Pulmonary embolism in combination with a reversible and irreversible airflow obstruction
Pulmonary thromboembolism, combined with bronchial obstruction is the most difficult in the diagnosis, because it can be presented as a combination of unventilated and not perfused areas and this disorders can occur in the acute phase of embolism, and also in long-term period after the onset. Aim: To evaluate influence of different disorders of blood circulation in the lungs on the development of bronchial obstruction in patients with different forms of PE. Material and Methods: We analyzed of the results of radiological methods: perfusion scintigraphy, single photon emission computed tomography using the combined technology (SPECT-CT) and multislice computed tomography - high-resolution computed tomography (VRKT), functional tests, multislice computed tomography angiography (MSCTA) in 250 patients (without concomitant pathology of bronchopulmonary system) suspicious of pulmonary embolism. Results and conclusions: Bronchoconstriction in patients with pulmonary embolism of small branches pulmonary artery increases severity of the disease. Analyzing the patients data we founded out that distinct clinical effect was achieved only with additional treatment with bronchodilators. In chronic course of the pulmonary embolism development of emphysema was detected, at first local - in ischemic segments, then involving the adjacent lung regions. In this case, the severity of the disease is caused not by embolism itself, but also because of development of persistent bronchial obstruction. These changes are considered as «postembolic pulmonary disease», and determine severity of perfusion and ventilation dysfunction.