Pulmoner arter anevrizması ile nazal septal perforasyonun beraberliği

Kırk beş yaşındaki erkek hasta bir haftadır var olan yan ağrısı, öksürük ve nefes darlığı yakınmalarıyla başvurdu. Hastanın sekiz yıldır kronik obstrüktif akciğer hastalığı tanısı vardı. İlk çekilen akciğer grafisi sol alt zonda bir infiltrasyon olduğunu gösterdi. İkili antibiyotikten oluşan tedaviye rağmen kaviter bir lezyon gelişti. Toraksın bilgisayarlı tomografisinde iki taraflı kaviter lezyonlar ve ana pulmoner arterlerde anevrizma olduğu görüldü. Daha sonra hasta ağzında tekrarlayan ülserler oluştuğunu ifade etti. Ancak rinoskopide nazal septal perforasyon gözlendi. Nazal septum ve yanak mukozasından alınan biyopsiler kesin tanıyı koydurtamadı.

Anahtar Kelimeler:

Pulmoner arter, Ölümle sonuçlanma, Akciğer hastalığı, kronik obstrüktif, Erkek, Orta yaşlı, Vaskülit, merkezi sinir sistemi, Wegener granülomatozu, Nazal septum, Anevrizma

The coexistence of pulmonary artery aneurysm and nasal septal perforation

A 45-year-old male patient presented with a one week history of pleuritic chest pain, cough, and breathlessness. He had a diagnosis of chronic obstructive pulmonary disease for eight years. His initial chest radiograph revealed left lower zone infiltration. A cavitary lesion developed despite treatment with two antibiotics. Thorax computerized tomography scan revealed bilateral cavitary lesions and aneurysms in the main pulmonary arteries. Later, the patient reported recurrent oral ulcers, but rhinoscopy demonstrated nasal septal perforation. A definitive diagnosis could not be established despite biopsies from the nasal septum and buccal mucosa.

Keywords:

Pulmonary Artery, Fatal Outcome, Pulmonary Disease, Chronic Obstructive, Male, Middle Aged, Vasculitis, Central Nervous System, Wegener Granulomatosis, Nasal Septum, Aneurysm,

PDF

___

1) Mascarenhas R, Tellechea O, Oliveira H, Reis JP, Cordeiro M, Migueis J. Nasal septum perforation as the presenting sign of lupus erythematosus. Dermatol Online J 2005;11:12.
2) Lamblin C, Darras J, Dubrulle F, Wallaert B. Ear and upper respiratory manifestations of systemic diseases. Eur Respir Rev 2001;18:68-78.
3) Jones NS. Nasal manifestations of rheumatic diseases. Ann Rheum Dis 1999;58:589-90.
4) Kriskovich MD, Kelly SM, Jackson WD. Nasal septal perforation: a rare extraintestinal manifestation of Crohn's disease. Ear Nose Throat J 2000;79:520-3.
5) Hoffman GS, Kerr GS, Leavitt RY, Hallahan CW, Lebovics RS, Travis WD, et al. Wegener granulomatosis: an analysis of 158 patients. Ann Intern Med 1992;116:488-98.
6) Takei H, Komaba Y, Kitamura H, Hayama N, Osawa H, Furukawa T, et al. Aneurysmal subarachnoid hemorrhage in a patient with Wegener's granulomatosis. Clin Exp Nephrol 2004;8:274-8.
7) Shitrit D, Shitrit AB, Starobin D, Izbicki G, Belenky A, Kaufman N, et al. Large vessel aneurysms in Wegener's granulomatosis. J Vasc Surg 2002;36:856-8.
8) Farzaneh-Far R, Watkins J, Tahir H, Wykes F, Beynon H. Small vessel vasculitis with pulmonary aneurysms and silent myocardial infarction. Rheumatology (Oxford) 2003;42:1022-4.
9) Senf R, Jürgensen JS, Teichgraber U, Kampf D, Schindler R. Ruptured arterial aneurysm of the kidney in a patient with Wegener's granulomatosis. Nephrol Dial Transplant 2003;18:2671-3.
10) Seo JB, Im JG, Chung JW, Song JW, Goo JM, Park JH, et al. Pulmonary vasculitis: the spectrum of radiological findings. Br J Radiol 2000;73:1224-31.
11) Chirinos JA, Tamariz LJ, Lopes G, Del Carpio F, Zhang X, Milikowski C, et al. Large vessel involvement in ANCA-associated vasculitides: report of a case and review of the literature. Clin Rheumatol 2004;23:152-9.
12) Fauci AS, Haynes BF, Katz P, Wolff SM. Wegener's granulomatosis: prospective clinical and therapeutic experience with 85 patients for 21 years. Ann Intern Med 1983;98:76-85.
13) Devaney KO, Travis WD, Hoffman G, Leavitt R, Lebovics R, Fauci AS. Interpretation of head and neck biopsies in Wegener's granulomatosis. A pathologic study of 126 biopsies in 70 patients. Am J Surg Pathol 1990;14:555-64.
14) Jones GL, Lukaris AD, Prabhu HV, Brown MJ, Bondeson J. Wegener's granulomatosis mimicking a parotid abscess. J Laryngol Otol 2005;119:746-9.
15) Rosenberg DM, Weinberger SE, Fulmer JD, Flye MW, Fauci AS, Crystal RG. Functional correlates of lung involvement in Wegener's granulomatosis. Use of pulmonary function tests in staging and followup. Am J Med 1980;69:387-94.