Eriþkinlerde malign olmayan trakeoözofageal fistüller genellikle entübasyon sonrasý komplikasyonlar nedeniyle ortaya çýkar. Üç ay önce kafa içi kanama sonrasý uzamýþ entübasyon nedeniyle trakeostomi ve beslenme sorunlarý nedeniyle gastrostomi öyküleri olan 80 yaþýnda kadýn hasta tekrarlayan ateþ ve yoðun kývamlý sekresyon artýþý nedeniyle baþvurdu. Bilgisayarlý toraks tomografisinde saptanan þüpheli trakeoözofageal fistül (TÖF) bronkoskopi ve endoskopi ile doðrulandý. Bronkoskopide hem fazla þiþirilmiþ cuff hem de özefagus kasýlmalarýyla açýlýp kapanan TÖF izlendi. Ameliyata uygun bulunmayan hastaya stent yerleþtirilmesi hasta yakýnlarýn tarafýndan kabul edilmedi. Hasta gastrostomi hattýndan jejunostomi kateteri gönderilerek ve reflüyü engellemek için en az 45 derece dik konumda tutulmasý önerileriyle taburcu edildi.

Non-malignant tracheoesophageal fistulas in adults often occur due to complications after intubation. We present an 80-year-old female patient who was consulted because of fever and increased thicky secretions that need frequent. An intracranial hemorrhage 3 months earlier led to her undergoing a tracheostomy and gastrostomy due to the resulting prolonged intubation and nutritional issues. Both bronchoscopy and endoscopy confirmed the presence of a tracheoesophageal fistula (TEF) detected on computed thorax tomography. In bronchoscopy, TEF, which was opened and closed by both over-inflated cuff and esophageal contractions, was observed. She was not a candidate for surgery, and her relatives declined an esophageal stent placement. We managed the case by sending a jejunostomy catheter through the gastrostomy tube and positioning at least 45 degrees to minimize the reflux.

Trakea ve özafagus arasýnda patolojik bir baðlantý olmasý trakea-özafagiyal fistül (TÖF) olarak adlandýrýlýr, doðuþtan veya bening ya da maling nedenlere baðlý sonradan oluþabilmektedir. TÖF, akciðer ve özefagus kanserlerinde kemoradyoterapi sonrasý veya mediastinal invazyon nedeni ile geliþen, yüksek morbidite ve mortaliteye neden olan bir komplikasyondur. Son yýllarda Non-small cell akciðer kanseri (NSCLC) tedavisinde immun kontrol inhibitör (ICI) ilaçlarýn kullanýmýnýn artýþýna baðlý nadir görülen yan etkiler ortaya çýkmakta ve olgu bazýnda bildirilmektedir. Yetmiþ sekiz yaþýnda bir yýl önce NSCLC tansý ile sol pnömonektomi olan olgumuzda mediastene invaze kitlenin özafagusa basýsýna baðlý disfaji nedeni ile iki ay önce özafagusa stent uygulama ve nivolumab kullaným öyküsü vardý. Yatýþýnýn ilk haftasýnda hastada TÖF geliþti. Trakeaya stent yerleþtirilmesi düþünülen olgumuz, masif hemoptizi geliþmesi nedeni ile eksitus oldu. Ayýrýcý taný sonrasý ICI ilaça baðlý yan etki olarak TÖF geliþtiði düþünüldü. Nadir bir yan etki olarak görülmesi nedeni ile olgumuzu literatür bilgileri ile sunmak istedik.

Tracheoesophageal fistula (TEF) is a pathological connection between the trachea and the esophagus that can be congenital or can develop in older ages as a result of benign or malignant causes. It develops as a result of mediastinal invasion or after chemoradiotherapy in lung and esophageal cancers, and is associated with high mortality and morbidity. TEF has been reported in the past to be a rare side effect of immune control inhibitor (ICI) drugs used for the treatment of non-small cell lung cancer, and several cases have been reported. A 78-year-old patient who underwent a left pneumonectomy after being diagnosed with NSCLC one year earlier had a history of esophageal stenting and Nivolumab use two months previously to relieve the pressure of a mediastinum mass invading the esophagus that was causing dysphagia in the patient. The patient developed TEF in the first week of hospitalization, which was thought to be a side effect of the ICI drugs. Our case, who was thought to place a stent in the trachea, died after developing massive hemoptysis. We present this case of the development of TEF to literature due to its rarity as a side effect of ICI drugs.

Rothmund Thompson Sendromu (RTS) oldukça nadir görülen bir sendromdur. Ýki klinik alt formu tanýmlanmýþtýr: poikiloderma, ektodermal displazi ve jüvenil katarakt ile karakterize RTS-I formu ve konjenital kemik defektleri, çocuklukta artmýþ osteosarkom ve cilt kanseri riski ile karakterize RTS-II formudur. Burada sunulan hasta, kemik deformiteleri, cilt kanseri öyküsü ve geliþme geriliði nedeniyle RTS-II formu idi. Hasta, iki gündür baþlayan nefes darlýðý ve hýrýltý þikayeti ile hastanemize baþvurdu. Posteroanterior akciðer grafisinde ve toraks bilgisayarlý tomografide sað akciðerde total atelektazi, özefagusda ileri düzeyde dilatasyon ve özefagus distalinde obstrüksiyon izlendi. Aspirasyon pnömonisi tanýsýyla, antibiyoterapi, oksijen tedavisi ve destek tedavi baþlandý. Tedavi altýnda iken, kanama bozukluðu nedeniyle alveolar hemoraji ve hematüri geliþti. Destek tedaviye raðmen çoklu organ yetmezliði (solunum yetmezliði, böbrek yetmezliði, pansitopeni) geliþen hasta 8. günde exitus oldu. Olgu RTS hastalarýnda kanamaya eðilim ve aspirasyon pnömonisi geliþimine dikkat çekmek adýna sunulmuþtur.

In the few studies of Rothmund Thompson Syndrome (RTS) to date in literature, two clinical subforms have been identified: the RTS-I form, characterized by poikiloderma, ectodermal dysplasia and juvenile cataract; and the RTS-II form, characterized by congenital bone defects, increased risk of childhood osteosarcoma and skin cancer. We present here a case with the RTS-II form with bone deformities, history of skin cancer and growth retardation. The patient was admitted to our hospital with complaints of dyspnea for two days. Total atelectasis in the right lung and severe dilatation and obstruction in the distal esophagus were observed on a posteroanterior chest X-ray and thorax computed tomography, and antibiotherapy, oxygen therapy and supportive treatments were initiated after a diagnosis of aspiration pneumonia was made. Alveolar hemorrhage and hematuria developed during follow up due to bleeding disorder. Despite supportive treatment, the patient developed multiple organ failure (respiratory failure, renal failure, pancytopenia), and died on the 8th day of hospitalization. We present this case study to draw attention to the risk of bleeding tendency and aspiration pneumonia in RTS patients.

Bronþiyal atrezi nadir görülen bir durumdur. Radyolojik olarak genellikle perihiler kitle lezyonu ve periferal havalanma artýþý þeklinde karþýmýza çýkar. Yirmi dokuz yaþýnda asemptomatik erkek hastanýn iþ baþvurusu sýrasýnda yapýlan saðlýk taramasýnda çekilen akciðer grafisinde sað perihiler kitle saptanmýþ. Kliniðimize baþvuru öncesinde hastaya kontrastsýz toraks tomografisi (BT) ve PET-CT çekilmiþ. Fizik muayenesi normal olan hastaya kontrastlý toraks BT çektik, sað santral kitle ve periferinde hava hapsi saptadýk. Solunum fonksiyon testi normaldi. Bronkoskopide tüm bronþlar açýktý, sað üst lob posterior segment giriþinde küçük kör sonlanan orifis görüldü. Bu olguyu, radyolojik olarak kanser le karýþabilmesi ve nadir görülmesi nedeniyle sunmak istedik. Kitle imajý ve periferik hava hapsi ile karakterize olan bronþiyal atreziye klinik ve radyolojik olarak taný koyulabilir ve gereksiz invazif giriþimlerden kaçýnýlabilir.

Bronchial atresia (BA) is a rare condition that appears radiologically as a perihilar mass lesion and increased peripheral aeration. A 29-year-old asymptomatic male patient was identified with a right perihilar mass during a routine medical examination linked to a job application. Before applying to our clinic, the patient had had undergone non-contrast thoracic CT and PET-CT. Physical examination was normal, while contrast-enhanced thorax tomography revealed a right central mass and signs of air trapped in its periphery. A pulmonary function test was normal. All bronchi were open on bronchoscopy, however a small blunt orifice was observed at the right upper lobe posterior segment entrance. We present this case due to it being a rare condition and the potential for confusion with cancer radiologically. BA with mass image and increased peripheral aeration on thorax CT can be diagnosed based on clinical and radiological findings, allowing unnecessary invasive interventions to be avoided.

Rhodococcus equi is HIV pozitif ve organ nakil alýcýsý olan immunsüpresif hastalarda özellikle tüberküloz ile sýklýkla karýþan kaviter akciðer infeksiyonuna neden olan nadir bir etkendir. Altmýþ dokuz yaþýnda böbrek transplant alýcýsý ve immünsüpresif tedavi alan erkek hasta 6 aydýr devam eden kilo kaybý, öksürük ve hemoptizi semptomlarý olmasý üzerine dýþ merkeze baþvurmuþ. Çekilen bilgisayarlý tomografide sol akciðer alt lob üst segmentte kavite saptanmýþ. Malignite düþünülmesi üzerine PET-CT çekilmiþ ve yüksek SUV-max tutulumu tespit edilmiþ. Hasta hastanemize baþvurduðunda mevcut þikayetleri devam etmekteydi. Alýnan Bronkoalveolar Lavaj kültüründe ve kan kültürlerinde R. equi üremesi oldu. Hasta entübe edilerek mekanik ventilatör ile takip edildi. Kontrol ETA (endotrakeal aspirat) kültüründe A. baumannii üremesi oldu. Bunun üzerine tedaviye kolistin de eklendi. Hasta tedavisinin 23. gününde kolistine baðlý nefrotoksisite nedeniyle exitus oldu. Bildiðimiz kadarýyla bu olgu ülkemizde R. equi kaviter pnömonisinin R. equi bakteriyemisi ile birlikte görüldüðü ilk olgudur.

Rhodococcus equi is a rare cause of cavitary lung infection that is often mistaken for tuberculosis in immunosuppressed patients who are HIV positive and in organ transplant recipients. A 69-year-old male kidney transplant patient was admitted to an external healthcare center with complaints of weight loss, cough and hemoptysis that had started 6 months earlier. A computed tomography revealed a cavity in the upper segment of the left lung lower lobe, and a PET-CT revealed a high SUV-max uptake. Upon application to our hospital, the same symptoms were identified, along with R. equi growth observed in Bronchoalveolar Lavage and blood cultures. The patient was followed up with mechanical ventilator as intubated. Acinetobacter baumannii grew in the control ETA (endotracheal aspirate) culture on the 6th day of hospitalization, and he died subsequently on the 23rd day of hospitalization from colistin-induced nephrotoxicity. To the best of our knowledge this is the first case in which R. equi cavitary pneumonia has been seen together with R. equi bacteremia in our country.

Gebe hastalarda COVID-19 hastalýðý, gebeliðin getirmiþ olduðu fizyolojik deðiþiklikler nedeni ile daha ciddi seyredebilmektedir. Çoðu COVÝD-19’lu gebe hastamýz, hastane yatýþýna gerek duyulmadan ayaktan takip edilmekle birlikte, özellikle 3. trimesterde artan immünsupresyon, hastanýn aþýsýz olmasý gibi risk faktörleri varlýðýnda, olgumuzda olduðu gibi COVÝD-19 enfeksiyonu hýzlý progresyon gösterip solunum yetmezliðine neden olabilir. Gebeliðinin 3. trimesterinde olan hastamýzýn yatýþýnýn 3. gününde COVÝD-19 pnömonisine baðlý yoðun bakým ihtiyacý göstermesi üzerine multidisipliner bir yaklaþým ile önce acil doðum operasyonu gerçekleþtirildi ve hasta postop yoðun bakým ünitesinde mekanik ventilasyonda takip edildi. Hastamýzý, gebeliðinin 3. trimesterinde ciddi seyreden COVÝD-19 hastalýðýna bir örnek teþkil etmesi nedeni ile sunmak istedik.

The course of COVID-19 disease may be more severe in pregnant patients due to the physiologic changes induced by pregnancy. Although most pregnant patients with COVID-19 are followed up as outpatients, requiring no hospitalization, COVID-19 infection, especially in the presence of risk factors such as increased immunosuppression in the third trimester and lack of vaccination, can progress rapidly and lead to respiratory failure, as in our case. Our patient was in the third trimester of her pregnancy, and required intensive care due to COVID-19 pneumonia on the third day of hospitalization, and an emergency delivery was performed initially with a multidisciplinary approach. The patient was then followed up in the respiratory intensive care unit under mechanical ventilation. Our patient is a remarkable example of severe COVID-19 disease in the third trimester of pregnancy.

Pandemi, doktorlarýn tüm viral pnömonileri birinci ön taný olarak COVID-19 olarak deðerlendirmeye yatkýn hale getirmiþtir. COVID-19'un kesin tanýsý, pozitif bir RT-PCR testi ile konur, ancak bazen RT-PCR test sonuçlarý negatif olan, fakat COVID-19'u gösteren toraks BT bulgularý olan olgular da vardýr. Bu nedenle, COVID-19 tedavilerinden fayda görmeyen hastalarda ayýrýcý tanýda immünsupresif sebeplerin ve diðer viral pnömonilerin araþtýrýlmasý çok önemlidir. Buzlu cam opasiteleri ayýrýcý tanýsýnda HIV enfeksiyonu saptanan bir olgu sunulmuþtur.

The pandemic has predisposed all healthcare professionals to assess all viral pneumonia cases preliminarily as COVID-19, with a definitive diagnosis of COVID-19 made on the basis of a positive RT-PCR result. Occasionally, however, there are cases with negative RT-PCR test results both with thoracic CT findings indicative of COVID-19. It is thus very important to consider immunosuppressive conditions and other viral types of pneumonia in the differential diagnosis in patients who do not seem to respond to COVID-19 treatments. We present her a case of HIV infection identified in a differential diagnosis of ground glass opacities.

Hastanýn COVÝD-19 geçirdikten sonraki akciðer tomografisinde bilateral fibrotik odaklar mevcuttu. Ýki ay sonraki baþvurusu tomografisi ile karþýlaþtýrýldýðýnda fibrotik odaklarýn bal peteði lezyonlarýn öncülü olduðu ve COVÝD pnömonisi sonrasý olaðan interstisyel pnömoni (UÝP) paterninin meydana geldiði görüldü. COVÝD-19 öncesi dispnesi olan ancak interstisyel akciðer hastalýðý tanýsý almayan hastada mevcut lezyonlarýn UÝP öncü lezyonlarý olduðu ve hastalýk döneminde fibroblast aktivitesinin artýþý ve fibrotik yolaklarýn tetiklenmesi ile beraber progresyon gösterdiði düþünüldü. Hasta idiopatik pulmoner fibrozis (IPF) olgusu olarak deðerlendirildi. Uzun dönem kontrollerde antiinflamatuvar tedaviler ile rahatlamayan ilerleyici fibrozis saptanan COVÝD-19 hastalarýnda eðer UIP görünümü geliþmiþ ise mutlaka ÝPF olasýlýðýnýn düþünülmesini ve bu yönü ile hastalarýn COVÝD-19 öncesi klinik ve radyolojik bulgularýnýn erken IPF açýsýndan araþtýrýlmasýný öneriyoruz.

A chest tomography taken after COVID-19 revealed bilateral fibrotic foci areas, and two months later it was seen that they had been precursors to honeycomb lesions, and that the usual interstitial pneumonia (UIP) pattern associated with post-COVID pneumonia had occurred. It was noted that the fibrotic lesions in the left lung were already present before the disease. The lesions present in the patient, who had dyspnea pre-COVID-19 but had not been diagnosed with ILD, were considered to be UIP precursor lesions that progressed with the increase in fibroblast activity and the triggering of fibrotic pathways in the course of the disease. The patient was thus diagnosed with Idiopathic Pulmonary Fibrosis (IPF). We suggest that if a UIP appearance develops in COVID-19 patients with progressive fibrosis that is not relieved by anti-inflammatory treatments in long-term examinations, the possibility of IPF should be considered, and so the clinical and radiological findings of patients’ pre-COVID-19 should be investigated for the early identification of IPF.

Metanol intoksikasyonunda merkezi sinir sistemi bulgularý ön planda olsa da akciðerler de etkilenmektedir. Literatürde otopsi olgularýnda akciðer bulgularý tariflenmekte olup klinik olgulara rastlanmamýþtýr. Olgumuz, radyolojik olarak akciðer ödemi varlýðý olmasý ve COVID-19 ayýrýcý tanýsýnda yer almasý nedeniyle sunulmaktadýr.

Although central nervous system findings are prominent in methanol intoxication, the lungs are also affected. There have been several studies in literature describing autopsy-based lung findings, while there have been no clinical cases reported on to date. We present here a case identified radiologically as pulmonary edema that was included in the differential diagnosis of COVID-19.

Diffüz alveoler hemoraji, öksürük, hemoptizi, yaygýn pulmoner infiltratlar, anemi ve hipoksemik solunum sýkýntýsý ile karakterize bir sendromdur. Etyolojisinde akciðer enfeksiyonlarý da rol oynamaktadýr. Enfeksiyon riski nedeniyle COVID-19 hastalarýnda bronkoskopi kullanýmýnýn kýsýtlanmasý, diffüz alveoler hemorajinin COVID-19’da yeterince tanýnamamasýna neden olmaktadýr. Burada SARS-CoV-2 baðlamýnda laboratuvar, radyolojik ve bronkoskopik olarak diffüz alveoler hemoraji kanýtý olan 35 yaþýndaki hastada SARS-CoV-2 için nasofarengeal sürüntü polymerase chain reaction (PCR) testi negatif saptanmýþ, COVID-19 tanýsý bronþ lavajý ile konulabilmiþtir. Yüksek enfeksiyon riski nedeniyle pandemi döneminde bronkoskopi kullanýmýnýn kýsýtlanmasý, SARS-CoV-2 PCR testi negatif immünsupresif hastalarda COVID-19 tanýsýnýn yanlýþlýkla dýþlanmasýna veya SARS-CoV-2 PCR pozitif hastalarda diffüz alveoler hemoraji ve sekonder enfeksiyon gibi durumlarýn yeterince tanýnamamasýna neden olmaktadýr.

Diffuse alveolar hemorrhage is a syndrome characterized by cough, hemoptysis, diffuse pulmonary infiltrates, anemia, and hypoxemic respiratory distress, and lung infections also play a role in its etiology. The restricted use of bronchoscopy in COVID-19 patients due to the risk of infection has led to the poor recognition of diffuse alveolar hemorrhage in COVID-19. We present here the case of a 35-year-old patient with laboratory, radiological and bronchoscopic evidence of diffuse alveolar hemorrhage who was diagnosed with COVID-19 by bronchial lavage. The restrictions on the use of bronchoscopy during the pandemic due to the high risk of infection has led diagnoses of COVID-19 to be mistakenly excluded in immunosuppressive patients with a negative SARS-CoV-2 polymerase chain reaction test, and the under-recognition of conditions such as diffuse alveolar hemorrhage and secondary infection in patients with a positive SARS-CoV-2 PCR.

Son derece bulaþýcý ve hýzla yayýlan koronavirüs 2 (SARS-CoV 2) hastalýðý, potansiyel olarak ölümcül bir hastalýk olan þiddetli akut solunum sendromuna neden oldu. Akut miyokard enfarktüsü nedeniyle koroner arter baypas ameliyatý olan hastada ameliyat sonrasý erken dönemde koronavirüs 2 (SARS-CoV-2) pnömonisine baðlý akut solunum yetmezliði geliþti. Hastaya mekanik ventilatör (MV) ve V-V (veno-venöz) ECMO (Ekstrakorporeal Membran Oksijenasyonu) desteði verildi. Takipte pnömotoraks, uzamýþ hava kaçaðýný takiben ampiyem ve plevral kalýnlaþma geliþmesi nedeniyle dekortikasyon uygulanan olguyu sunduk.

The highly contagious and rapidly spreading coronavirus 2 (SARS-CoV 2) has been associated with the development of severe acute respiratory syndrome, a potentially fatal disease. A patient who underwent coronary artery bypass surgery for an acute myocardial infarction developed acute respiratory failure due to coronavirus 2 (SARS-CoV-2) pneumonia in the early postoperative period. The patient was placed on mechanical ventilation (MV) and V-V (veno-venous) ECMO (Extracorporeal Membrane Oxygenation) support. Here we discuss the application of decortication in the patient due to the development of pneumothorax and prolonged air leak empyema in the follow-up, and the subsequent development of pleural thickening.

Sunulan bu olgular, cerrahi iþlemler sonrasý göðüs duvarýndaki bir defektten akciðer hernisi olabileceðini göstermeyi amaçlamýþtýr. Þubat 2009 ile Haziran 2017 arasýnda, ameliyattan sonra öksürük ve göðüs duvarýnda gözle görülür þiþlik geliþen dört hasta incelendi. Akciðer hernisi, göðüs cerrahisinden ziyade en sýk travmaya baðlý görülen nadir bir durumdur. Olgularýmýzda iki torakotomi, bir VATS ve bir tüp torakostomide herniasyon görüldü. Olgularýn tamamý interkostal yerleþimliydi. Pnömotoraks riski taþýyan bir hasta dýþýnda tüm hastalar iki hafta baskýlý pansuman ile takip edildikten sonra ameliyat edildi. Metotreksat kullanan bir hasta dýþýnda postoperatif komplikasyon görülmedi. Bu hasta miyoplasti sonrasý komplikasyonsuz olarak taburcu edildi. Akciðer hernisi göðüs cerrahisinin nadir görülen bir komplikasyonudur ve daima akýlda tutulmalýdýr. Semptomatik cerrahi sonuçlarý aðrý ve kozmetik nedenler açýsýndan cesaret vericidir.

The four cases presented here reveal the possibility of herniation in the lung from defects in the chest wall following surgical procedures. A review was made of four cases who developed cough and a visible swelling of the chest wall after surgery between February 2009 and June 2017. Lung hernia is a rare condition that is most commonly associated with trauma rather than thoracic surgery. In the four presented cases, the herniation occurred following thoracotomies in two cases, VATS in one case and tube thoracostomy in one case. All cases had an intercostal localization. Aside from one patient who was at risk of pneumothorax, all patients were operated after being followed up with a pressure dressing for two weeks. No postoperative complications occurred other than in one patient who was using methotrexate, and this patient was discharged without complications after myoplasty. Lung herniation is a rare complication of thoracic surgery and should always be kept in mind. Symptomatic surgery results are encouraging from the perspectives of pain and aesthetics.

Liposarkom eriþkinlerde en sýk görülen yumuþak doku sarkomlarýndan biridir; genellikle alt ekstremitelerde ve retroperitonda ortaya çýkar. Miksoid, iyi diferansiye, farklýlaþmamýþ (dediferansiye) ve pleomorfik olmak üzere çeþitli histolojik alt tipleri vardýr. Mediastenden kaynaklanan liposarkomlar son derece nadirdir. Bu tümörler genellikle yavaþ büyürler ve asemptomatik kalýrlar ancak büyük boyuta ulaþýp komþu yapýlara basý yaptýðýnda semptomatik olabilirler. Bilgisayarlý tomografi ve manyetik rezonans görüntüleme taný için faydalý veriler saðlar. Kesin taný için doku biyopsisi gereklidir ve tanýsý tipik patolojik özelliklere dayanýr. Kemoradyoterapiye duyarlý olmadýðýndan tam cerrahi rezeksiyon birinci basamak tedavi seçeneðidir. Nüks oraný yüksek olduðundan uzun süreli takip yapýlmalýdýr. Bu yazýda öksürük þikayeti ile baþvuran primer mediastinal liposarkomlu 56 yaþýnda kadýn olgu nadir görülmesi sebebiyle sunuldu.

Liposarcoma is one of the most common forms of soft tissue sarcoma in adults, and usually occurs in the lower extremities and retroperitoneum. It has several histological subtypes, including myxoid, well-differentiated, dedifferentiated and pleomorphic. Liposarcomas originating from the mediastinum are extremely rare, and usually grow slowly and remain asymptomatic, but may become symptomatic when they become large enough to press on the adjacent structures. Computed tomography and magnetic resonance imaging provide useful data for diagnosis, while tissue biopsy based on typical pathological features is required for a definitive diagnosis. Complete surgical resection is the first-line treatment option as it is resistant to chemoradiotherapy. Due to the high risk of recurrence, long-term follow-up should be continued. We present here the rare case of a 56-year-old female patient with primary mediastinal liposarcoma who presented with a complaint of cough.

Kronik granülomatoz multisistem bir hastalýk olan sarkoidoz sýklýkla akciðer, lenf nodlarý, cilt ve göz tutulumlarý ile seyreder. Nadir olarak kemik tutulumlarý da görülür. Tüm kemikler etkilenebilir ancak en sýk el ve ayak parmaklarý gibi kýsa kemikleri tutar. Vertebra tutulumu ise daha nadirdir. Asemptomatik seyirli olmasý nedeni ile kemik tutulumlarý genellikle tesadüfen tespit edilir. Yedi yýl önce pulmoner sarkoidoz tanýsý alan ve yeni geliþen bel aðrýsý þikayeti nedeniyle kliniðimizde tekrar deðerlendirilen 62 yaþýnda bir osseöz sarkoidoz olgusu sunduk.

Sarcoidosis is a chronic granulomatous multisystem disease that often progresses with lung, lymph nodes, skin and eye involvement, while bone involvement may occur more rarely. All bones can be affected, however, although the short bones, such as fingers and toes, are the most commonly affected, while vertebral involvement is rare. Bone involvement is usually determined incidentally due to the asymptomatic course of the disease. We present here the case of a 62-year-old female osseous sarcoidosis case who was diagnosed with pulmonary sarcoidosis seven years earlier and re-evaluated in our clinic due to recently developed low back pain.

Sarkoidoz etiyolojisi bilinmeyen, kronik, multisistemik nonkazeifiye granülomatöz bir hastalýktýr. Tanýsý, klinik ve radyografik bulgularýn birlikteliðine, tipik granülomlarýn gösterilmesine dayanýr ve çoðu zaman diðer granülomatöz hastalýklarýn dýþlanmasýyla konulabilir. Akciðer tutulumu %90 oranýndadýr. Sarkoidozda akciðer tutulumu sýklýkla parankimal hastalýk þeklindeyken, nadiren endobronþiyal kitle þeklinde tutulum görülebilir. Yaklaþýk 3 yýl önce sarkoidoz tanýsý konan ve tedavisiz izlemde olan olgumuza son bir yýl içinde ayný lokalizasyonda üç kez tekrarlayan pnömoni öyküsü olmasý nedeniyle bronkoskopi yapýldý. Bronkoskopide endobronþiyal lezyon görülüp alýnan biyopsisinde granülomatöz inflamasyon saptanan hastada klinik, radyolojik bulgularla progresif sarkoidoz düþünüldü ve steroid tedavisi baþlandý. Ayný lokalizasyonda tekrarlayan pnömoni ile gelen ve endobronþiyal tutulum gözlenen sarkoidoz olgusunu, endobronþiyal kitle lezyonlarýn ayýrýcý tanýsýnda sarkoidozu vurgulamak için sunduk.

Sarcoidosis is a chronic, multisystem and non-caseating granulomatous disease of unknown etiology. Its diagnosis is based on a combination of clinical and radiographic findings and the demonstration of typical granulomas, and can often be made based on the exclusion of other granulomatous diseases. There is lung involvement in 90% of cases, often in the form of parenchymal disease, while involvement in the form of an endobronchial mass is a rarer condition. Our patient underwent bronchoscopy after being diagnosed with sarcoidosis around 3 years earlier, and was followed up without treatment due to a history of pneumonia that had recurred three times in the same localization in the previous year. An endobronchial lesion was identified on bronchoscopy, while a biopsy revealed granulomatous inflammation. Progressive sarcoidosis was considered based on the clinical and radiological findings and the patient was started on steroid treatment. We present this study of a case of sarcoidosis with recurrent pneumonia in the same localization and endobronchial involvement to emphasize the need to consider sarcoidosis in the differential diagnosis of endobronchial mass lesions.