The capabilities of computed tomography in diagnosis of purulent destructive lung diseases
Objective: To determine and specify the character of computed tomography signs of purulent destructive lung diseases. Material and Methods: CT findings of the investigation of chest organs were analyzed in 26 patients aged 18-78 with purulent destructive lung diseases (abscess and gangrene). The diagnosis was verified using clinical laboratory examination, instrumental studies (bronchoscopy), disease dynamics. Results: Computed tomography signs of abscesses and gangrene were specified. Non-drained acute abscesses in 19.2% (5 cases) were similar to the initial phase of infiltration and necrosis of infection destruction. The phase of forming was similar to spherical pneumonia, looked like one or several infiltrations of high optic density with homogeneous structure measuring 5-10 cm. This was followed by development of one or several cavities in the area of the infiltration. After draining of acute abscesses (61.5 %) axial sections demonstrated a spherical cavity, gas and fluid levels were typical. The most frequent were abscesses 6 cm in the diameter (6 persons, 37.6%). A characteristic sign of gangrenous abscess was visualization of sequestration in its cavity, which was present in 3 patients (18.8 %). In gangrene (3.8 %), the cavities formed by means of merging of separate zones of fusion. Unfavorable dynamics and CT manifestations allowed differentiation of gangrene and gangrenous abscess, the changes were characterized by enlargement of the cavities, involvement of new areas of the lungs, development of new large sequestrations. The abscess was complicated by pleurisy, empyema of the pleura, and formation of pulmonary pleural fistulas. In 15.4% of cases chromic abscesses were characterized by thick-wall destruction cavities, subpleural location and diminishing of the volume of the involved lung area. Conclusion: Simultaneous use of traditional radiography and CT increased the efficacy of the diagnosis and allowed to limit the use of invasive methods of investigation. Computed tomography of purulent destructive lung diseases allows timely diagnosis and differential diagnosis using characteristic signs in some cases.