Nurhayat YILDIRIM, Hande D. İKİTİMUR, Fatma TOKER, Tunçalp DEMİR, A. Kürşat BOZKURT

İnterstisyel akciğer hastalığının tanısında VATS: Beş olgu sunumu

Interstisyel akciğer hastalığı (lAH) tanısında video yardımlı torakoskopik cerrahi (VATS), son yıllarda gittikçe artan sıklıkta kullanılan bir yöntem olmuştur. Hastaların klinik, fizik muayene, biyokimyasal ve radyolojik incelemesi sonucunda uyarılan ön tanıları ile, VATS sonucu elde edilen materyalin patolojik değerlendirilmesi sonucu ulaşılan tanı arasında belirgin farklar olabilmektedir. Çalışmamızda, VATS sonucunda klinik tanıyla farklı patolojik tanı elde edilen beş olgu incelenmiştir. Klinik ue radyolojik ön tanıları lenfanjiyoleiomiyomatozis, hipersensitive pnömonisi ve idiyopatik pulmoner fibrozis (IPF) (iki olgu) olan dört olguya başlangıçta, asidorezistan basil (ARB) pozitif saptanan akciğer tüberkülozlu bir olguya ise tedavinin üçüncü ayında regresyon olmaması üzerine VATS uygulanmıştır. Olguların tümünde patolojik tanılar klinik tanıdan farklı olarak bulunmuştur. Lenfanjiyoleiomiyomatozis düşünülen 22 yaşındaki kadın hastada patolojik tanı histiyositozis-X olarak bulunurken, hipersensitive pnömonisi ön tanısı olan 55 yaşındaki kadın hastada sarkoidoz, IPF düşünülen 58 yaşında erkek hastada nonspesifik intersüsyel pnömoni saptandı. ARB pozitif saptanan fakat üç aylık takipte klinik ve radyolojik gerileme olmayan 62 yaşındaki olgu ile IPF düşünülen 65 yaşındaki erkek hastada VATS sonucunda bronkoalveoler karsinom tanısı konmuştur. Sonuç olarak; VATS'ın intersüsyel akciğer hastalığı ön tanısı ve değerlendirilen olgularda kesin tanı için kullanılması gereken en önemli tanı yöntemlerinden biri olduğunu söyleyebiliriz.

Videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease

Video-assisted thoracoscopic surgery (VATS) is a diagnostic method, used with increasing frequency in recent years, in the diagnosis of interstitial lung diseases. There are significant differances in the diagnosis of diseases which are diagnosed with clinical, biochemical and radiological investigation and with pathological evaluation of material obtained by VATS. in our study, five patients with different clinical and VATS guided pathological diagnosis, were analyzed. VATS was applied to four patients with clinical and radiological diagnosis of lymphangioleiomyomatosis, hypersensitivity pneumonitis and idiopathic pulmonary fibrosis (IPF) (two patients) at the beginning and to another patient with pulmonary tuberculosis (Tbc) who was ARB posive and no regression could be achieved with anti-Tbc treatment at the third month. Clinical and pathological diagnosis was different in ali patients. in a 22 year old female, who was thought to be lymphangioleiomyomatosis, was pathologically diagnosed as histiocytosis-X; in a 55 year old female, who was thought to be hypersensitivity pneumonitis, was diagnosed as sarcoidosis; in a 58 year old male, who was thought to be IPF, was diagnosed as nonspecific interstitial pneumonia. Sixty-two year old patient with ARB positive pulmoner Tbc who had no clinical and radiological regression with three month anti-Tbc therapy, and 65 year old male patient uıho was thought to be IPF were diagnosed by VATS as bronchoalueolar carcinoma. in condusion; VATS is öne of the most important methods for defınite diagnosis of interstitial lung diseases, in patients with interstitial involvement

PDF

___

1.Schwarz Ml, King TE Jr, Raghu G. Approach to the evaluation and diagnosis of interstitial lung disease. In: Schwarz Ml, King TE Jr (eds). Interstitial Lung Disease. 4th ed. London: BC Decker Inc Hamilton, 2003: 1-31.
2.McElvein RB. The surgical approach to interstitial lung disease. Clin Chest Med 1982; 3: 485-90.
3.Bensard DD, Mclntyre RC, Waring BJ, et al. Comparison of video thoracoscopic lung biopsy to open lung biopsy in the diagnosis of interstitial lung disease. Chest 1993; 103: 765-70.
4.Rena O, Casadio C, Leo F, et al. Videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease. Eur J Cardiothorac Surg 1999; 16: 624-7.
5.Chinnet T, Sanbert F, Dusser D, et al. Effects of inflammation and fibrosis on pulmonary function in diffuse lung fibrosis. Thorax 1990; 45 :675-8.
6.Fink JN. Hypersensitivity pneumonitis. Clin Chest Med 1992; 13: 303-9.
7.King TE Jr, Costabel U, Cordier JF, et al. American Thoracic Society. Idiopathic pulmonary fibrosis; diagnosis and treatment. International consensus statement. American Thoracic Society (ATS), and European Respiratory Society (ERS). Am J Respir Crit Care Med 2000; 161: 646-64.
8.Vassallo R, Ryu JH, Limper AH. Pulmonary langerhans cell histiocytosis a 22 year experience at the Mayo Clinic. Am J Respir Crit Care Med 1999; 159: 63.
9.Schonfeld N, Frank W, Wenig S, et al. Clinical and radiologic features, lung function and therapeutic results in pulmonary histiocytosis X. Respiration 1993; 60: 38-44.
10.Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Cranutomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999; 160: 736-55.
11.Smith CW, Murray GF, Wilcox BR. The role of transbronchial lung biopsy in diffuse pulmonary disease. Ann Thorac Surg 1977; 24: 54-8.
12.King TE Jr. Idiopathic interstitial pneumonias. In: Schwarz Ml, King TE Jr (eds). Interstitial Lung Disease. 4th ed. London: BC Decker Inc Hamilton, 2003: 701-87.
13.Karnak D, Kayacan O, Beder S. Reactivation of pulmonary tuberculosis in malignancy. Tumori 2002; 88:251-4.
14.Çelik M, Halezerogiu S, Şenol C, et al. Video-assisted thoracoscopic surgery: Experience with 341 cses. Eur J Cardiothorac Surg 1998; 113-6.
15.Krasna MJ, White CS, AisnerSC, et al. The role ofthoracoscopy in the diagnosis of interstitial lung disease. Ann Thorac Surg 1995; 59: 348-51.