Harun AYHAN, Şahin ÇOLAK, Burcu GENÇYAVUZ, Hayati KANDİŞ, Mehmet Özgür ERDOĞAN

PULMONER EMBOLİ KLİNİĞİNİ TAKLİT EDEN EKSTERNAL PULMONER ARTER DARLIĞI

Edinilmiş pulmoner stenoz erişkinlerde çok nadir olup tanının konulabilmesi yüksek şüphegerektirir. Mediastinal malign kitleler, kardiyak yapılara ve büyük damarlara bası yapabilir.45yaşında bayan hasta nefes darlığı ve göğüs ağrısı ile acil servise başvurdu. Arteriyel kan gazındahipoksi ve respiratuar alkaloz (pH 7,51, pCO2 26 mmHg, pO2 65, HCO3 26 mEq/L ve laktatdüzeyi 6 mmol/L) tespit edildi. Sağ hemitoraksda solunum seslerinde azalma, kardiyak apeksde2-3/6 sistolik ejeksiyon üfürüm, pretibiyal ödem, juguler venöz dolgunluk,elektrokardiyografisinde sağ aks sapması ve sinüs taşikardisi vardı.D-dimer değeri 300 ng/mlbulundu. Toraks bilgisayarlı tomografi anjiyografisinde trombüs ve diseksiyona rastlanmadı.Toraks tomografisinde sağ efüzyon yanında sağ pulmoner artere bası yapan yumuşak dokukitlesi bulundu. Pulmoner arter external basıları pulmoner tromboemboliyi klinik olarak taklitedebilir. Pulmoner arter embolisini ekarte eden D-dimer seviyesinin düşüklüğü, pulmoner arterexternal basılarında görülebilir. Açıklanamayan dispne olgularında tomografik görüntülemetercih edilmelidir

Anahtar Kelimeler:

Mediastinal tümörler, pulmoner arter darlığı, D-dimer

External Pulmonary Artery Stenosis Mimicking Pulmonary Thromboembolism

Acquired pulmonary stenosis is very rare in adults and diagnosis requires a high index ofsuspicion. Malignant mediastinal masses may compress cardiac structures and great vessels.45year-old female patient was admitted to the emergency department with dyspnea and chest pain.Arterial blood gas analysis revealed hypoxia and respiratory alkalosis (pH 7,51, pCO2 65mmHg, pO2 65, HCO3 26 mEq/L, lactate 6 mmol/L).patient had decreased breath sounds inthe right hemithorax, 2-3/6 apical systolic ejection murmur, pretibial edema, jugular venouspressure. Electrocardiogram revealed right axis deviation and sinus tachycardia. D-dimer valuewas 300 ng/ml. Thorax computed tomography angiography revealed no thrombus or dissection.CT revealed soft tissue mass compressing right pulmonary artery and right pleural effusion.External compression of pulmonary artery may clinically mimic pulmonary thromboembolism.Low D-dimer levels may rule out pulmonary thromboembolism. External pulmonary arterycompressions may not increase D-dimer levels.Tomographic imaging should be preferred inpatients with unexplained dyspnea

Keywords:

Mediastinal tumors, pulmonary artery stenosis, D-dimer,

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