Some 95% of all detected lung nodules are benign, although it is essential to determine the underlying cause, given that lung cancer is the leading cause of oncological death in the United States. When choos-ing a diagnostic tool, reducing the number of proce-dures without compromising the diagnostic value is essential. This case report focuses on the successful use of the latest robotic-assisted bronchoscopy in combination with existing radial and linear endo-bronchial ultrasound-guided transbronchial needle aspiration for the biopsy of a peripherally located lung nodule and mediastinal lymph nodes. Combin-ing the two procedures allowed the peripheral nodule and lymph nodes to be sampled with no complica-tions in a single procedure. The nodule showed no cancerous growth, although the lymph nodes showed granulomas consistent with Histoplasma.

The differential diagnosis of silicosis includes sar-coidosis, berylliosis, hypersensitivity pneumonia, malignancy, tuberculosis and other granulomatous infections. Sarcoidosis is a systemic granulomatous disease with an unknown etiology, although it is thought that occupational exposure to such substanc-es as silica and beryllium may be a trigger. An in-complete occupational history may lead to a diagno-sis of sarcoidosis rather than pneumoconiosis in many cases, although various associations of these two diseases, such as the coexistence and detection of one before or after the other, have been reported in literature. The coexistence of sarcoidosis and sili-cosis is discussed in the present study with reference to five cases who applied to the Occupational Dis-eases department of a university hospital. Active pulmonary tuberculosis and lung malignancy were excluded in all cases, and histopathologic examina-tions of all samples were reported as non-caseating granulomatous inflammation. In the specimen of one case, a birefringent body was identified upon polar-ized microscopy. In the light of these cases, it is aimed to draw attention to the usefulness of a well-received occupational history in the differential diag-nosis and etiology of sarcoidosis and silicosis.

Factitious hemoptysis is fairly rare condition, the diagnosis of which can be challenging to physicians. A 40-year-old incarcerated male with hemoptysis for four years had previously undergone a detailed inves-tigation, but the etiology of the hemoptysis could not be determined. The hemoptysis has increased in frequency and quantity, however, numerous diagnos-tic tests, including radiological imaging and bron-choscopy, has been unable to reveal the localization and etiology of the bleeding. As we were about to diagnose idiopathic hemoptysis, some suspicious behaviors and contradictory statements led us to conduct a psychiatric evaluation, and the patient was subsequently diagnosed with axis two personality disorder and factitious disorder. Factitious hemoptysis is difficult to diagnose and may be confused with idiopathic hemoptysis, and should be considered in patients with hemoptysis in which the location and cause of bleeding cannot be determined after a de-tailed examination.

We report here on the successful management of a patient who developed dyspnea after an elective arthroscopic procedure and who was diagnosed with Negative Pressure Pulmonary Edema (NPPE). A 29-year-old male patient with no known medical history was admitted to our hospital due to a rotator cuff tear sustained during a military operation. An arthroscopic procedure under general anesthesia was performed; however, the patient developed dyspnea 2 hours after extubation. He was desaturated, tachypneic and began to produce frothy pink sputum. Pulmonary computed-tomography angiography revealed wide-spread ground-glass opacities in both lungs suggest-ing non-cardiogenic pulmonary edema without acute pulmonary thromboembolism. The patient was thus diagnosed with NPPE and treated with non-invasive mechanical ventilation, intravenous furosemide and inhaled short-acting beta-agonists. Significant recov-ery was observed in a couple of days, and the patient discharged after his respiratory symptoms abated. NPPE should immediately be suspected in individuals who develop respiratory failure following extubation, as it can be life threatening.

We present here a case of diffuse alveolar hemor-rhage (DAH) following exposure to inhaled anesthetic sevoflurane. A 29-year-old male was admitted to the plastic surgery department with gynecomastia. Sur-gery was performed without complication under gen-eral anesthesia with intravenously administered mid-azolam (4mg), fentanyl and inhaled sevoflurane. Immediate hypoxemia and massive hemorrhage was detected at the end of the operation, and a chest radiography revealed bilateral widespread alveolar infiltrates. The serum hemoglobin level dropped by 2.5 g/dl (from 13 to 10.5 gr) in the postoperative setting. The patient was treated with methylpredniso-lone (1 gr) administered intravenously daily for 3 days. The hypoxemia resolved and alveolar infiltrates on the chest radiograph disappeared on the 4th day. There is limited data in literature reporting on the association between sevoflurane and DAH. None of the predisposing factors or causative reasons for DAH were detected in our case, and so it can be conclud-ed that the use of sevoflurane as an inhaled anesthet-ic was responsible for the DAH.

Spleen tuberculosis has occasionally been described in literature, mostly in immunocompromised patients with various risk factors. The presence of spleen in-volvement and splenomegaly makes this type of My-cobacterium tuberculosis infection difficult to diag-nose. A 56-year-old woman who had mediastinal and abdominal lymphadenopathies with splenomeg-aly and was investigated with a pre-diagnosis of lymphoma, and with no significant medical history, presented with complaints of fever and malaise. Here, we present a case of tuberculous lymphadenitis and pleuritis accompanied by splenic tuberculosis with the appearance of granulomatous inflammation on pleu-ral and spleen biopsy. Tuberculosis should be kept in mind as a differential diagnosis in diseases accom-panied by a fever of unknown origin and lymphade-nopathy.

Respiratory tract infections are common in Down syndrome. A 24-year-old male patient with Down syndrome with concurrent diabetes mellitus under-went antibiotic treatment with a diagnosis of lung abscess in an external center with complaints of fever and vomiting, but was referred to us after his symp-toms did not regress. Despite the improvement in the lung abscess noted in a radiological examination, the patient was identified with a brain abscess upon an examination due to the continuation of fever, vomit-ing and the onset of headache. Particular attention should be paid to additional abscess foci such as brain abscess in cases with lung abscess with an underlying comorbidity.

We present here the case of a 29-year-old male with primary pleural synovial sarcoma. The patient had no complaints, no significant medical history and did not smoke. A well-circumscribed giant mass, adjacent to the chest wall was observed on a PA chest X-ray, with a solid mass lesion in the lateral right hemithorax with diffuse amorphous calcifications noted on thorax computed tomography. An F18-FDG uptake with a SUVmax of 5.0 was detected in the mass defined by PET/CT. A Tru-cut biopsy revealed monophasic as histological subtypes composed of a dense cellular and interlaced fascicular proliferation of spindle cells, and SYT-SSX1 fusion (X;18)(p11.23;q11) consistent with synovial sarcoma. The patient was followed-up in the oncology center after surgery and chemoradio-therapy, and has been stable for 1 year. This paper draws attention to a diagnostic approach to primary pleural synovial sarcoma, which is a rare and aggres-sive tumor, and the need for the prompt initiation of treatment for an improved outcome.

Kommerell's diverticulum (KD) is a congenital dilata-tion of the distal portion of the aortic arch that is usually located at the origin of an aberrant right subclavian artery (ARSA) or the aberrant left subclavi-an artery (ALSA). We describe here a 40-year-old male patient with a right-sided aortic arch (RAA) with ligamentum arteriosum (LA) and ALSA originating from the KD. The applied to our outpatient clinic with a history of dyspnea and dysphagia that had persist-ed for the last year. The patient underwent chest computed tomography (CT) in our clinic, revealing ALSA-level KD in RAA with ligamentum arteriosum. Surgical resection of KD and LA was planned based on the symptoms. NE was resected from the descend-ing aorta and ALSA was transferred to the left carotid artery, and the patient was discharged 6 days after the operation without complications. After the opera-tion, the patient's dyspnea and dysphagia subsided completely.

Aberrant right subclavian artery (ARSA) is a rarely seen congenital and often asymptomatic anomaly. The most common clinical presenting symptom in adult ARSA patients is dysphagia, while patients may rarely present with respiratory complaints. We present here the case of a 79-year-old patient with dysphagia who was diagnosed based on thorax and neck CT and esophagography findings. The patient was treat-ed for pneumonia in the centers to which she applied with complaints of cough and inability to swallow, and was subsequently referred to us with the suspi-cion of a mediastinal mass after radiograms were obtained. The diagnosis of ARSA was made based on contrast-enhanced computed tomography. With this in mind, ARSA should be included in the differential diagnosis of patients presenting with dysphagia, despite it being a rarely seen etiology.

HIV (Human Immunodeficiency Virus) is the virus that causes AIDS (Acquired Immune Deficiency Syndrome), while PCP (Pneumocystis jiroveci pneumonia), tuber-culosis, CMV (Cytomegalovirus) and candidiasis are the OIs (opportunistic infections) occurring due to immune deficiency. OIs, and bacterial pneumonias in particular, are the most common causes of mortality, which makes the screening and prophylactic therapy for OIs necessary. The synergy between tuberculosis and HIV has long been known, and worsens the prognosis. PCP is an OI that is caused by a fungus named P. jiroveci. COVID-19 has emerged as a new cause of death among AIDS patients. Screening and prophylactic therapy for Ols is vital for patients with AIDS, however, mortality may be high due to delays in screening and prophylaxis in those whose HIV positivity is detected coincidentally. We report here on a patient who applied to our hospital with suspected COVID-19 pneumonia who was found during follow-up to be HIV positive with PCP and pulmonary tuber-culosis.

COVID-19 is a new type of coronavirus infection with a wide clinical spectrum, ranging from asymptomatic to severely symptomatic, and that mostly affects the respiratory tract. Although the respiratory tract is the primary area affected by the disease, neurological symptoms such as headache, dizziness and muscle ache have also been reported in some patients since the early stages of the pandemic. COVID-19 symp-toms and complications can affect the peripheral and central nervous systems as well as the skeletal mus-cles, while epileptic seizure is a rare manifestation of COVID-19. We present here the case of a female patient admitted to hospital with epileptic seizure due to COVID-19 encephalopathy.

Although there have been many studies determining the occurrence of post-COVID pulmonary fibrosis and thromboembolism, there are a limited number of studies and case reports in literature on the develop-ment of bronchiectasis. The present study presents a case of bronchiectasis sequel in the post-COVID 11th month. A 49-year-old male, non-smoker with diabe-tes mellitus and hypertension was admitted with exer-tional dyspnea. The patient had been followed up in the hospital 11 months earlier for 1.5 months with severe COVID-19 pneumonia and respiratory failure for which he was treated with Favipiravir, pulse methylprednisolone and broad-spectrum antibiotics. There was no need for invasive mechanical ventila-tion, and no secondary bacterial infection was de-tected. Compared to the previous CT, a chest CT revealed that bronchiectasis had persisted despite the disappearance of fibrotic changes. In the coming years, one of the first questions raised regarding the etiology of bronchiectasis may be the patient’s COVID-19 history.