NLS AND rADIoLoGIc exAmINAtIoN metHoDS IN DIAGNoStIcS oF Acute puruLeNt AbSceSSeS oF LuNGS

S.N. makarova
Urgency of diagnostics and treatment of acute purulent abscesses of lungs issue is determined by prevalence and severity of this pathology. Acute purulent abscesses of lungs (APAL) are a part of diseases usually called purulo-destructive diseases of lungs (PDDL). Gangrenous abscess, pulmonary gangrene and pleural empyema are also included into this group. In our country number of patients with abscesses, pulmonary gangrene and pleural empyema has upward tendency. It is the result of late diagnostics and hospitalization, inadequate therapy of pneumonia. In spite of treatment methods improvement, mortality at PDDL remains rather high and may reach 70%. In more that one third of patients transition from acute process to chronic is registered. Lethality at acute abscesses of lungs ranges from 7.2% to 28.3%; at gangrenous processes from 23.4% to 74.1%. Due to this fact well-timed and accurate diagnostics of disease gains significant practical importance; results of such diagnostics are the basis of patients treatment tactics choosing. mAterIAL AND metHoDS oF reSeArcH We monitored 48 patients suffering from acute purulent abscesses of lungs; they were divided into three groups: the first group 20 patients, subjected to standard treatment, including sanation bronchoscopy; the second group 15 patients, subjected to endoscopic drainage of abscess; the third group 13 patients, subjected to immunomodulators injection into abscess cavity after drainage. In its turn every group was divided into two subgroups taking into account the most probable pathogenetic mechanism of abscess development postpneumonic and aspiration abscesses. NLS-research of breast was carried out with Metatron-4025 system, manufactured by the Institute of Practical Psychophysics, equipped with digital trigger sensors of 4.9 GHz and unit of continuous spiral scanning. Radiologic investigation of breast organs was performed with apparatus manufactured by Philips. We applied both radiography of frontal and lateral projection and, if necessary, tomographic imaging. reSuLtS oF tHe StuDy AND DIScuSSIoN As a result of the study we described four phases of acute purulent abscesses of lungs, which correspond to clinical phases of disease and characterized by a number of radiological and NLS-graphic signs. Lung tissue destruction phase was characterized by presence of shadows with heterogeneous intensity with indistinct external outlines at radiographs, which is the result of lung tissue destruction process and marked perifocal infiltration. NLS-examination detected lung tissue with heterogeneous structure, in which, with hypochromic background, hyperchromic (6 points according to Fleindlers scale) areas were detected; they appeared due to liquid (pus) presence. Outlines of a nidus were indistinct.

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3D computer NLS-graphy
Capsule forming phase was characterized by presence of cavity with evident capsule, with rather high amount of liquid in it, perifocal infiltration of lung tissue. NLS-examination detected marked hyperchromogenic liquid neoplasm with homogeneous content (if process of lung tissue dissolution was completed). If there in abscess cavity sequestrum of lung tissue remained, NLS-examination showed them as moderately chromogenic (4 5 points) inclusions, which tessellated a nidus. Capsule was visualized as hypochromogenic tunics delimiting cavity from surrounding lung tissue. At radiographs abscess breaking phase was characterized decreasing of abscess cavity size and liquid content in it. NLSpicture was also characterized by decreasing of abscess cavity size, shape of which became irregular and contained small amount of liquid (hyperchromogenic areas). Capsule was visualized partially. In case of complete recovery, discharging phase was characterized by complete obliteration of cavity and forming linear or stellate scar on the place of abscess and resorption of perifocal infiltration. NLS-examination registered decreasing of nidus size, its filling with fibrin (hypochromogenic areas). With hypochromogenic background we detected small hyperchromic areas, appeared in result of small amount of liquid presence. Nidus outlines again became indistinct, capsule was not visualized.

Survey radiograph of patients chest with abscess of inferior lobe or left lung oval cavity with liquid is detected in left lung

NLS-graphy of lung. Abscess with liquid on the left

cquired results prove that acute purulent abscesses of lungs most frequently develop in right lung, localizing mainly in upper or lower lobe. We registered prevalence of process development in gravi-dependent segments S2, S6 and S10. This data relates to aspiration abscesses, at the same time postpneumonic abscesses may be detected in almost any part of lungs. As analysis of presented data proves, separation of disease phases that we offered allows to register certain differences between aspiration and postpneumonic acute purulent lung abscesses. At aspiration abscesses we registered

capsule forming phase more often, at postpneumonic abscesses destruction phase. Abscess sizes ranged from 2 to 8 cm. At aspiration abscesses we detected nidi of 4 6 cm, at postpneumonic abscesses of 2 4 cm. Therefore separation of four phases of acute purulent lung abscesses according to NLS-graphic signs seems to be reasonable. Completing of traditional radiologic examination make possible to study pathologic nidus structure in details; combined evaluation of radiologic and NLS-examinations results may be a basis for patient treatment tactics choosing.

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