The «bronchiolitis» unites a heterogeneous group of diseases of inflammatory nature, the anatomical substrate of which are Airways without cartilage wall-bronchioles. Despite the etiological diversity of bronchiolitis, pathomorphological they manifest a certain set of changes in the lung tissue. This determines the similarity of visualization of different types of bronchiolitis during computed tomography of the chest. The key to successful diagnosis of bronchiolitis is a clear understanding of the definition of this pathology and a comprehensive analysis by a Clinician of anamnestic, clinical, laboratory and radiological data. In this article, we will consider three types of cellular bronchiolitis, which are combined by imaging on computed tomography of the chest pattern «tree in the kidneys»: infectious, aspiration bronchiolitis and diffuse panbronchiolitis.
Computed tomography (CT) of chest organs is one of the most accurate diagnostic methods allowing the physician to assess the condition of lung parenchyma. Correct interpretation of CT results requires the clinician to recognize normal appearance of lung parenchyma on X-ray and know changes visualized in various bronchopulmonary diseases. It is important that the physician knows and understands underlying cause of a particular radiological pattern in order to discuss with the radiologist lung tissue changes that have been identified considering clinical symptoms. Descriptions of radiological patterns and discussion of corresponding typical clinical observations are presented in the article devoted to air cyst syndrome and cystoid changes in the lung tissue.
Nontyphoid Salmonella are gram-negative bacteria that induce Th1-mediated immunity. They rarely lead to a generalized infection, primarily developing in immunocompromised patients with cellular immunity defects. Septic pulmonary embolism is also a rare condition in which emboli contain microorganisms from extrapulmonary infective foci. The article presents a rare clinical case of a patient with pulmonary embolism and generalized nontyphoid salmonellosis due to the presence of Asp299Gly and Thr399Ile genetic polymorphisms in the TLR4 gene. Such a defect of cell-mediated immunity was a trigger for destructive changes in the lung parenchyma, prothrombotic state, and generalization of the infectious process.
Рассмотрен клинический случай развития тромбоэмболии легочной артерии (ТЭЛА) у 65-летнего пациента с частыми обострениями ХОБЛ.Трудность постановки диагноза была обусловлена неспецифичностью клинических симптомов, которые могли соответствовать как ТЭЛА, так и обострению хронической обструктивной болезни легких (ХОБЛ) на фоне инфекционного заболевания и развития пневмонии. Отсутствие специфичных для ТЭЛА изменений при проведении рентгенологического исследования органов грудной клетки также затрудняло постановку правильного диагноза. В статье обсуждаются проблемы, с которыми сталкиваются клиницисты при постановке диагноза ТЭЛА на фоне обострения ХОБЛ.
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И. М. Сеченова» МЗ РФ (Сеченовский университет), г. Москва, РФ 2 ФБУЗ «НПЦ Медицинской радиологии ДЗ г. Москвы», г. Москва, РФ 3 ФГБОУ ВО «РНИМ У им. Н. И. Пирогова» МЗ РФ, Москва, РФ Представлен случай заболевания лангергансоклеточным гистиоцитозом с поражением легких и плоских костей у мужчины 40 лет, курильщика. Прослежены все фазы заболевания на протяжении 4 лет. Диагноз поставлен по результатам торакоскопической биопсии легких. Лечение цитостатиком на фоне отказа от курения дало положительный клинико-рентгенологический эффект.
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