MATERIALS AND METHODS. Preliminary clinical and morphological analysis of a group of patients with various post-COVID complications and with surgical treatment was performed. For the period 2020-2021 in the clinic of thoracic surgery of the SI “National institute of phthisiology and pulmonology named after F.G. Yanovsky of the NAMS of Ukraine” 12 patients were treated who had coronavirus disease (COVID-19) in anamnesis and underwent surgery for COVID-19 complications. RESULTS AND DISCUSSION. Data on the type of surgery, X-ray conclusion and preliminary clinical diagnoses of patients with post-COVID pulmonary complications are presented. At the time of surgical treatment, according to clinical data, 4 (22.2 %) patients were diagnosed with lung abscess, 4 (22.2 %) patients had a disseminated process in the lungs of unclear origin, 2 (11.0 %) – a solitary formation of the lung, one (5.5 %, respectively) observation – spontaneous pneumothorax and suspected tumor of the lung. The results of the histopathological conclusion on the operative material and the final clinical diagnosis in the group of patients with atypical lung lesions after COVID-19 are presented. The results of histopathological examination showed that after 3 months and more after recovery from COVID-19 in some patients there are persistent pathological changes in lung tissue of various characters, and quantitatively among them prevail cases of various pathologies associated with damage to the vascular bed of the lungs. CONCLUSIONS. In most cases of pulmonary complications after suffering COVID-19, preliminary clinical diagnoses did not fully correspond to the identified pathological process. Morphological examination of the operative material of patients with a history of COVID-19 and postcocious complications associated with the lungs, found that vascular pulmonary pathology predominates: persistent microvasculitis of small blood vessels, pulmonary infarction, metacarpal metaplasia, secondary vascular malformation.
Objective — to analyze the diagnostic possibilities of histological examination of single necrotized focal lung lesions by determining their histological features and etiology. Materials and methods. The study was conducted as a cohort, retrospective. The group included 68 patients with solitary focal lesions of the lungs (from 1 to 3), the size of each focus did not exceed 3 cm. The size, shape and contours of the detected foci were evaluated based on the results of radiographs or tomograms. Morphological diagnostics included cytological and histological examination. The results of microbiological examination of operative material for the presence of mycobacteria and non-specific microorganisms, the results of molecular genetic analysis for the presence of tuberculosis mycobacteria must be taken into account; as well as a number of indicators of clinical-biochemical and immunological studies of biological fluids, clinical data as needed. Histological findings, preliminary and final clinical diagnoses were compared. Results and discussion. According to the results of X-ray analysis and traditional histological examination, a number of signs of solitary necrotic foci-nodules were identified and compared with the results of histochemical, microbiological and molecular genetics examination. It was established that solitary necrotic nodules (78.0 %), larger than 1 cm (81.0 %) of irregular shape predominate. In two-thirds of cases (62.0 %), a granulomatous process was observed, and namely in these cases mycobacteria were detected during microbiological examination. Also, only in cases of histological diagnosis of caseous necrosis or necrosis of mixed type, positive results of microbiological examination for the presence of MBT were obtained. Final histological conclusions with an accurate formulation of the pathological process were obtained in 88.2 %, while the etiology was established in 85.3 % of cases. The final clinical diagnoses had differences compared to the histological conclusions because they have a different formulation principle. Conclusions. A complex histological study in combination with microbiological and molecular genetic studies plays a decisive role in establishing of the etiology of solitary necrotic pulmonary foci. According to the results of our work, the dominated etiology of nodules was foci as a result of limited disturbances in the pulmonary blood circulation system (infarcts and focal thrombus, infarct pneumonia), tuberculous and fungal nature. The overall diagnostic efficiency of morphological diagnostics was 85.3 %.
BACKGROUND. At present radiological criteria for diagnosis of viral pneumonia associated with SARS-CoV-2 have been defined. However, with the further course of the pandemic, physicians began to observe more and more often destructive processes developing in the lungs of patients with non-hospital pneumonia of viral etiology (COVID-19). Due to the development of surgical complications (pneumothorax, pneumomediastinum, vanishing lung syndrome) the question of their differential diagnostics with purulent-destructive lung diseases became actual. OBJECTIVE. To show the possibilities of differential diagnostics of infectious lung destruction (ILD) with cyst-like changes in the lungs at COVID-19 using clinical examples and data of computed tomography (CT) scan of the chest and pathomorphological study. MATERIALS AND METHODS. CT of the patients with ILD (lung abscess) and 90 patients with non-hospital pneumonia of viral etiology (COVID-19), who were treated in the National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine were analyzed. RESULTS AND DISCUSSION. There were analyzed 90 CT scans of the whole body of patients with non-hospital pneumonia of viral etiology (COVID-19); among them 27 cases (15 male and 12 female, aged from 23 to 78 years) with radiological signs of vanishing lung syndrome were revealed, which made 30 % of all patients with a complicated course of the disease. Chest CT findings and pathomorphologic findings in cyst-like changes in patients with COVID-19 were compared with those in patients treated for lung abscess. CONCLUSIONS. Clinical picture, pathogenesis and pathomorphological changes of pulmonary parenchyma at ILD differ greatly from non-hospital pneumonia of viral etiology (COVID-19) and form specific changes, which are revealed by chest CT. Necessary development of indications for surgical treatment in vanishing lung syndrome which occurs in patients with complicated course of COVID-19.
The article shows the possibility of applying radiomics in the processing of chest CT data in the diagnosis of pulmonary tuberculosis. Currently, a subjective method based on the knowledge and experience of a radiologist is used to process CT images. A new approach to CT image analysis can fundamentally change the diagnostic process. Its essence is to create mathematical models and computer algorithms that take medical images as input and produce pathophysiological features of tissues.Dragonfly software, provided free of charge by OBYECT RESERCH SYSTEMS (ORS), Montreal, Canada, is used for CT slice analysis, which enables segmentation, mathematical and statistical processing of images, construction of ordinary and segmented histograms. To work with the program, dicom - CT files are transformed into raster files (Tiff, Jpeg, Raw) and further analysis of CT slices is performed by grayscale gradations (behind image pixels, not behind dicom file voxels). It should be emphasized that the grayscale analysis correlates with the Hounsfield units.It has been shown that based on the data of pathomorphological examination of the affected tissue, it is impossible to determine the difference between chemoresistant and susceptible pulmonary tuberculosis.Processing of CT data with the construction of conventional and segmental histograms using Dragonfly software tools makes it possible to identify pathophysiological features of tissues in the diagnosis of sensitive and chemoresistant pulmonary tuberculosis. Further research is needed to identify patterns and differences in the determination of densities in the diagnosis of sensitive and chemoresistant pulmonary tuberculosis.
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