Ayşe YILMAZ, Berat ACU, Sibel DORUK, Göçmen Serpil ÖCAL

Is tin fume exposure benign or not? Two case reports

Stannosis, kalay (tin-oksid/stannik oksid) toz ve buhar inhalasyonunun sonucu olarak kalayın pulmoner parankimde biriktiği fibrotik olmayan bir pnömokonyozdur. Göğüs radyografisinde her iki akciğerde çok sayıda ve dens nodüller vardır. Stannozisin radyolojik bulgularının aşikar olmasına rağmen hastalar klinik olarak iyi durumdadır ve solunum fonksiyon testi değerlerinde sapma yoktur. Dört yıldır efor dispnesi olan 70 yaşında erkek hasta. Kırk yıldır kalaycılık yapıyordu. Solunum fonksiyon testinde hafif restriksiyon saptandı. Göğüs grafisinde yaygın, küçük, dens retikülonodüler opasiteler vardı. Toraksın yüksek çözünürlüklü bilgisayarlı tomografisinde dens, yaygın nodüler lezyonlar, retikülasyon ve bal peteği görünümü vardı. Elli yaşında kadın hasta. Otuz üç yıldır kalay tozuna maruziyeti vardı ve hiç sigara içmemişti. Solunum fonksiyon testinde normal FVC ve hafifçe düşük FEV1 değeri saptandı. Göğüs grafisinde yaygın retikülonodüler opasiteler saptandı. Toraks yüksek çözünürlüklü bilgisayarlı tomografide, bazı bölgelerde buzlu cam dansiteler, yaygın interlobüler septal kalınlaşmalar, her iki akciğerde perihiler bölgede belirgin olan peribronşiyal kalınlaşmalar ve sağ akciğerin üst ve orta lobunda subplevral milimetrik nodüler dansiteler gözlendi. Kalay tozu maruziyeti olan iki hasta tanımlanmıştır. Bununla birlikte, beklenenin aksine her iki hasta da klinik olarak kötüleşti ve solunum yetmezliği nedeniyle öldü.

Kalay toz-buharı maruziyeti benign midir yoksa değil midir? İki olgu sunumu

Stannosis is a non-fibrotic form of pneumoconiosis in which tin-oxide is accumulated in pulmonary parenchyma as a result of inhalation of tin-oxide (stannic oxide) dust and fume. Chest radiograph shows numerous small very dense nodules in both lungs. Although radiological findings of stannosis were apparent, the patients were clinically in good condition, and pulmonary function test (PFT) values showed no disability. Case 1, 70-year-old man had exercise dyspnea for four years. He worked as a tinner for 40 years. A slight restriction was detected in his PFT. Diffused, small, dense, reticulonodular opacities were detected on chest X-ray. Thorax high resolution computerized tomography (HRCT) revealed dense, common noduler lesions, reticulation and honeycomb appearance. Case 2, the patient was a 50-year-old woman. She had been exposed tin fume for 33 years and never smoked. In PFT, a slightly low FEV1 value and a normal FVC value were detected. Diffused reticulonodular opacities were detected on chest X-ray. On thorax HRCT, ground glass densities in some areas, widespread interlobulary septal thickening, peribronchial thickening predominant in perihilar regions in both lungs and subpleural milimetric nodular densities were observed in the upper and middle lobe of the right lung. Two patients who exposed to tin fume are described. However, contrary to what is expected, both patients clinically deterioted and died as a result of respiratory failure.

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