Проблеми діагностики і ведення хворих з округлими тінеутвореннями легень (клінічне спостереження)

Abstract

В статті на конкретному клінічному прикладі продемонстровано проблемність діагностики і ве- дення пацієнтів з округлими тінеутвореннями легеневої локалізації. Зазначено, що за відсутності можливості провести точну бактеріологічну, гістологічну або цитологічну діагностику ідеальним варіантом ведення пацієнтів з округлими тінями в легенях є проведення торакотомії з резекцією уражених ділянок, яка забезпечує не тільки точну діагностику етіології патологічних змін в легенях, а й лікувальний ефект.

В статье на конкретном клиническом примере продемонстрировано проблемность диагностики и ведения пациентов с округлыми тенеобразованиями легочной локализации. Отмечено, что при отсутствии возможности провести точную бактериологическую, гистологическую или цитологическую диагностику идеальным вариантом ведения пациентов с округлыми тенями в легких является проведение торакотомии с резекцией пораженных участков, которая обеспечивает не только точную диагностику этиологии патологических изменений в легких, но и лечебный эффект.

Syndrome of the round shadow in the lungs includes pathological processes that are characterized by the presence of infiltrates of a round shape, with a clear contour and a homogeneous or inhomogeneous structure. There are a large number of pulmonary diseases that are characterized by a similar x-ray pattern. This greatly complicates their differential diagnosis. Most of them are oligosymptomatic or asymptomatic, especially in the early period of their development. Therefore, they are more often detected during x-ray examination of the chest organs. If there is no history and clinical manifestations of the disease, then a disease is almost impossible diagnosed based on only x ray imaging data. In such conditions, first of all think about the most common diseases. The incidence of tuberculosis in Ukraine keeps the character of the epidemic. In the structure of oncological incidence a cancer of lung is on first place in Ukraine. That is why when a round shadow is found in the lungs, one should first think of tuberculosis and lung cancer. Peripheral lung cancer may not have clinical manifestations during 3-5 years. A patient may not have clinical manifestations of tuberculosis until the appearance of the phase of destruction and bacterial excretion. The article on the clinical example shows the problem of diagnosis and management of patients with rounded shadows of pulmonary localization. The patient was gathered detailed medical history, all the necessary diagnostic methods were prescribed: clinical, radiological, laboratory, methods for detecting mycobacterium tuberculosis (bacterioscopic, bacteriological, molecular genetic), endoscopic, histological, cytological, but none of these methods did not confirm the etiology of pathological shadows in the lungs. An accurate diagnosis was established only after diagnostic thoracotomy and histological examination of excised pathological changes in the lungs. The presented clinical case clearly demonstrates the problematic diagnosis and management of patients with rounded shadows of pulmonary localization. Lack of opportunity to conduct an accurate bacteriological, histological or cytological diagnostic creates uncertainty in the choice of drug treatment. In this case, as shown by the clinical observation described in the article, the ideal option for managing patients with round shadows in the lungs is to conduct thoracotomy with resection of the affected areas. This provides not only a curative effect, but also an accurate histological and bacteriological diagnosis, which meets the requirements of evidence-based medicine and, if necessary, provides the possibility of a full-fledged medical treatment.