Akın KAYA, Suat FİTOZ, Serdar AKYAR, Kıvılcım YAVUZ, Gökhan ÇELİK, Çetin ATASOY

Deskuamatif interstisyel pnömoninin sıradışı prezentasyonu: "Crazy-paving" görünümü (Olgu sunumu)

Efor dispnesi ile başvuran 42 yaşındaki erkek hastada deskuamatif interstisyel pnömoninin atipik bir görünümü sunulmaktadır. Akciğer grafisinde bilateral orta ve alt zonlarda retikülonodüler infiltrasyonlar saptandı. Yüksek rezolüsyonlu bilgisayarlı tomografide buzlu cam yoğunluk alanları üzerine süperpoze interlobüler septalarla karakterize "crazy-paving" görünümü izlendi. Her iki akciğer difüz ue simetrik etkilenmiş olmakla birlikte tutulum alt zonlarda daha belirgindi ve subplevral alanlar görece korunmuştu. Açık akciğer biyopsisiyle deskuamatif interstisyel pnömoni tanısı kondu. Kortikosteroid tedavisiyle hastanın yakınmaları ve solunum fonksiyon testleri belirgin olarak düzeldi. Kontrol akciğer bilgisayarlı tomografisinde, buzlu cam yoğunluk alanlarında belirgin gerileme görüldü. Akciğerin santral alanlarının tutulması ve periferal kesimlerinin korunması deskuamatif interstisyel pnömoni için alışılmadık bir durumdur. Benzer şekilde "crazy-paving" görünümü de deskuamatif interstisyel pnömonide bildirilmemiştir.

An unusual presentation of desquamative interstitial pneumonia: Crazy-paving appearance (A case report)

We describe an atypical presentation of desquamative interstitial pneumonia diagnosed in a 42-year-old male patient with exercise dyspnea. Chest radiograph revealed bilateral reticulonodular opacities in the mid to lower lung zones. High resolution computed tomography of the chest showed smooth linear densities superimposed on a background of ground-glass density, creating a crazy-paving appearance. The abnormality affected both lungs in an almost diffuse and symmetrical fashion, though the lower lung zones were involved to a greater extent and the subpleural regions were partly spared. The diagnosis proved to be desquamative interstitial pneumonia after an open lung biopsy, and the patient was started on corticosteroids. Both the symptoms and results of respiratory function tests improved with treatment, and a follow-up computed tomographic scan at 6 months of therapy showed a dramatic regression of the ground-glass areas. Sparing of the peripheral lung with a predominantly central involvement is atypical for desquamative interstitial pneumonia. So far as we are aware, crazy-paving appearance has not been reported in this disease.

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