Tülay Özdemir

Doppler ultrasonography versus venography in the detection of deep vein thrombosis in patients with pulmonary embolism

In patients with acute pulmonary embolism (PE) the frequency of deep vein thrombosis (DVT) varies between 13–93%. The aim of this study was to compare Doppler ultrasonography (DUSG) and venography in the detection of DVT in patients with PE. Fifty-one patients who were clinically diagnosed as having PE from January 1st 2001 to January 31st 2005 were entered into the study and comorbid conditions and risk factors were noted. The diagnosis of PE was confirmed by ventilation-perfusion (V/Q) scintigraphy, spiral tomography and angiotomography while the diagnosis of DVT was made by DUSG and venography. DVT was confirmed by both DUSG and venography in 19 (37,3%) patients. In the remaining 32 patients DUSG was negative. Venography confirmed DVT in 6 of these patients while in 26 no DVT was found. The sensitivity and specifity of DUSG in the diagnosis of DVT were 76% and 100% respectively and the negative and positive predictive values were 81% and 100% respectively. The mean d-dimer concentration was 1187 in patients with DVT and 641 in patients without DVT (p > 0.05). Aquired risk factors were found in 4 of 6 patients with DVT, CRP was elevated in 5 (83%) and ALT-AST were elevated in 2 (33%). Although DUSG alone is considered sufficient for the diagnosis of DVT, venography still remains the gold standard in the diagnosis of DVT. Especially in patients with PE, where the diagnosis of DVT may increase the success of treatment, venography or other diagnostic tools may be used instead of a second DUSG if the first DUSG is negative.

Acute respiratory failure and tracheal obstruction in patients with posterior giant mediastinal (intrathoracic) goiter.

The extension of a thyroid goiter into the mediastinum, commonly known as a substernal goiter, is commonly located in the anterior mediastinum. Substernal enlargement of a goiter can cause compression of several mediastinal structures including the trachea. Tracheal compression may rarely lead to acute respiratory failure. We present a patient with tracheal compression and respiratory failure due to a posterior mediastinal goiter in the light of the literature.

Takayasu’s Arteritis Presenting with Bilateral Parenchymal Consolidations and Severe Respiratory Failure

This is a report of an unusual case of Takayasu’s arteritis presenting with bilateral parenchymal infiltrations and severe respiratory failure caused by pulmonary hemorrhage. The patient was initially diagnosed and treated as protracted pneumonia. After the diagnosis of Takayasu’s arteritis, she was successfully treated with high-fractioned oxygen and corticosteroid therapy.

A case of allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis.

Allergic bronchopulmonary aspergillosis usually occurs in children with underlying airway disease such as asthma and cystic fibrosis. While the colonization and infection of pre‐existing tuberculosis lesions by aspergillus species is well known, occurrence of allergic bronchopulmonary aspergillosis following pulmonary tuberculosis in children has not been reported yet. Here, an 11‐year‐old girl who developed allergic bronchopulmonary aspergillosis following active pulmonary tuberculosis is reported and the mechanisms of causality are also speculated. Pediatr Pulmonol. 2009; 44:86–89.

Wegener's Granulomatosis after Treatment with Montelukast in a Patient not Receiving Systemic Corticosteroid Treatment.

Leukotriene antagonists are the first new class of 1. Case Report drugs for the treatment of asthma in more than 20 A 62-year-old woman presented with cough, years. These drugs include one enzyme inhibitor of blood-streaked sputum, dyspnoea, fever up to 5-lipoxygenase (zileuton) and three chemically dis39.8°C and migratory polyarthralgia. She had had tinct cysteinyl leukotriene type-1 receptor antagondyspnoea and cough continuously for 4 days and ists (zafirlukast, pranlukast and montelukast). The fever for 1 day. Her past medical history was regreatest concern raised during treatment with cysmarkable for a 2-year history of asthma that had teinyl leukotriene receptor antagonists is the develbeen followed up by our department. Results of her opment of Churg-Strauss syndrome (CSS).[1,2] The spirometric reversibility test were compatible with causal role of these drugs in the development of CSS asthma. She had received inhaled budesonide (800 μg/day) and formoterol (24 μg/day) on a regular has not been completely clarified.[3] It has been basis and terbutaline as needed for her asthma for postulated that the induction of CSS is not due to almost 1 year. She had not received systemic cortidirect effects of leukotriene antagonists, but rather costeroid treatment for at least the last 5 months. She indicates the emergence of an underlying disease had developed hoarseness due to budesonide therbecause of the withdrawal of corticosteroids.[1,4] apy 20 days earlier. Inhaled corticosteroids were In this report, we describe the case of an asthmatdiscontinued and oral montelukast (10 mg/day; ic patient who developed Wegener’s granulomatosis Singulair,® Merck Sharp Dohme, Cramlington, while receiving montelukast therapy. She had not UK)1 was started. Ten days before admission she received systemic corticosteroids. To the best of our noticed a migratory polyarthralgia in her ankles, knowledge, this is the first report of a case of knees, shoulders, wrists and interphalangeal joints. Wegener’s granulomatosis that was associated with She also noted a rash and swelling in her wrists and leukotriene antagonist therapy. knees. Each arthralgia attack lasted 2–3 days and

Right Hilar Mass in a Patient with β-Thalassemia major

Accessible online at: www.karger.com/journals/res A 55-year-old man was admitted to hospital because of atrial fibrillation and dilated cardiomyopathy. He had no respiratory problems except for dyspnea, which was controlled by cardiotonic and diuretic drugs. His medical history included regular blood transfusions for ß-thalassemia major and a splenectomy for hypersplenism in 1965. On physical examination, vital signs were normal. He had arrhythmia and hepatomegaly. A chest radiogram showed a regular-shaped mass at the right hilar region apart from the cardiac contour which was later found to be located in the posterior mediastinum by right lateral radiography (fig. 1). A CT scan of the thorax revealed a regular-shaped mass localized in the right hemithorax, arising near the 6th thoracic vertebral body and extending to the paravertebral space inferiorly with a length of 6 cm (fig. 2). It was observed that the mass was in contact with the spine and ribs, but neither an erosion in the bone structure nor an invasion into the neural foramen was observed. In addition, at the edge of the mass, soft tissue densities were detected, which were located bilaterally in the paravertebral space extending inferiorly. A CT scan demonstrated no pathologic findings at the level of the carina and hilus (fig. 3). Based on the patient’s medical history and the clinical, radiographic and laboratory findings, what is your diagnosis? What is your next step in the diagnostic workup?

Antineutrophil Cytoplasmic Antibody-Positive Vasculitis Associated with Propylthiouracil Therapy

1. Case Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 817 2. Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 819 3. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 820

A 22-year-old woman with pleural effusion.

Accessible online at: www.karger.com/res A 22-year-old nurse was admitted to our emergency department with complaints of right-sided pain and high fever. The anamnesis revealed that she had been hospitalized at another health center with complaints of fatigue, high fever and diarrhea. Her diarrhea ceased on the day after her admission. She was operated on for appendicitis because of right lower quadrant pain and tenderness; however, she developed leukocytosis (21,280/mm3) during the follow-up. On pathological examination, her appendix was found to be normal; however, the patient’s general condition did not improve after surgery; the fever and right-sided pain persisted and did not respond to ceftriaxone-clarithromycin. She was referred to our hospital for further investigation. At physical examination, her body temperature was 39.4°C; chest examination with percussion revealed dullness in the right lower hemitho-

A 56 yr-old female with chronic cough and persistent infiltration on CT examination

A 56-yr-old female who had chronic dry cough for 1 yr was evaluated. She was otherwise healthy and immunocompetent. There was no history of past or present lung disease, smoking habit or recent oral operation.