibroma zemininde geliþen malign periferik sinir kýlýfý tümörünü sunuyoruz.

Malignant peripheral nerve sheath tumors account for 5–10% of all soft tissue tumors. These tumors are closely related with Neurofibromatosis type 1. Although many such tumors have been reported in different locations, malignant peripheral nerve sheath tumors arising from diffuse neurofibroma located in the chest wall are extremely rare. In the present study we report on a malignant peripheral nerve sheath tumor arising out of a diffuse neurofibroma of the chest wall.

Vücudun birçok yerine dalak dokusunun yayýlmasý ototransplantasyon splenosis olarak tanýmlanýr. Edinsel ve nadir bir durumdur. Diyafragma laserasyonuna baðlý olarak dalak dokusunun toraks içine fokal yayýlýmý torasik splenosis olarak adlandýrýlmaktadýr. Sol hemithoraxta birden fazla plevral bazlý nodül olarak görülür. Genellikle dalak yaralanmasý ve sol diyafragmatik rüptür kombinasyonuna neden olan künt travma sonrasýnda ortaya çýkar. Çalýþmamýzda, 14 yýl önce ateþli silah yaralanmasý sonrasý nedeniyle splenektomi yapýlmýþ 18 yaþýndaki erkek hastada geliþen intratorasik splenozis olgusunu sunuyoruz.

The spread of spleen tissue through different parts of the body is referred to as autotransplantation splenosis, and is an acquired and rare condition. The focal spread of splenic tissue into the thorax due to diaphragm laceration is referred to as thoracic splenosis, and may present as more than one pleural nodule in the left hemithorax. It usually occurs after a blunt trauma causing a combination of spleen injury and left diaphragmatic rupture. In the present study, we present a case of intrathoracic splenosis in an 18-year-old male patient who had undergone a splenectomy 14 years earlier after suffering a gunshot wound.