Pleural effusion in pulmonary embolism.

PURPOSE OF REVIEW: Pulmonary embolism is a common and potentially lethal disease that recurs frequently and is associated with long-term impairment and suffering. Patients with pulmonary embolism are at risk of death, recurrence of embolism, or chronic morbidity. Appropriate therapy can reduce the incidence of all. Pulmonary embolism is the most commonly overlooked disorder in patients with pleural effusion. Recent findings of pleural effusions due to pulmonary embolism are discussed in this review. RECENT FINDINGS: The presence of pleuritic chest pain in a patient with a pleural effusion is highly suggestive of pulmonary embolism. Nearly all pleural effusions due to pulmonary embolism are exudates, frequently hemorrhagic, and with a marked mesothelial hyperplasia. Patients with a pleural effusion are likely to have an embolus in the central, lobar, segmental, or subsegmental pulmonary arteries and these are the regions in which spiral computed tomography pulmonary angiography (CTPA) can detect an embolus. No specific treatment is required for pleural effusion. The presence of bloody pleural fluid is not a contraindication for the administration of anticoagulant therapy. SUMMARY: Pulmonary embolism is probably responsible for a significant percentage of undiagnosed exudative pleural effusions. Spiral CTPA is the best way to evaluate the possibility of pulmonary embolism in a patient with a pleural effusion. The treatment protocol of the patient with pleural effusion secondary to pulmonary embolism is the same as that for any patient with pulmonary embolism.

Sarcoidosis and Gullain-Barré syndrome.

A 35-year-old female presented with three days' history of aching discomfort in her back, chest, and ankles. She had also noticed increasing weakness of her legs and a week before admission had shown flu-like symptoms. Chest X-ray showed bilateral hilar and right paratracheal lymphadenopathy. Bronchoscopic biopsies revealed non-caseating granuloma. She was diagnosed with sarcoidosis and was given prednisolone. The patient developed facial palsy and rapidly progressive ascending paralysis beginning from the lower extremities on the third and fourth days after initial presentation, respectively. Analysis of lumbar puncture showed acellular fluid with a high protein content. EMG was consistent with diffuse sensorimotor demyelinating polyneuropathy. Thus, the diagnosis was Guillain-Barré syndrome (GBS) presenting with sarcoidosis. Intravenous immune globulin was given and prednisolone stopped. One month after initial presentation the patient was completely recovered and discharged on prednisolone therapy. If neurologic symptoms such as aching discomfort and weakness are the main complaints in patients with suspected or biopsy proven sarcoidosis, GBS should be suspected.

An unusual cause of dyspnea.

BACKGROUND: Right-sided arcus aorta (RSAA) is a rare condition and usually asymptomatic. However, it may be symptomatic if it causes tracheal or esophageal compression. METHODS: The authors evaluated clinical and radiological features of seven patients with RSAA who had the diagnosis between May 2006 and May 2009. RESULTS: The authors found that the incidence of RSAA was 0.16% in patients who had applied to their clinic. The age of patients ranged from 17 to 55 years. The male to female ratio was 6/1. Four patients were symptomatic due to RSAA. Most common symptoms were dyspnea during exercise, which is similar to exercise-induced asthma and dysphagia. Two patients were misdiagnosed as asthma. The flow-volume curves on spirometry of the patients showed intrathoracic upper airway obstruction. Thorax magnetic resonance imaging (MRI) revealed marked narrowing of the tracheal air column due to external compression of RSAA in three patients. CONCLUSIONS: RSAA should be included in the differential diagnosis of asthma. Spirometry may help to suspect RSAA. Thorax computed tomography (CT) and/or MRI are the best imaging methods for the diagnosis of RSAA.

[The evaluation of 92 interstitial lung disease patients]. / Klinigimizde interstisyel akciger hastaligi tanisi alan 92 hastanin incelenmesi.

Interstitial lung diseases (ILD) include many acute and chronic pulmonary disorders. We aimed to evaluate the patients diagnosed as ILD in our clinic. Between January 2000 and August 2004, 92 patients were included in the study. Fifty eight (63%) of our patients were female, 34 (37%) were male and the median age was 50.2 + or - 14.2 (19-80) years. The most frequent diagnoses were sarcoidosis in females, and IPF in males. The diagnostic methods used were as follows; clinically and radiologically in 36 (39.1%) patients, bronchoscopy in 33 (34.8%) patients, mediastinoscopy in 10 (10.9%) patients, open lung biopsy in 8 (8.7%) patients, skin biopsy in 2 (2.2%), oral mucosal biopsy in 1 (1.1%), lymph node biopsy in 1 (1.1%), renal biopsy in 1 (1.1%) and pleural fluid examination in 1 (1.1%). Bronchoscopic biopsies were diagnostic in 60.9% of sarcoid patients. Twelve (48%) IPF patients had an occupational toxic exposure history. Medical treatment were given to 80 patients. There were good clinical and radiological response in patients with sarcoidosis (96.9%) and cryptogenic organizing pneumonia (COP) (85.7%), however disease was stable in CTD patients and only three of idiopathic pulmonary fibrosis (IPF) patients (15.7%) responded to treatment. In IPF patients, diagnosis was established medially 35.7 months later after the first symptom appeared. Two of the IPF patients had also lung cancer. Treatment related complications occurred in six patients. Fourteen patients died during the follow-up period and eight were IPF. ILD is frequently encountered in general practice of pulmonary physicians and should be considered in differential diagnosis during routine pulmonology clinic. Sarcoidosis and IPF were the most commonly seen diseases. Although ILD is a difficult challenge to diagnose in clinical practice, it may be diagnosed by means of clinical features, radiologic techniques and several biopsy procedures.

Pulmonary involvement in Behçet's disease.

BACKGROUND: Behçet's disease (BD) is a multisystem vasculitis and pulmonary involvement in BD is reported to indicate poor prognosis and high mortality. OBJECTIVES: The aims of this study were to report on patients with pulmonary involvement and to discuss pulmonary artery thrombus and small-sized vasculitis associated with BD, with respect to previously published cases. METHODS: Fifteen patients with BD and pulmonary involvement were included in this study. Massive hemoptysis was observed in all patients having pulmonary artery aneurysm (PAA). RESULTS: Eleven patients had macroscopic pulmonary vascular disease (2 PAA, 3 PAA and thrombi and 6 only thrombi) and 3 patients had microscopic pulmonary vascular disease. The remaining patient had pulmonary cryptococcosis. CONCLUSIONS: Data regarding treatment and outcomes of patients having BD-related pulmonary emboli/infarct and small-sized vasculitis are limited. Pulmonary vasculitis affects different levels of the pulmonary artery in BD and should be classified as macroscopic and microscopic vascular disease. 'Pulmonary artery thrombosis' should be used instead of 'pulmonary emboli'. Spiral CT angiography is the best radiological tool for evaluation of pulmonary problems in BD. Treatment of vasculitis should be based on the type of vascular disease and may vary among different types of vascular disease. Anticoagulation can be used in patients with microscopic vascular disease and nonaneurysmal macroscopic vascular disease. More studies are needed to clarify this issue.

Massive pulmonary emboli and CT pulmonary angiography.

BACKGROUND: Massive pulmonary embolism (PE) is a devastating form of PE which usually results in acute right ventricular failure and death within 1-2 h. OBJECTIVES: To retrospectively assess pulmonary vascular, cardiac, pleural, and parenchymal findings on CT pulmonary angiography (CTPA) in patients with a diagnosis of massive PE (systolic blood pressure <90 mm Hg, syncope and/or shock). METHODS: In 33 consecutive patients with proven massive PE, hemodynamic severity was assessed by the extent of right ventricular dysfunction (RVD); diameter of the main pulmonary artery; the shape of the interventricular septum; and the extent of obstruction to the pulmonary arterial circulation (CT obstruction index). RESULTS: Central pulmonary arteries were embolized in all patients. RVD was detected in all patients (94% of them had severe RVD); the diameter of the main pulmonary artery was wider than normal in 76% of the patients; the shape of the interventricular septum was abnormal in all patients, and the CT obstruction index was higher than or equal to 50% in 85% of the patients. Wedge-shaped pleural-based consolidation was the most common parenchymal abnormality (36%). Pleural effusions were seen in 26 patients (79%). Twenty-eight patients were alive, and only the use of thrombolytic therapy was found to be statistically significant. CONCLUSIONS: In patients with acute massive PE, embolization of the central pulmonary arteries, RVD and displacement of the interventricular septum are commonly seen with CTPA. A CT obstruction index of >50% is commonly observed in massive PE. There was no association between CTPA findings and survival.

Isolated pleural and pericardial effusion in a patient with ankylosing spondylitis.

Ankylosing spondylitis (AS) is a chronic seronegative spondyloarthritis with the major histocompatibility antigen HLA B27. Pulmonary involvement in AS is rare and is usually in the form of upper lobe fibrocavitary disease. Herein, we present a case with recurrent pleural and pericardial effusion without apical fibrobullous disease who responded to prednisolone treatment well. It is believed that this is the first case report complicating AS without parenchymal involvement in the literature.

An increase of BNP levels in massive pulmonary embolism and the reduction in response to the acute treatment.

Type B Natriuretic Peptide (BNP) is a neurohormone that is secreted from the cardiac ventricles in response to dilatation or an increase of pressure. Right ventricle dysfunction is seen in pulmonary embolism patients, but it may be hard to diagnose. Echocardiography is the most sensitive means of diagnosis for acute right ventricle dysfunction. However, echocardiography is also limited in some ways. BNP levels may increase with right ventricle dysfunction when the patients is in bed and decrease with treatment. We presented a case study in which diagnosed with mitral valve regurgitation, pulmonary embolism and pregnant for 1.5 months. Initial BNP levels of 633 pg/ml decreased to 233, 65.2, 58.4 levels respectively which was parallel to improvements in the clinical state and right ventricle function detected in echocardiography. We used a rapid bedside test for determination of BNP.

The prevalence of clubbing in different types of lung cancer.

BACKGROUND: The aim of the study was to determine the relative frequency of digital clubbing in small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC), and to find out whether there is a gender predominance in the frequency of clubbing. PATIENTS AND METHODS: The study was a single center prospective study conducted at the Pulmonary Medicine Department in a university hospital. Between January 1988 and December 1998, 738 patients with histopathologic diagnoses of SCLC or NSCLC were enrolled. Twenty-six patients with a diagnosis of in differentiated lung cancer were excluded. RESULTS: Clubbing was present in 128 (17.3%) of the 738 patients and was detected in 17.5% of patients with NSCLC vs. 16.7% of patients with SCLC (chi(2) test, P>0.05), and it was more common in males (18.6%) than in females (4.4%, Fisher's exact test, chi(2)=8.74, P<0.01). CONCLUSION: The incidence of clubbing was similar in both SCLC and NSCLC patients, which is inconsistent with classical knowledge in the literature, and digital clubbing was significantly more common in males than in females with lung cancer.

[Clinical features of non-small cell lung cancer cases]. / Küçük hücreli disi akciger kanserli hastalarin klinik özellikleri.

The aim of this study was to evaluate the clinical features of non-small cell lung cancer (NSCLC) cases that were diagnosed in our clinic. The patients who were diagnosed as NSCLC in our clinic between January 1988 and January 1999 were comprised the study group. The files and records of the study group were retrospectively reviewed to identify patients and all the data including demographic characteristics, history, physical examination findings, laboratory values, diagnostic procedures, radiologic findings and staging procedures. The study group included 564 patients (506 male, 58 female). The mean age was 60 years (28-97). 87% of the patients were current smokers or ex-smokers. The most frequent symptoms on admission were cough, sputum, and dyspnea. The most common radiologic finding was a central mass with a diameter of more than 4 cm with an irregular border. The diagnosis was established by histopathologic examination of biopsy specimens obtained by various means, in which bronchoscopy was the sole means of diagnosis in 83% of the patients. Histopathologic examination of the biopsy specimens resulted as follows: 85.8% squamous cell carcinoma, 10.3% adenocarcinoma, 1.4% large cell carcinoma, 0.45% adenosquamous carcinoma, and 2.1% undifferentiated NSCLC. Staging procedures that were done in all patients revealed that 85% of the patients were diagnosed at the stage IIIB and IV. Metastasis was most frequently to the bones followed by brain and liver. In our study squamous cell carcinoma was the most common histopathologic type with a higher percentage than the previous reports in the literature. The percentages of stage IIIB and IV were also higher in our study than previous papers in the literature.

[Correlation of serum IgE levels with severity of acute pulmonary thromboembolism]. / Akut pulmoner tromboembolizmin agirligi ile serum IgE düzeylerinin korelasyonu.

UNLABELLED: We aimed to investigate whether there is a direct correlation of serum IgE concentration with severity of acute pulmonary thromboembolism (PTE). DESIGN: Prospective study. SETTINGS: University medical center. Forty-six patients (27 female, 19 male) who were diagnosed as acute PTE in our clinic between 01 October 2000 and 30 November 2001 comprised the study group. Mean age was 55 (range was 20-82). The study group was divided into three groups according to severity of PTE: Group A, submassive PTE without pulmonary infarction (20 patients); group B, submassive PTE with pulmonary infarction (15 patients); and group C, massive PTE (11 patients). Serum IgE concentrations were measured by ELISA method at 1st, 5th, 15th, 30th, 60th, 90th days, and 120th days, if needed, after the diagnosis. Statistical analysis was made by Post hoc Tukey test. First day serum IgE levels were highest in group B (mean 507.7) followed by group C (mean 324.2), and were lowest in group A (mean 117.2). The differences between group B and group C, between group B and group A, and also between group C and A were all statistically significant (p< 0.5, p< 0.0001, p< 0.015, respectively). 5th day and 15th day results showed statistically significant differences between group B and A, and between group C and A (at 5th day: p<0.0001, p< 0.015 respectively, and at 15th day: p< 0.0001, p< 0.012 respectively). At 30th, 60th, and 90th days of diagnosis serum IgE concentrations were higher in group B than in group A which were statistically significant (p< 0.0001, p< 0.0001, p< 0.019 respectively). Patients with submassive PTE and pulmonary infarction had the highest serum IgE concentrations and the longest duration of high levels of IgE.

An unusual cause of precordial chest pain.

Extraskeletal chondrosarcoma in anterior mediastinum is very rare. A 45-year-old male patient was admitted to the hospital with precordial chest pain. A large and well-shaped mass in the anterior mediastinum was seen radiologically, and there was a clearly compression of the heart by the mass. The lesion was totally resected, and extraskeletal mediastinal chondrosarcoma was histopathologically diagnosed. We aimed to present and discuss the radiologic, clinic, and histopathologic features of unusual presentation of extraskeletal chondrosarcoma in a case.

A very rare cause of pleuritic chest pain: bilateral pleuritis as a first sign of familial mediterranean Fever.

The familial Mediterranean fever (FMF), also called recurrent polyserositis, is characterized by reccurrent episodes of serositis at pleura, peritoneum, and synovial membrane and fever. We present a patient with recurrent bilateral pleural effusion due to serositis attacks as a first sign of FMF. A 59-year-old Turkish man suffered from recurrent pleuritic chest pain due to pleural effusion and atelectasis. The etiology was not found, and his symptoms were spontaneously recovered during several weeks. The pleuritic chest pain was associated with abdominal pain in the last attack. The gene mutation analysis revealed the homozygosity of FMF (F479L) gene mutation in both our patient and his grandchild. After the colchicine treatment, the attack has not developed. In conclusion, recurrent pleural effusion and pleuritic chest pain may be the first signs of the FMF.

Percutaneous cavitary lavage in the diagnosis of pulmonary cavities.

OBJECTIVE: To investigate diagnostic significance of percutaneous cavitary lavage (PCL) in differential diagnosis of benign and malignant pulmonary cavitary lesions. METHODS: An alternative diagnostic method called PCL was performed on 16 patients having peripherally located pulmonary cavitary lesions with thin walls which were not suitable for tissue biopsy and whose diagnosis could not be made by sputum examination and bronchoscopic procedures. A 22-gauge needle was inserted into the cavity under computed tomography (CT) guidance. Saline was injected through the needle and then aspirated. The specimen was examined cytologically and microbiologically. RESULTS: PCL could make a correct diagnosis in 12 of 16 patients (75%). In three patients (18.7%) appropriate specimen could not be taken. Diagnostic sensitivity and specificity of PCL for malignant-benign differentiation was 80% and 100%, respectively. The accuracy of PCL for this differentiation was 92.3%. There was only one complication, a small pneumothorax resolved without any intervention. CONCLUSIONS: PCL is an alternative method in the differential diagnosis of thin walled pulmonary cavitary lesions especially for patients whose diagnosis could not be made by sputum and bronchoscopic procedures and who are not suitable for cutting needle biopsy.

Diagnostic efficacy of computed tomography-guided transthoracic needle aspiration and biopsy in patients with pulmonary disease.

BACKGROUND: Computed tomography-guided transthoracic needle aspiration (TTNA) and biopsy (TTNB) is a well established, safe, and rapid method of reaching a definitive diagnosis for most thoracic lesions. The present study aimed to determine the roles of TTNA and TTNB in the diagnosis of pulmonary diseases and to compare the results using these two techniques. METHODS: TTNB and TTNA were performed in 105 patients admitted to our clinic due to peripheral pulmonary lesions between May 2005 and November 2007. Needle biopsies were performed using 18-gauge Tru-Cut® biopsy needles and aspirations was performed using 18-20-22-gauge Chiba needles. RESULTS: Malignant lesions diagnosed by TTNB were non-small cell lung carcinoma (51 patients, 73%), small cell lung carcinoma (nine patients, 13%), malignant tissue (three patients, 5%), lymphoma (two patients, 3%), thymoma (two patients, 3%), plasmacytoma (one patient, 1%), rhabdomyosarcoma (one patient, 1%), and metastasis (one patient, 1%). The malignant lesions diagnosed by TTNA were non-small cell lung carcinoma in eleven patients (92%) and malignant tissue in one patient (8%). Three (100%) of the benign lesions diagnosed by TTNB were granulomas and two (100%) benign lesions diagnosed by TTNA were infarctions. When the diagnostic value of TTNB and TTNA was compared, TTNB was significantly superior. Malignant lesions were identified in 70 (84%) and benign lesions were identified in three (4%) of the 83 patients in the TTNB group. Ten (12%) patients in the TTNB group could not be diagnosed. Malignant lesions were found in 12 (55%) and benign lesions were found in two (9%) of the 22 patients in the TTNA group. Negative results were obtained in eight (36%) patients. The diagnostic sensitivity, specificity, and accuracy of TTNB was calculated to be 92%, 100%, and 93%, respectively (Table 5). The diagnostic sensitivity, specificity, and accuracy of TTNA was 78%, 100%, and 82%, respectively. TTNB had a sensitivity of 92% (70/76) in malignant cases and 100% (3/3) in benign cases, while the sensitivity of TTNA in malignant and benign cases was 75% (3/4) and 67% (2/3), respectively. CONCLUSION: TTNB is a safe and easy procedure which provides a highly accurate diagnosis of benign and malignant lung lesions without causing a significant increase in complication rates.

Long-term survival rates of patients with stage IIIB and IV non-small cell lung cancer treated with cisplatin plus vinorelbine or gemcitabine.

Limited data exist concerning the long-term (≥5 year) survival rates of patients with stage IIIB and IV non-small cell lung carcinoma (NSCLC) receiving chemotherapy. We aimed to determine the long-term results of cisplatin plus third-generation (vinorelbine or gemcitabine) cytotoxic chemotherapy in patients with locally advanced and advanced NSCLC. The study included 141 patients, and all patients were followed up from the time of diagnosis until death. The median age of the patients was 59.1±9.9 years. The male-to-female ratio was 124/17; 62.4% of the patients had stage IIIB and 37.6% had stage IV NSCLC. Squamous cell carcinoma, adenocarcinoma and undifferentiated NSCLC subtypes accounted for 69.5, 17.7 and 12.7% of the cases, respectively. The overall response rate was 32.6% and the median survival time was 12.3 months (95% CI, 10.2-14.5). The median survival times for stages IIIB and IV were 12.6±1.4 and 11.9±1.7 months, respectively. The 1-, 2-, 3- and 5-year survival rates were 33, 7.5, 4.3 and 2.8%, respectively. In conclusion, cisplatin-based new-generation cytotoxic agents for combined modality therapy offer an increased hope of long-term survival for patients with locally advanced and advanced NSCLC.

Right sided arcus aorta as a cause of dyspnea and chronic cough.

BACKGROUND: Right sided arcus aorta (RSAA) is a rare condition that is usually asymptomatic. Patients may present with exertional dyspnea and chronic cough. A recent article suggested that RSAA should be included in the differential diagnosis of asthma, especially in patients with intractable exertional dyspnea. We aimed to present the clinical, radiologic and spirometric features of thirteen patients with RSAA observed in four years at the Rize Education and Research Hospital and Samsun Chest Diseases and Thoracic Surgery Hospital. METHODS: The characteristics of patients with RSAA, including age, gender, symptoms, radiologic and spirometric findings, were retrospectively evaluated. RESULTS: A total of thirteen patients were diagnosed with RSAA. Their ages ranged from 17 to 86 years and the male to female ratio was 11:2. Seven of the patients (54%) were symptomatic. The most common symptoms were exertional dyspnea, dysphagia and chronic cough. Five patients had received treatment for asthma with bronchodilators. Spirometry showed intrathoracic tracheal obstruction in five patients. CONCLUSIONS: The RSAA anomaly occurs more frequently than might be estimated from the number of patients who are detected. Patients with intractable exertional dyspnea and chronic cough should be evaluated for the RSAA anomaly by thoracic CT.

Endobronchial tuberculosis: histopathological subsets and microbiological results.

BACKGROUND: Endobronchial tuberculosis (EBTB) is defined as a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence, with or without parenchymal involvement. Bronchoscopic appearances of EBTB have been divided into seven subtypes: actively caseating, edematous-hyperemic, fibrostenotic, tumorous, granular, ulcerative, and nonspecific bronchitic. However, information for establishing a definite microbiological diagnosis in each of these categories is lacking.We aimed to present bronchoscopic appearances and percentages for the EBTB subtypes and to compare bronchoscopic appearances with microbiological positivity in bronchial lavage fluid. METHODS: From 2003 to 2009, 23 biopsy-proven EBTB patients were enrolled in the study. Diagnosis of EBTB was histopathologically confirmed in all patients. RESULTS: The commonest subtype was the edematous-hyperemic type (34.7%); other subtypes in order of occurrence were: tumorous (21.7%), granular (17.3%), actively caseating (17.3%), fibrostenotic (4.3%), and nonspecific bronchitic (4.3%). Although all patients were sputum-smear-negative for acid-fast bacilli (AFB), 26% of patients were smear-positive for AFB in the bronchial lavage fluid. The bronchial lavage fluid grew Mycobacterium tuberculosis in 39.1% of all patients.The bronchial lavage smear positivity for AFB in the bronchial lavage fluid was 75%, 25%, 20%, 12.5%, 0%, and 0% for the granular, actively caseating, tumorous, edematous-hyperemic, fibrostenotic, and nonspecific bronchitic subtypes of EBTB, respectively. Culture positivity for Mycobacterium tuberculosis in bronchial lavage fluid was 75%, 50%, 40%, 25%, 0%, and 0%, respectively. CONCLUSION: The commonest subtype of EBTB was the edematous-hyperemic subtype. The granular type had the highest smear positivity and culture positivity for Mycobacterium tuberculosis in bronchial lavage fluid. Bronchoscopy should be performed in all patients suspected to have EBTB.

Tracheal bronchus in the adult population.

BACKGROUND: Tracheal bronchus is an abnormal bronchus that comes directly off the lateral wall of the trachea (ie, above the main carina) and supplies ventilation to the upper lobe. A new nomenclature and classification system has been developed for tracheal bronchus. The purpose of this study was to evaluate the anatomic and bronchoscopic features of tracheal bronchus subtypes on the basis of the new nomenclature and classification system. METHODS: A retrospective study was performed using data from eight patients with tracheal bronchus. RESULTS: The incidence of tracheal bronchus was found to be 0.06% (8 of 12,648 patients) and the distribution of the subtypes was as follows: displaced type (7 patients, 87.5%) and supernumerary type (1 patient, 12.5%). Among the patients with displaced tracheal bronchus, 6 had displaced preeparterial (75%), 1 had displaced preeparterial and posteparterial tracheal bronchus (12.5%), and 1 patient had supernumerary eparterial tracheal bronchus (12.5%). In all cases, the tracheal bronchi were located on the right side of the trachea. The mean distance between the origin of the tracheal bronchus and main carina was 16.25 mm (range, 5 to 40 mm). In 1 case, posteparterial bronchus was detected with its orifice on the lateral side of the intermediate bronchus. CONCLUSIONS: Displaced preeparterial tracheal bronchus was the most common subtype of tracheal bronchus. Furthermore, in all cases, tracheal bronchus was located on the right side of the trachea. Both flexible bronchoscopy and computed tomography of the chest were crucial for its diagnosis.

The costs of hospitalization in patients with acute exacerbation of chronic obstructive pulmonary disease.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a major public health problem. It imparts a substantial economic burden on individuals and society. Acute exacerbations are the main cause of hospital admissions and hospitalizations in patients with COPD in Turkey. OBJECTIVES: We aimed to determine the costs of hospitalization in patients with acute exacerbations of COPD (AECOPD). RESULTS: A total of 7832 (1556 women, 6276 men) patients were hospitalized due to acute exacerbations of COPD between 2005-2009 in the Samsun Chest Diseases and Thoracic Surgery Hospital, northern Turkey. The mean age was 64.6 ± 19.8 years old and median length of hospital stay was 14.8 ± 9.5 days. The mean cost per admission was US$718 ± 364. Drug costs accounted for the largest portion (53.5%) of the mean cost, followed by bed cost (19.6%). One hundred seventy-four (2.2%) of the total hospitalized patients with AECOPD died in hospital. CONCLUSION: AECOPD continues to have both significant economic burden and high mortality rate.