Semih HALEZEROĞLU, Murat KARA, Cengiz Tanju BAVBEK, Emine Handan ZEREN

Mediastinotomi ile Tanı Konulan Blastomikoz Olgusu

Pulmoner blastomikozis, Blastomyces dermatitidis tarafından oluşturulan ve genellikle güç tanı konulabilen bir mantar enfeksiyonudur. Tanı mikroorganizmanın doku, balgam, eksuda veya kültürde direk olarak mikroskopik incelemesi ile konur. Balgam ya da bronşiyal veya gastrik yıkamaların incelemesi tanı için yetersiz olabilir. Bu olgu sunumunda paraaortik bölgedeki lenf bezlerinin tutulumu ile birlikte seyreden ve sol üst lobunda blastomikoz saptanan 49 yaşındaki erkek olguyu sunuyoruz. Balgam ve bronkoskopi ile alınan bronş lavajı örneklerinin sitolojik ve direk mikroskopik incelemeleriyle tanı konulamayan olguda mediastinotomi ile yapılan paraaortik lenf nodu biopsisi ise tanı için yeterli olmuştur. Pulmoner blastomikoz olgularında sitolojik incelemeleri de içeren tanısal işlemler yetersiz kaldığında daha invaziv işlemler öncesinde mediastinotomi ile yapılacak lenf bezi biopsisinin tanıya yardımcı olabileceğini vurgulamayı amaçladık.

A Case of Blastomycosis Diagnosed With Mediastinotomy

Pulmonary blastomycosis is a difficult to diagnose fungal infection caused by blastomyces dermatitidis. Diagnosis is made by direct examination of the microorganism in the tissues, sputum, exudates or culture. The examination of sputum or bronchial, gastric washings might be nondiagnostic. We present a case of 49 - year old male who was found to have blastomycosis in his left upper lobe and also the involvement of paraaortic lymph nodes. Diagnosis could not be established with either cytologic or microscopic examinations of sputum and bronchoscopic lavage samples. However, paraaortic lymph node biopsy with mediastinotomy was an adequate procedure for the diagnosis. We tried to emphasize that lymph node biopsies with a mediastinotomy might aid to the diagnosis in cases with blastomycosis prior to more invasive diagnostic methods when the initial diagnostic methods fail.

Keywords:

blastomycosis, pulmonary, diagnosis,

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