Pulmoner Arter Oklüzyonuna Sebep Olan Kist Hidatik Kavitesi İçinde Gelişen Bir Pulmoner Aspergilloma Vakası

Öz

Özet Pulmoner aspergilloz; invaziv pulmoner aspergilloz, kronik pulmoner aspergilloz, aspergilloma, kronik kaviter pulmoner aspergilloz ve alerjik bronkopulmoner aspergilloz gibi farklı klinik formlarda ortaya çıkabilen bir enfeksiyon spektrumudur. Hemoptizi, aspergillomanın en sık ve en ciddi klinik bulgularından biri olup yaşamı tehdit edebilen komplikasyonlara yol açabilmektedir. Daha önce tedavi edilmiş pulmoner hidatik kist kavitesi içerisinde aspergilloma gelişimi tanımlanmış olmakla birlikte, eşlik eden pulmoner vasküler tutulum oldukça nadirdir. On beş gündür devam eden balgamlı öksürük ve hemoptizi şikâyeti ile başvuran, çocukluk döneminde bilateral pulmoner hidatik kist nedeniyle opere edilmiş ve daha önce aspergilloma tanısı almış 23 yaşındaki kadın hasta sunulmuştur. Toraks bilgisayarlı tomografisinde sağ üst lobda hava-hilal (air-crescent) bulgusu içeren 20×19 mm boyutunda kaviter lezyon, sol alt lobda 23×21 mm boyutunda kalın duvarlı kavite ile birlikte sağ ana pulmoner arter ve pulmoner vende tam oklüzyon saptandı. Bronkoskopik değerlendirme ve bronkoalveoler lavaj incelemeleri aspergilloma ile uyumlu bulundu. Aktif tüberküloz, tekrarlayan mikrobiyolojik incelemelerle dışlandı. Vorikonazol tedavisi sonrası hemoptizi tamamen geriledi ve hasta medikal tedavi ile taburcu edildi. Bu olgu, rezidüel hidatik kist kavitesi zemininde gelişen pulmoner aspergillomaya eşlik eden majör pulmoner vasküler oklüzyonun nadir bir örneğini sunmaktadır. Aspergillomalı hastalarda özellikle tekrarlayan hemoptizi varlığında pulmoner vasküler yapıların ayrıntılı değerlendirilmesi önem taşımaktadır. Anahtar Kelimeler: Pulmoner aspergilloma, hidatik kist, pulmoner arter oklüzyonu, hemoptizi, kaviter akciğer hastalığı.

Anahtar Kelimeler

• Pulmoner aspergilloma
• hidatik kist
• pulmoner arter oklüzyonu
• hemoptizi
• kaviter akciğer hastalığı.

A Case Of Right Pulmonary Artery Occlusion Due To Pulmonary Aspergilloma Forming On The Hydatid Cyst Cavity

Öz

Pulmonary aspergillosis encompasses a spectrum of clinical entities, including invasive pulmonary aspergillosis, chronic pulmonary aspergillosis, aspergilloma, chronic cavitary pulmonary aspergillosis, and allergic bronchopulmonary aspergillosis. Hemoptysis is one of the most common and potentially life-threatening manifestations of aspergilloma. Development of aspergilloma within residual cavities of previously treated pulmonary hydatid cysts has been reported; however, concomitant pulmonary vascular involvement is exceedingly rare. We present a 23-year-old immunocompetent woman with a history of bilateral pulmonary hydatid cyst surgery during childhood and a previous diagnosis of pulmonary aspergilloma. She was admitted with productive cough and recurrent hemoptysis persisting for 15 days. Thoracic computed tomography demonstrated a 20 × 19 mm cavitary lesion with an air-crescent sign in the right upper lobe, a 23 × 21 mm thick-walled cavity in the left lower lobe, and complete occlusion of the right main pulmonary artery and pulmonary vein. Bronchoscopic evaluation revealed hemorrhagic secretions originating from the right bronchial system, while bronchoalveolar lavage culture and cytological examination were compatible with aspergilloma. Repeated microbiological investigations excluded active tuberculosis. The patient was treated with voriconazole, resulting in complete resolution of hemoptysis. This case highlights a rare association between pulmonary aspergilloma, residual hydatid cavity, and major pulmonary vascular occlusion. Careful assessment of the pulmonary vasculature should be considered in patients with chronic cavitary aspergillosis presenting with recurrent hemoptysis.

Anahtar Kelimeler

• Pulmonary aspergilloma
• ; Hydatid cyst
• Pulmonary artery occlusion
• Chronic cavitary lung disease
• Hemoptysis

Kaynakça

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