AMAÇ: Bu çalýþmada, Ondokuz Mayýs Üniversitesi (OMÜ) Týp Fakültesi Saðlýk Uygulama ve Araþtýrma Merkezi’ne gelen karbonmonoksit (CO) zehirlenmesi olgularýnýn klinik ve epidemiyolojik özelliklerinin belirlenmesi ve baþka çalýþmalardaki veriler ile karþýlaþtýrýlmasý amaçlanmýþtýr. GEREÇ-YÖNTEM: OMÜ Týp Fakültesi Saðlýk Uygulama ve Araþtýrma Merkezi’ne 01.01.2004-31.12.2004 tarihleri arasýnda baþvuran adli olgular içerisinden CO zehirlenmesi tanýsý alan 64 olgunun dosyalarý incelenmiþtir.
BULGULAR: CO zehirlenmeleri en fazla aralýk ayýnda (%40,6) ve cumartesi (%21,9) ile pazar (%20,3) günleri meydana gelmiþtir. Orijin 62 (%96,9) olguda kaza, 2 (%3,1) olguda intihardýr. Zehirlenmelere en fazla soba (%37,5) ve þofben (%37,5) neden olmuþtur. Hastaneye geliþ yakýnmalarý en sýk bulantý (%48,4), halsizlik (%39,1) ve baþ dönmesidir (%37,5). Labaratuvar bulgularý içerisinde en belirgini 22 (%52,3) olguda görülen kan pH düþüklüðüdür. Olgularýn 57 (%89,1)’si tedavi sonrasý þifa ile taburcu edilmiþ, 5 (%7,8)’i ölmüþtür. SONUÇ: CO zehirlenmesi olgularý ülkemizde sýk karþýlaþýlan zehirlenmelerdendir. Kaza sonucu görülen ve özellikle kýþ aylarýnda görülme sýklýðý oldukça artan bu sorunun önlenmesine yönelik çalýþmalar oldukça önemlidir. Halkýn eðitiminin saðlanmasý, riskli ortamlarda CO dedektörlerinin kullanýlmasý ve soba–þofben gibi araçlarda güvenlik standartlarýnýn yükseltilmesi sorunun çözümüne katkýda bulunacak en kolay giriþimler olacaktýr.

AIM: In this study, it is aimed at determining the clinical and epidemiological characteristics of the cases of CO poisoning consulted Ondokuz Mayis University, Hospital Of Medical Faculty and comparing them to the data from other studies.
MATERIALS-METHODS: Among the forensic cases consulted Ondokuz Mayis University, Hospital Of Medical Faculty between 01.01.2004 and 31.12.2004, 64 cases of CO poisoning are examined. RESULTS: CO poisoning is mostly common in December (40.6%) and on Saturday (21.9%) and Sunday (20.3%). The origin is accidental in 62 cases (96.9%) and suicidal in 2 cases (3.1%). Poisoning is caused mostly by stove (37.5%) and geyser (37.5%). Common complaints are nausea (48.4%), fatigue (39.1%) and vertigo (37.5%). The most evident laboratory finding is the low blood pH in the case. 57 of the cases were discharged with full recovery (89.1%) and 5 cases (7.8%) died.
CONCLUSION: CO poisoning is a common type of poisoning in our country. The studies to prevent this problem are really important. Educating people, using CO detectors in risky places and increasing the safety standards in devices such as stove and geyser will be the easiest attempts to solve the problem.

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AMAÇ: Plevral sývýlarýn tanýsýnda, transüda ve eksuda olarak ayýrým yapmak ilk basamaðý oluþturmaktadýr. Transüda-eksuda ayrýmýnda Light kriterlerinin, albumin gradienti, ALP, total kolesterol, total bilirübin ve ürik asit ölçümlerinin deðerini araþtýrmak amaçladý.
GEREÇ-YÖNTEM: Çalýþmaya 53 hasta alýndý. 18’i transüda (yaþ ortalamasý 61.44±11.81), 35’i eksuda (yaþ.ort. 40.49±17.44) olarak sýnýflandýrýldý.
BULGULAR: Plevra total proteini, plevra/serum (p/s) total protein oraný, plevra LDH’ý, p/s LDH oraný, s-p albumin gradienti, plevra ALP’ý, plevra total kolesterolü, p/s total kolesterol oraný, p/s total bilirübin oraný, plevra ürik asit ortalamalarý transüdalý hastalarda sýrasýyla 1.94±0.80, 0.29±0.10, 118.83±100, 0.36±0.22, 2.17±0.81, 20.50±14.23, 30.61±19.69, 0.16±0.11, 0.43±0.27, 6.40± 1.92; eksudalý hastalarda ise sýrasýyla 5.09±0.63, 0.73±0.08, 541.03±401, 3.09±2.77, 0.55±0.28, 55.17±17.33, 88.40±24.80, 0.59±0.14, 0.87±0.41, 4.73±1.44 olarak bulundu. Her iki grupta “Student-t Testi” kullanýlarak yapýlan karþýlaþtýrmalarda yukarýdaki tüm deðerler için tansüda-eksuda ayrýmýnda anlamlý sonuçlar elde edildi. Ayrýca sensitivite ve spesifite ölçümleri sýrasýyla p/s total protein 0.52 oraný için %100-%100 (eksuda tanýsýnda), p/s LDH 0.61 oraný için %100-%89 (eksuda tanýsýnda), s-p albumin gradienti 1.2’de %94-%100 (transüda tanýsýnda), plevra ALP’ý 42 deðerinde %77-%95 (eksuda tanýsýnda), plevra total kolesterolü 64 deðerinde %91-%95 (eksuda tanýsýnda), p/s total kolesterol 0.33 oraný için %97-%84 (eksuda tanýsýnda), p/s total bilirübin 0.61 oraný için %77-%89 (eksuda tanýsýnda), plevra ürik asiti 5.5 deðeri için %55-%78 (transüda tanýsýnda) olarak tespit edildi.
SONUÇ: Bulgularýmýz Light kriterleri, albumin gradienti, ALP, total kolesterol, total bilirübin ve ürik asit ölçümlerinin transüda-eksuda ayrýmýnda tanýsal deðerleri olduðunu göstermektedir. Bununla birlikte, Light kriterleri bu ayrýmda en anlamlý yöntem olmaya devam etmektedir.

step in the diagnosis of pleural effusions. MATERIAL-METHOD: Fifty three patients with pleural effusions were included in the study which was made to evaluate the values of Light’s criteria, albumin gradient, alkaline phosphatase(ALP), total cholesterol, total bilirubin and uric acid analysis to discriminate exudates from transudates. Eightteen cases (mean age 61.44±11.81) were grouped as transudates and 35 cases (mean age 40.49±17.44) as exudates. RESULTS: Mean pleural fluid total protein, mean pleura/serum (P/S) total protein ratio, mean pleura LDH, mean p/s LDH ratio, mean albumin gradient, mean pleura ALP, mean pleura total cholesterol, mean p/s total cholesterol ratio, mean p/s total bilirubin ratio, mean pleura uric acid were measured 1.94±0.80 g/dL, 0.29±0.10, 118.83±100 U/L, 0.36±0.22, 2.17±0.81 g/dL, 20.50±14.23, 30.61±19.69 mg/dL, 0.16±0.11, 0.43±0.27, 6.40±1.92 mg/dL in patients with transudates, respectively; 5.09±0.63 g/dL, 0.73±0.08, 541.03±401 U/L, 3.09±2.77, 0.55±0.28 g/dL, 55.17±17.33, 88.40±24.80 mg/dL, 0.59±0.14, 0.87±0.41, 4.73±1.44 mg/dL in patients with exudates, respectively. Significant values for above measurements were found in compared transudates and exudates groups by employing “Student-t Test”(p<0.01). Sensitivity and Specificity: P/S total protein ratio for diagnosis of exudates effusions were %100-%100(cut-off: 0.52),P/S LDH ratio for exudates were %100-%89 (cut-off: 0.61), S-P albumin gradient for diagnosis of transudates were %94-%100 (cut-off: 1.2),pleura ALP for exudates were %77-%95 (cut-off: 42),pleura total cholesterol for exudates were %91-%95 (cut-off: 64), P/S total cholesterol ratio for exudates were %97-%84 (cut-off: 0.33), P/S total bilirubin ratio for exudates were %77-%89 (cut-off: 0.61), pleura uric acid for transudates were %55-%78 (cut-off: 5.5),respectively. CONCLUSION: Our findings indicate that measurements of Light’s criteria, albumin gradient, ALP, total cholesterol, total bilirubin and uric acid in pleural fluid become of diagnostic value in differential diagnosis of transudates and exudates. However, Light’s criteria remain the best method of separating transudates from exudates.

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AMAÇ: Çalýþmamýzda radyolojik olarak sýnýrlý evre düþünülen küçük hücreli akciðer kanseri hastalarda kesin evrelendirme için kemik iliði biyopsisinin (KÝB) deðerini araþtýrmak ve KÝB ile evrenin deðiþip deðiþmediðini saptamayý amaçladýk. GEREÇ-YÖNTEM: Temmuz 2002-Temmuz 2003 arasýnda kliniðimizde histopatolojik olarak tanýsý konan 40 küçük hücreli akciðer kanseri hastasýndan radyolojik tetkikler sonunda metastaz saptanmayarak sýnýrlý evre kabul edilen 19 hastadan kemik iliði biyopsisi alýndý. BULGULAR: Hastalarýn hiçbirinde kemik iliði tutulumu saptanmadý. SONUÇ: Akademik çalýþma protokolleri haricinde, LDH ve hemogram deðerleri normal olan sýnýrlý evre KHAK hastalarýnda evrelendirme için KÝB kullanýmýna gerek olmadýðýný düþündürmektedir.

AIM: In the current study, we aimed to find out value of bone marrow biopsy in staging limited stage small cell lung cancer cases and to demonstrate whether bone marrow biopsy altered the stage of the disease. MATERIAL-METHOD: Of 40 small cell lung cancer patients histopathologically diagnosed in our clinic between July 2002 and July 2003 19 cases demonstrated no metastatic sites radiologically and were considered as limited stage. These cases underwent bone marrow biopsy. RESULTS: None of them demonstrated bone marrow invasion. CONCLUSION: We concluded that bone marrow biopsy is not needed in staging of SCLC cases having normal LDH and complete blood count results, unless an academic survey recommends.

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AMAÇ: Pulmoner tromboemboli (PTE) önemli bir morbidite ve mortalite nedenidir. Bu çalýþmada PTE tanýsý alan olgularýn baþvurusundaki yakýnma, klinik, radyolojik ve laboratuvar bulgularýný incelenmeyi amaçladýk. GEREÇ-YÖNTEM: 39 PTE olgusunun baþvurusundaki yakýnma, akciðer grafisi, spiral CT anjiografi, alt ekstremite venöz doppler ultrasonografi, ekokardiografi, arter kan gazý, serum D dimer ve kardiyak enzim düzeyleri, hastanede yatýþ süresi ve mortalite oranlarýný retrospektif olarak incelendi.
BULGULAR: Akut nefes darlýðý ve bacak aðrýsý en sýk rastlanan yakýnmalar idi. Akciðer grafisinde en sýk saptanan bulgu hemidiafram elevasyonu idi. Ekokardiografide sýklýkla saptanan bulgular triküspit yetmezliði, pulmoner hipertansiyon ve sað ventrikül dilatasyonu idi. Sað ventrikül yetmezliði ve dilatasyonu olan olgularda serum troponin düzeyi olmayanlara göre yüksek bulundu. Kan gazý analizinde en sýk saptanan bulgu respiratuvar alkaloz ve hipokapni idi. Her iki ana pulmoner arterde trombüsü olan olgularda PaO2 düzeyi daha düþük idi. D dimer olgularýn % 77’sinde normalden yüksek saptandý. Bacak aðrýsý olanlarda serum LDH ve myoglobin daha yüksek idi. 6 olgunun major, 33 olgunu minör embolisi vardý. Ortalama hastanede yatýþ süresi 15±8 gün ve hastane mortalitesi %7.6 idi. SONUÇ: PTE’den þüphe edilen olgularda radyolojik ve laboratuvar incelemelerin yanýnda klinik deðerlendirme yapýlmasýnýn da önemli olduðunu düþünmekteyiz.

AIM: Pulmonary thromboembolism (PTE) remains an important cause of mortality and morbidity. We aimed to analyse symptoms, radiological, clinical and laboratory findings on admission in patients with PTE. MATERIAL-METHOD: We evaluated 39 patients’ symptoms, chest x-ray, spiral CT angiography features, lower extremity venous doppler ultrasonography, echocardiography, arterial blood gases, blood D dimer, cardiac enzymes on admission, treatment options, lenght of stay in hospital and mortality rates, retrospectively. RESULTS: Acute dyspnea and leg pain were the most frequent symptoms. Most common finding in chest X-ray was hemidiaphragm elevation. In echocardiography tricuspid insufficiency, pulmonary hypertension and right ventricular dilatation were frequently determined. In patients with right ventricular dilatation and failure mean blood troponin levels were higher than the others. Respiratory alcalosis and hypocapnia were the most significant findings in arterial blood gase analysis. Patients with PTE in both pulmonary arteries have lower PaO2 levels. D dimer concentrations were high in 77% of patients. Patients with leg pain had higher LDH and myoglobin levels. Among 39 patients 6 of patients had major, 33 cases had minor thromboemboli. The mean lenght of stay in hospital was 15±8 days. In-hospital mortality rate was 7.6%. CONCLUSION: We propose that ýt is important to evaluate the patients suspected PE with clinical findings beside of radiological and laboratory diagnostic methods.

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AMAÇ: Bu çalýþmada, Þanlýurfa'da çalýþan hekimlerin tüberkülozun taný ve tedavisine olan yaklaþýmlarýný belirlemeyi amaçladýk. GEREÇ-YÖNTEM: Çalýþmamýza 143 pratisyen 44 uzman olmak üzere toplam 187 hekim alýndý. Bu hekimlerden; 15 sorudan oluþan ve çoktan seçmeli anket formunu cevaplandýrmalarý istendi. BULGULAR: Tüberkülozda bulaþmanýn solunum yoluyla olduðunu ifade edenlerin oraný %98.9 idi. Hekimlerin %56.8'i tüberküloz tanýsýnýn bakteriyolojik olarak koyulduðunu belirtti. Ankete katýlan hekimlerin %33.9'u tüberküloz tanýsýnýn radyoloji ile konduðunu, %51'i takibin sadece radyoloji ile yapýldýðýný ve tedavi süresi olarak hekimlerin %38.5'i 6 ay, %44.9'si 9 ay olduðu yanýtlarýný verdiler. Ýlaç kombinasyonu olarak en sýklýkla %19.7 oranýnda RIF+INH+SM tercih ediliyordu. Tedavi baþarýsýzlýðý olan olgularda hekimlerin %65.8'i tek ilaç ekleyeceklerini iþaretlediler. SONUÇ: Tüberküloz taný ve tedavisi konusunda hekimlerin önemli ölçüde bilgi eksikliði olduðu saptanmýþ olup buna yönelik çalýþmalarýn yapýlmasý gerektiðini düþünmekteyiz.

OBJECTIVE: The aim of this study was to determine the approaches to diagnosis and treatment of tuberculosis of the physicians in Sanliurfa. MATERIAL-METHOD: The study group was consisted of 187 physicians with 44 specialists and 143 general practitioners. Data were obtained by a self administered questionnaire in 15 questions. RESULTS: The 98.9 percent of the participants reported respiratory route as transmission way of tuberculosis. While 56.8 percent of inquired physicians diagnosed tuberculosis by bacteriology, 33.9 percent of them diagnosed it with radiology. The 51 percent of the physicians reported that follow up of cases were made with radiology. Preferred therapy durations were 9 (44.9%) and 6 (38.5%) months. The most selected combination was INH+RIF+SM (19.7%). For the patients with treatment failure, 65.8 percent of the physicians decided to add a new drug to the regimen. CONCLUSION: In conclusion, as insufficient knowledge of the doctors about tuberculosis diagnosis and therapy were determined, we think that education of physicians in Sanlýurfa region concerning tuberculous is necessary.

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Malign plevral efüzyonlar taný ve tedavi yönünden yaygýn bir klinik problemdir. Mezotelyomayý da içeren akciðer kanserleri malign efüzyonlarýn en sýk nedeni olsa da meme, over, mide kanseri ve lenfomanýn bütün formlarý da malign plevral efüzyona neden olabilir. Malign plevral efüzyon tanýsý için hem histolojik hem de sitolojik malign hücrelerin plevra sývýsý veya dokuda gösterilmesi gerekir. Ortalama yaþam süresi altta yatan hastalýðýn tipine ve evresine baðlýdýr. Malign plevral efüzyonlarýn ayrýcý tanýsýnda birçok sývý testleri ve invazif iþlemler yararlýdýr. Bu yazýda, malign plevral efüzyonlara taný yaklaþýmý sunulmuþtur.

Malign pleural effusion is a common clinical problem because of difficulties in diagnosis and treatment. Lung cancer including malign mesothelioma is the most cause of malign pleural effusion however, all form of cancer including cancer of breast, ovary, stomach, lymphoma may cause malign pleural effusion. The diagnosis of malign pleural effusion requires either histological or cytological demonstration of malignant cells in the pleural tissue or pleural fluid. Median survival is dependent on the stage and type of the underlying malignancy. Many pleural fluid tests and invasive procedure are useful in differential diagnosis of malign effusions. In this review, approach to diagnosis of malign pleural effusion is presented.

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Akciðerde birden fazla odakta geliþen kanserler multipl primer akciðer kanseri (MPAK) olarak adlandýrýlýrlar. Multipl primer akciðer kanserleri senkron ve metakron olmak üzere ikiye ayrýlýr. Ýki veya daha fazla primer akciðer tümörü ayný anda saptanýrlarsa, senkron akciðer kanseri olarak tanýmlanýrlar. MPAK’lerinin gerçek sýklýðý bilinmemekle beraber çeþitli çalýþmalarda %0.72–11,4 arasýnda deðiþen oranlarda bildirilmektedir.
Bu makalede senkron primer akciðer karsinomu tanýsý alan seksen iki yaþýndaki erkek hasta sunulmuþtur. Hastanýn akciðer tomografisinde, sað alt lopda 3x2 cm boyutunda kitle lezyonu ve sol üst zonda hava bronkogramý içeren konsolidasyon alanlarý izlendi. Bronkoalveolar lavaj sitolojisi malignensi yönünden þüpheli pozitif gelince, her iki lezyona transtorasik ince iðne biyopsisi yapýldý. Saðdaki lezyona epidermoid karsinom soldaki lezyona ise bronkoalveolar karsinom tanýsý kondu. Taramalarýnda uzak metastaz saptanmadý. Hastanýn genel durumunun iyi olmamasý nedeniyle destek tedaviyle takibine karar verildi. Olgumuz, tedaviye yanýtsýz parankimal konsolidasyonlarýn ayýrýcý tanýsýnda akciðer malignitelerinin mutlaka düþünülmesi gerektiðini ve yine nadir de olsa primer kitleye senkron ikinci bir tümörün eþlik edebileceðini göstermektedir. Bu yüzden böyle olgularda ileri tanýsal giriþimlerin gerekliliði vurgulanmaktadýr.

Multiple primary lung cancer (MPLC) defined as more than one tumor is presented. Multiple primary lung cancer is divided into synchronous and metachronous lung cancer. When two or more primary lung cancers are detected at the same time, it diagnosed as synchronous lung cancer. Although the real incidence of MPLC is unknown, its frequency is estimated ranging from 0.72–11, 4 %. We presented case of an 82-year-old man who has with two synchronous lung cancers. In patient’s chest tomography, 3x2 cm diameter mass in right low lobe and lobe consolidation with air trapping in left upper lobe were revealed. When bronchoalveolar fluid was malignancy probably positive, bilaterally transthoracic needle biopsies were made. Epidermoid carcinoma in the right low lobe and bronchoalveolar carcinoma in the left upper lobe was diagnosed. There were no distant metastases. Because our patient’s performance status was 3, palliative therapy was given. The case shows that lung malignancy should certainly be considered to make a certain diagnosis of paranchimal consolidations which does not respond to therapy positively and that a primary tumor may a rarely be accompanied by a second tumors. Hence, in such cases, advanced diagnostic procedure is highly necessary.

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Brusellozis, Brucella cinsi bakterilerle oluþan, sistemik tutulum gösteren kronik bir hastalýktýr. Hastalýk hayvancýlýkla uðraþan ve taze süt ürünleri tüketen toplumlarda daha sýk görülmektedir. Solunum sistemi tutuluþu; plevral effüzyon, hiler lenfadenopati ve nodüler akciðer lezyonlarý þeklinde karþýmýza çýkmaktadýr. Plevra tutulumu oldukça nadir görülmektedir. Bu makalede hem serolojik, hem de kültür sonuçlarýyla brusellaya baðlý plevral effüzyon saptanan 24 yaþýndaki bir olguyu literatür bilgileri eþliðinde sunmayý uygun bulduk.

Brucellosis is a chronic disease with systemic manifestations caused by the Brucella genus. The disease is more frequently seen in populations consuming fresh dairy products and working as farmers. Pulmonary system involvement reveals pleural effusion, hiliary lymphadenopathy and nodular pulmonary lesions. In this article, we present with regard to current liteature a case of a 24 year old male with pleural brucellosis and pleural effusion that is proven both serologicly and by culture positivity.

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Ýdiopatik pulmoner hemosiderozis; primer olarak çocukluk çaðýnda görülen tekrarlayan hemoptizi, demir eksikliði anemisi ve göðüs radyogramýnda diffüz parankimal infiltrasyonla karakterize nadir bir alveoler hemoraji nedenidir. Patogenezi bilinmemektedir. Kesin taný, balgam, bronkoalveoler lavaj sývýsý veya açýk akciðer biyopsisinde hemosiderin yüklü makrofajlarýn gösterilmesiyle konur. Bu makalede, hastanemize hemoptizi ile baþvuran, 12 yaþýndan beri demir eksikliði anemisi tanýsý
ile çok sayýda kan transfüzyonlarý yapýlmýþ olan, bir yýl önce akciðer tüberkülozu tanýsýyla 6 ay düzenli tüberküloz tedavisi alan, 20 yaþýnda bir erkek olguyu sunuyoruz. Akciðer radyogramýnda bilateral retikülonodüler infiltrasyonlar izlenen hastanýn transbronþiyal akciðer biyopsisinde hemosiderin yüklü makrofajlarý bulunduran alveoler hemoraji ve interstisyel fibrozis saptandý. Alveoler hemoraji sendromlarý yönünden tetkik edilen olguya idiopatik pulmoner hemosiderozis tanýsý konuldu ve oral kortikosteroid tedavisiyle klinik ve radyolojik olumlu yanýt alýndý. Sonuç olarak; yüksek mortalite riski nedeniyle idiopatik
pulmoner hemosideroziste erken taný ve tedavi çok önemlidir. Nedeni açýklanamayan anemisi olan çocuklarýn izleminde akciðer radyogramý çektirilmeli, bilateral infiltrasyon varlýðýnda ayýrýcý tanýda idiopatik pulmoner hemosiderozis akýlda tutularak sitolojik tetkikler yapýlmalýdýr.

Idiopathic pulmonary haemosiderosis (IPH) is a rare, but potentially lethal cause of alveolar hemorrhage, which usually occurs in childhood and characterized by recurrent hemoptysis, iron deficiency anemia and diffuse parenchymal infiltration on chest radiogram. Pathogenesis is not well-known. The diagnosis is confirmed by demonstrating haemosiderinladen alveolar macrophages in sputum, bronchoalveolar lavage fluid or open lung biopsy specimen. We wish to present a 20 years old male patient, who was admitted to our hospital with hemoptysis, who has been performed multiple blood transfusions for diagnosis of iron deficiency anemia since he was 12 years old, and who had been treated with diagnosis of pulmonary tuberculosis one year ago. He presented bilateral reticulonodular infiltration on chest X-ray. On transbronchial lung biopsy, alveolar haemorrhage including haemosiderin-laden alveolar macrophages and interstitial
fibrosis were demonstrated. The subject was investigated for other alveolar haemorrhagic syndromes. There was no positive finding. He was diagnosed as idiopathic pulmonary haemosiderosis and he has responded well to oral corticotherapy. In conclusion; because of high mortality risk early definitive diagnosis and treatment are imparitive in
IPH. A chest radiography should be included in follow up of children with unexplained anemia and when bilateral infiltration is present, cytological investigation must be made, keeping IPH in mind in differential diagnosis.

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Swyer-James/MacLeod Sendromu pulmoner arter hipoplazisine baðlý unilateral hiperlüsent akciðer görünümü ve etkilenen tarafta bronþektazi ile karakterize nadir görülen bir hastalýktýr. 57 yaþýnda sigara içmeyen bayan hasta, öksürük, bol balgam çýkarma ve ateþ yakýnmalarýyla baþvurdu. Öyküsünden bu þikayetlerinin çocukluk yaþlarýndan beri tekrarladýðý, hastanemiz dýþýnda, 6-7 yýl öncesine kadar kronik bronþit, son 6-7 yýldýr da bronþektazi tanýsýyla takip ve tedavi edildiði öðrenildi. Fizik incelemede; solunum seslerinin þiddeti sol orta ve alt zonda saða göre hafif azalmýþ, bu alanda kaba ralleri mevcuttu. PA AC grafisinde; sol hiperlusent akciðer görünümü, sol akciðerde hacim kaybý ve sol alt zonda bronþektazik alanlar izlendi. Toraksýn bilgisayarlý tomografisi (BT) ve yüksek rezolusyonlu BT'de; sol pulmoner arterde hipoplazi, sol pulmoner arter dallarýnýn çapýnda azalma, hiperlüsensi, sol akciðer üst lob posterior ve linguler segment ile alt lobda kistik bronþektazi saptandý. Renkli doppler ekokardiyografide; sol pulmoner arter hipoplazik ve ana pulmoner arter hafif geniþlemiþ olarak izlendi. Swyer-James/MacLeod Sendromu olgularýn çoðunda çocukluk ve genç eriþkin dönemde teþhis edilen bir hastalýk olmasýna karþýn, olgumuzda 57 yaþýna kadar þikayetleri nedeniyle çeþitli defalar tetkik edilmesine raðmen tanýmlanamadýðý ve hiperlüsent akciðer görünümü saptandýðýnda bu sendromun ayýrýcý tanýda düþünülmesi gerektiðini vurgulamak için sunuyoruz.

Swyer-James/MacLeod Syndrome is a rare disease which is characterized by unilateal hyperlucent lung due to hypoplasia of its pulmonary artery. A non-smoker, 57 years old female patient admitted to our clinic with cough, sputum production and fever. Her medical history revealed that these symptoms has been recurrent since her childhood. Furthermore she had been followed up with as a patient of chronic bronchitis or bronchiectasis outside of our clinic so far. Physical examination revealed diminished respiratory sounds and coarse crackles on middle and lower zones of left hemithorax.
Chest X Ray showed hyperluceny and volume loss of the left lung and bronchiectasis at the left lower zone. Computerized and High Resolution Computerized Tomography revelaed hypoplasia of left pulmonary artery with reduced diameters of its branches, hyperlucent left lung and cyctic bronchiectasis in left lower and superior & lingular segments of the left upper lobes. Colored Doppler Echocardiography showed hypoplasia of the left pulmonary artery and enlargement of the main pulmonary artery.
Swyer-James/MacLeod Syndrome is diagnosed in childhood or early adulthood of most of the cases. We present this case to emphasize the delayed diagnosis until the age of 57 although she had been investigated several times because of her recurrent symptoms since her childhood and to emphasize considering this syndrome especially when a hyperlucent lung was detected on chest X ray.

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