Free air in the mediastinum without any trauma is called spontaneous mediastinal emphysema. It is a self limiting benign disease which usually seen in young adults and recurrence is very rare. Altough it has many etiologies, structurial lung diseases, intense physical avtivity and Valsalva maneuver are the most common ones. But Raynaud's phenomenon and the spontaneous mediastinal emphysema co-occurrence is very rare in the literature. In this article we present a recurrent spontaneous mediastinal emphysema in a 21 years old male patient who has Raynaud's phenomenon for two years.

Chronic eosinophilic pneumonia is a rare type of eosinophilic pneumonia that gives excellent response to steroid treatment, however the probability of relaps is high when the treatment is stopped early. A steroid treatment of 1-3 years is usually sufficient, however, a life-long steroid treatment may be required in some cases. In this article, we present a case of chronic eosinophilic pneumonia, which was diagnosed to have eosinophilic pneumonia in another center and relapsed however after stopping the treatment early to emphasize the importance of the duration of steroid treatment.

Aim: To emphasize the importance of atypical paranchymal radiological findings of the sarkoidosis.Material and methods: The sarcoidosis patients, which were histopathologically diagnosed between 2002-2007, were examined retrospectively.Results: There were 34 patients, diagnosed as sarcoidosis between 2002- 2007. In six of these 34 patients (17.6%) atypical paranchymal findings were determined. Two patients were female (33%), four patients were male (66%) and mean ages were 30.5 +/- 10.1. The most frequent complaints were dyspnea and fatigue. The determined atypical radiological findings were as follows: bilateral pleural effusion, solitary pulmonary nodule 2.5 centimeters in diameters, bilateral patchy consolidations involving air bronchograms (alveoler sarcoidosis) (one patient), diffuse ground-glass appereance (one patient), diffuse mosaic perfusion defect (one patient) and alveoler sarcoidosis (three patients).Conclusion: The atypical paranchymal radiological findings of the sarcoidosis, which is also named as "great masquerader" in the literature, are various. These findings can be seen in approximately 20% of the patients in clinical practice. Therefore, keeping in mind the atypical radiological findings of sarcoidosis can provide early diagnosis and treatment.

A total of 34 patients with sarcoidosis diagnosed and followed-up between 2002 and 2007 were retrospectively investigated. Of the patients 9 (26.4%) were female and 25 (73.5%) were male. The most common complaints were dyspnea (58.8%), cough (47.1%) and chest pain (29%). Of all the patients 8 (23.5%) were in stage I, 23 (67.6%) in stage II and 3 (8.8%) in stage III. Eighteen patients (52.9%), 9 patients (26.4%), 4 patients (11.7%), 2 patients (5.8%) and one patient (2.9%) were diagnosed with transbronchial lung biopsy, mediastinoscopy and lymph node biopsy, transbronchial needle aspiration biopsy, open lung biopsy, and clinically, respectively. Erythema nodosum in 4 patients (11.7%), nephrolithiasis in 3 patients (8.82%), liver involvement in 1 patient (2.94%) and ocular involvement in 1 patient (2.94%) were detected as extrapulmoner manifestations. Atypical parenchymal radiological findings were detected in 6 (17.6%) of the patients, and the indication of systemic steroid treatment was determined in 18 (52.9%) of the patients. Our results in patients with sarcoidosis were in accordance with the literature findings, most of the patients were diagnosed with transbronchial lung biopsy and mediastinoscopy, and atypical radiological findings were detected in a significant extent.

Aim: We planned this study to determine the diagnostic yield of serum matrix metalloproteinase-9 (MMP-9) levels in the pulmonary tuberculosis (TB) patients.Methods: Twenty four pulmonary TB patients, who were hosptalized in our clinic between August 2005 and March 2006. As control groups were enrolled into this study. Group consisting of twenty four community acquried pneumonia (CAP) patients and another group consisting of twenty four healthy people were also included into the study. MMP-9 measured by ELISA method in the serums of all patients.Results: When we compared 3 groups in terms of serum MMP-9 levels, we noticed that there was a statistically significant difference between the three groups (p=0.001). In pulmonary TB patients, serum MMP-9 level were statistically lower than that in healthy control group (p=0.009). There was no difference between CAP and pulmonary TB patients.Conclusion: Our results suggest that, in active pulmonary TB patients serum MMP-9 levels might be lower than that in the healthy people. Since the difference was statistically significant, our results also suggest that serum MMP-9 levels may have some contribution to the diagnosis of pulmonary TB. On the other hand, it seems MMP-9 have no diagnostic value in distinguishing CAP, leading cause of the differential diagnosis, from pulmonary TB.