Olgu Sunumu / Case Report

Solunum Hastalıkları Cilt 22, Sayı 1, 2011,31–35
ISSN 1300-2961
Tüm hakları saklıdır, tamamen ve kısmen tıpkıbasımı yasaktır
Olgu Sunumu / Case Report
Round Pnömoni: İki olgunun değerlendirilmesi
Round Pneumonia: Report of two cases in adults
Sinem Güngör1, Murat Yalçınsoy2, Ateş Baran3, Bilgen Begüm Afşar3, Belma Akbaba Bağcı3, Esen Akkaya3
Alman Hastanesi, Göğüs Hastalıkları, İstanbul
TCSB Balıklıgöl Devlet Hastanesi, Göğüs Hastalıkları, Şanlıurfa
3 TCSB Süreyyapaşa Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları, İstanbul
1
2
Geliş Tarihi: 6 Şubat 2010
Kabul Tarihi: 26 Nisan 2011
Özet
Abstract
Round pnömoni genellikle çocuklarda görülmekle birlikte, nadiren erişkinlerde
de bildirilmiştir. Akciğer grafisinde yuvarlak konsolidasyon şeklinde görülmesi
nedeni ile bronkojenik karsinomayı taklit eder. Round pnömoni tanısı alan iki
erişkin olgu değerlendirmesini sunuyoruz. Olgular: Olgular (K/47, K/27) kliniğimize göğüs ağrısı ve ateş şikâyetleri ile başvurdu. Akciğer grafilerinde yuvarlak
konsolidasyon mevcuttu. Olgu 1’de arteriovenöz malformasyon ve halo işareti
nedeni ile tümörü düşündüren sağ orta ve alt zonda yuvarlak şekilli konsolidasyonlar mevcuttu. Olgu 2’de sağ orta zonda yuvarlak şekilli konsolidasyon mevcuttu. Olgulara sulbaktam-ampisilin tedavisi verildi. Kontrol akciğer grafilerinde
tam iyileşme görüldü. Hastalar round pnömoni olarak değerlendirildi. SONUÇ:
Grafilerinde nodüler dansite artışı saptanan hastalarda ayırıcı tanıda round pnömoninin akılda tutulması gereksiz invazif işlemleri önleyecektir.
Round pneumonia is usually seen in children and has been infrequently reported
in adults. It is characterized with oval-shaped consolidation on chest radiograph
and due to this radiological appearance, mimics bronchogenic carsinoma. We
report two adult cases of round pneumonia. Case report: We present two cases
(F/47, F/27) admitted to our clinic with chest pain and fever. Chest radiographs
revealed a spherical consolidation. Case 1 have two round shaped consolidation
in right middle and lower lung area and investigated because of thorax CT
appearance which mimics arteriovenous malformation and halo sign seen in
tumor. Fiberoptic bronchoscopy and MR angiography findings were normal. Case
2 have round shaped consolidation in right middle lung area. Patients treated
with sulbactam-ampicillin, control chest radiographs showed complete
resolution. Patients were evaluated as round pneumonia Conclusions: Patients
with nodular densities in radiograph, round pneumonia should be included in the
differantial diagnosis to avoid unnecessary diagnostic procedures
Anahtar sözcükler: Round pnömoni, pnömoni, erişkin
Keywords: Round pneumonia, pneumonia, adult
Introduction
İletişim adresi:
Sinem Güngör
Alman Hastanesi, Göğüs Hastalıkları,
İstanbul
Tel.:+90 212 293 21 50;
Faks:+90 212 293 93 19;
[email protected]
Round pneumonia which was defined as an round shaped consolidation on radiographs; often follows a benign course, with resolution after a course of antibiotics, or
even spontaneously. The importance of recognizing round pneumonia in clinical practice lies in its radiological appearance which often mimics lung cancer because of
this, it causes unnecessary diagnostic procedures. Round pneumonia is generally though to be a disease of children and has been infrequently reported in adults.[1-4] Camargo et all identified 31 adult cases until 2008, with the method of searching The
Medical Literature Analysis and Retrieval System Online (Medline) database restricted to the English and Portuguese-language Literature (Table 1).[1,5-17]
We report two adult cases of round pneumonia and one underwent unnecessary
diagnostic procedures.
© 2011 Atatürk Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesi
www.solunumhastaliklari.org
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Solunum Hastalıkları Cilt 22, Sayı 1, 2011,31–35
Case Report
Case 1
A 47-year-old female patient was admitted to our hospital with
chest pain and fever for one week. Her medical history revealed
asthma, hypertansion and diabetes mellitus and family history
was unremarkable. The physical examination was normal except a temperature of 39°C and laboratory data within normal
limits. Chest radiographs revealed a nonhomogeneous opacity
in parahilar lung area. Thorax CT revealed two same lesions
in right middle and lower lobes (Figure 1-2) We thought arteriovenous malformation and primary lung carcinoma in differential diagnosis because of right middle lung lesion seems
relevant with vascular structures and halo sign appearance (Figure 3). Fiberoptic bronchoscopy and MR angiography findings
were normal (Figure 4). Patient was treated with sulbactam-
ampicillin for fever and air-bronchogram appearance in this
duration, control chest radiograph revealed complete recovery
and case evaluated as round pneumonia (Figure 5).
Case 2
A 27-year-old female patient was admitted to hospital with
symptoms of chest pain and weakness for 3 days. There was no
other significant history. On admission, her body temperature
was 38°C, chest auscultation revealed inspiratory crackles at
the right lower hemithorax. The reminder of physical examination was unremarkable. Routine laboratory tests including
biochemistry, blood and urine analysis were within normal limits. Chest radiograph revealed a spherical consolidation in
right middle lung area (Figure 6). Because of fever and air
bronchogram apperance in right middle lung lesion, patient
Figure 1,2 Chest radiograph and thorax CT of case 1
Figure 3 Halo sign in thorax CT of case 1
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Round pnömoni: İki olgunun değerlendirilmesi S Güngör ve ark.
Figure 4 MR angiography of case 1
Solunum Hastalıkları Cilt 22, Sayı 1, 2011,31–35
Figure 5 Control chest radiograph
Figure 6 Chest radiograph case 2 on admission
was treated with sulbactam-ampicillin. Control chest radiograph revealed complete recovery after 10 days of treatment (Figure 7). With these findings case was evaluated as round
pneumonia.
common entity.[25] Patients usually present with fever, chest
pain, cough and dyspnea as in our patient.[26] But some patients
with round pneumonia had no clinical symptoms.[1] Round
pneumonia is often caused by streptococcus pneumonia, haemophilus influenzae, mycobacterium tuberculosis, klebsialla
pneumonia. Coxiella burnetti and corona virus have also been
described.[2,27] Millar et all reviewed the chest radiographs on
hospital admission of 32 cases of Q fever serologically confirmed, and the more frequent lung changes encountered (78%)
were multiple round segmental consolidations (from one to
Discussion
Pneumonia is one of the major infectious diseases responsible
for significant morbidity and mortality throughout the world.
Imaging plays a crucial role in the detection and management
of patients with pneumonia. Round pneumonia is defined as
an spherical consolidation on chest radiograph. The mechanism of RP has been explained by the high affinity of pneumococci with the type II alveolar cell.[18,19] So inflammatory
process begins in the alveolar tissue and spreads centrifugally
through the intra-alveolar channels (pores of Kohn and channels of Lambert), without circumbronchial relationship, and
also absence of segmental boundaries in the alveolar tissue can
produce round or spherical configuration.[5,20,21]
Round pneumonia, usually seen in children. According to
Zinkernagel et al. the higher incidence of RP among children
is mainly due to the closely apposed connective tissue septa and
smaller alveoli in this population, which contributes towards
the formation of more compact and confluent consolidations.[13]
Furthermore, disease progression tends to be slower, thus favoring radiological detection of the oval-shaped images. Round
pneumonia is generally thought to be a disease of children and
has been only infrequently reported in adults.[1-4] Camargo et
all identified 31 adult cases until 2008, restricted to the English
and Portuguese-language Literature. Real number of these cases
considered more than 31 in non–English-language journals.[2224] Author’s doubt whether some cases are round pneumonia or
focal organizing pneumonia. So round pneumonia could be less
Figure 7 Chest radiograph case 2 after treatment
Round pneumonia: Report of two cases in adults S Güngör et al.
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Solunum Hastalıkları Cilt 22, Sayı 1, 2011,31–35
seven), 5 to 10 cm in diameter, and usually situated in the lower
lobes. Some lesions became round during resolution. They concluded that the finding of a single or multiple round pneumonia was found to be good evidence that the patient had “Q
fever.” So some author’s suggest that treatment in these cases
should contain old and new macrolides (erythromycin and clarithromycin) and new quinolones (levofloxacin) which are curative and prevent chronic Q fever.[28,29]
Round pneumonia has been reported a benign course, with
complete resolution after antibiotics as in our cases or spontaneous resolution as in case of Camorgo et al. Mortality in round
pneumonia cases is related with virulent agent and host immunity.[1] It is predominantly located in the lower lobes but
multiple noduler densities have been reported.[1,27]
Round pneumonia is important that, its radiological appearance mimics lung carsinoma. Because of this apperance, further investigations may be done as in our case one, presence of
fever and spherical consolidation with air bronchogram led to
diagnosis as round pneumonia. Additional investigations performed in case one during pneumonia treatment. We treated
our patient with sulbactam ampicilin. We did not detect pathogen in bronchial lavage in case 1, and sputum culture in case
2, but clinical symptoms and mass appearence on the chest radiograph gradually recovered after two weeks which supported
our diagnosis.
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Round pnömoni: İki olgunun değerlendirilmesi S Güngör ve ark.
As a result if a case with an round opasity on chest radiography has respiratory tract infection symptoms round pneumonia can be considered in the differential diagnosis. In this
instance unnecessary investigations could be prevented and the
cost of pneumonia decreases.
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