Objective: to evaluate the clinical and radiological features of rare forms of sarcoidosis of the respiratory organs (SRO).

Material and methods. In 2006 to 2016, the Research Institute of Interstitial and Orphan Lung Diseases followed up 599 patients with sarcoidosis. 36 patients (6.0%) of them had atypical clinical and radiation manifestations that did not correspond to the traditional radiation pattern and the existing X-ray classification of SRO. Stages 2, 3, and 4 pulmonary sarcoidosis was diagnosed in 26, 7, and 3 patients, respectively. The patients’ mean age was 38.2±7.4 years (the female/male ratio was 26:10). All the patients underwent traditional X-ray studies (radiography in two projections), high-resolution computed tomography (CT), complex external respiratory function examination, and echocardiography.

Results. Analysis of the results of radiation examinations revealed the following rare forms of SRO: interstitial edematous, fibrous, and cavitary ones that had recognizable CT patterns. Each of these forms had clinical and functional features. In single cases, the CT pattern combined the features incompatible with the generally accepted classification (Stages 1 and 4 SRO); this was an offstage form. The features of the radiation pattern and clinical course required the differential diagnosis of these patients with more severe diseases (idiopathic pulmonary fibrosis, lymphogenic carcinomatosis, pulmonary edema, diffuse connective tissue diseases, pneumoconiosis, mycobacteriosis, and exogenous allergic alveolitis) and morphological verification.

Conclusion. The accumulation of experience with clinical and radiological examination of patients with SRO revealed its rare forms that are difficult to diagnose and necessitate the development of new approaches to therapy policy. 

Objective: to evaluate the X-ray radiological features of nontuberculous mycobacterial pulmonary disease (NTMPD) versus morphological findings.

Material and methods. The investigation enrolled 37 patients, in whom the radiographic signs of dissemination were determined and various types of NTMPD were identified. The investigation was conducted on a Siemens Somatom Emotion 16 multislice computed tomography (MSCT) scanner using a high-resolution algorithm (Quick Time Virtual Reality). To clarify the activity of pathological changes in the thoracic organs, 16 (43.2%) patients underwent a radionuclide study with 99mTc-technetrile on a Nucline Spirit gamma camera in planar and single photon emission computed tomography modes.

The diagnosis was verified by sputum smear microscopy and clinical laboratory and bronchologic examinations: bronchoalveolar lavage in 11 (29.7%) patients, various types of bronchial biopsies in 17 (46.0%), morphological examinations, and videoassisted thoracoscopic surgery for pulmonary resection in 9 (24.3%).

Results. The dissemination foci in mycobacterial diseases were characterized by their location in the lung parenchyma with vascular and bronchial involvement and reactive changes in the pulmonary pleurae and intrathoracic lymph nodes (ITLN). In 92.7% of cases, the detected foci were predominantly centrilobular with endobronchial localization. Their contours were mixed with clear and fuzzy outlines in 98.7% of cases. In 70.3% of cases, the foci were asymmetrically localized mainly in the subpleural areas of the lung and 12.3% of cases were accompanied by reactive involvement of the visceral pleura.

CT study revealed a tree-in-bud sign in 96.7% of cases, frosted glass in 10.2%, and mosaic perfusion in 13.2%. A more than 10-mm increase in ITLN was found in 11.7% of cases.

In a number of cases, it was difficult to speak about the activity of the pathological process in the lung and ITLN, as shown by MSCT. In this case, a lung radionuclide study with 99mTc-technetrile was carried out in the planar mode. The degree of tracer accumulation, localization, and extent were analyzed in the planar mode.

Conclusion. Thus, the CT typical signs of NTMPD are the asymmetric location of its foci with an endobronchial extension, peribronchovascular localization of foci; the presence of a CT tree-in-bud sign; and the slight involvement of the pulmonary pleurae in the process. 99mTs-technetril radionuclide study has established that the most active inflammatory process is located in the lung and the tracer accumulates in the pathologically altered lymph nodes.

Objective. To determine the opportunities of low-dose digital fluorography (LDDF) in differential diagnosis of phenotypic variants of chronic obstructive pulmonary disease (COPD).

Material and methods. There were 107 patients with clinically diagnosed COPD of varying severity examined. The average age of the patients was 51.8±1.5 years (46–59 years). All patients for LDDF of the chest in the frontal projection in the inspiratory and expiratory phase of respiration were undergone.

Results. The electron optical density of the lungs was determined in the upper, middle and lower zones of both lungs. As a result in patients with a predominance of emphysematous variant of COPD (n=15) the most characteristic radiological symptom was lung hyperventilation (14% of 107 patients) and inspiratory electron optical density value was 748.18±4.72 optical density units (ODU). In patients with a predominance of bronchitic variant of COPD (n=43) the most common radiological symptom was the presence of symptom amplification and deformation of lung pattern (40% of 107 patients) and inspiratory electron optical density value was 668.04±12.26 ODU. For patients with mixed phenotypic variant of COPD (n=49) it was characterized by a combination of X-ray symptom amplification and deformation of lung pattern with lung emphysema (46% of 107 patients); the average value of inspiratory electron optical density value was 815.24±17.25 ODU.

Conclusion. The technique of LDDF can detect X-ray symptoms and determine inspiratory and expiratory electron optical density of the lungs in patients with COPD that allows optimizing the differential diagnosis of phenotypic variants of chronic obstructive pulmonary disease.

Objective: to analyze current radiodiagnostic techniques in identifying tracheomalacia (TM) and estimating its severity and extent in patients with cicatricial tracheal stenosis (CTS) and to determine the important characteristics of TM according to follow-up multislice computed tomography (MSCT) and magnetic resonance imaging (MRI) findings.

Material and methods. The investigation included the results of examining 94 patients, 81 of whom were diagnosed with CTS. To analyze the efficiency of the studies, the patients were divided into three groups; a control group of patients was formed. The diagnosis of TM was verified by clinical examination, instrumental diagnosis, MSCT and MRI studies, and intraoperative revision. The patients’ postoperative features were taken into consideration. Diagnostic performance measures, such as sensitivity, specificity, and accuracy, were calculated. Static radiation techniques (MSCT and MRI) and follow-up procedures (fMSCT and fMRI) were compared.

Results. The follow-up procedures were proven to be twice as informative for the detection of the symptoms of TM as the endoscopic method that is considered the main method for the diagnosis of pathological tracheal changes. The diagnostic capabilities of MSCT, fMSCT, MRI, and fMRI were determined; criteria for identifying TM were formulated. The use of the follow-up procedures to identify clinically significant TM in patients with CTS could radically alter surgical tactic in 36.9% of cases.

Conclusion. The proposed algorithm for examination of patients with CTS, which includes follow-up radiation procedures to evaluate the functional state of the tracheal wall, makes it possible to determine an optimal treatment policy and to significantly reduce the risks of complications and disease recurrences.

Radiation diagnosis in evaluating chronic obstructive pulmonary disease (COPD) is used to distinguish clinically similar diseases and to identify concomitant pathological changes. Highresolution computed tomography (HRCT) is employed for detailed analysis of the status of the lung. HRCT can visualize primarily centrilobular, panlobular, paraseptal, and bullous emphysema and bronchiectases, is of great importance in the anatomical characteristics of the disease and in the identification of the phenotype of COPD.

The paper describes a clinical case of COPD with bullous emphysema in a 60-year-old man. The CT pattern presents with lower-density bilateral multiple centrilobular avascular areas without clear boundaries, as well as by paraseptal emphysema areas, also localized mainly in the lower segments of both lungs, with thin-walled air cavities occupying up to one third of the hemithorax on both sides. CT made it possible to visualize upperlobular centrolobular emphysema, pulmonary bullae, to estimate their sizes, and to identify compression atelectasis in the adjacent lung areas. The differential diagnosis included bronchiectasis disease, histiocytosis X, and lung carcinoma.

This clinical case demonstrates that HRCT is the method of choice for differential diagnosis, a follow-up, and assessment of the results of treatment for COPD with a preponderance of bullous emphysema, including in the presence of a doubtful radiographic pattern.

The paper describes a clinical example of the topical diagnosis of adrenocorticotropic hormone (ACTH)-producing typical peripheral pulmonary carcinoid. The first stage in its diagnosis was to rule out the production of ACTH by the pituitary gland. The paper presents information on the most common localization of functioning neuroendocrine tumors, as well as a diagnostic algorithm to search for an ectopic focus of the ACTH-secreting tumor that causes hypercorticism. Taking into account that bronchopulmonary neuroendocrine tumors with ectopic hormone production occur rarely (5%), a clinical example is given to demonstrate the capabilities of imaging techniques and standards for their implementation using an integrated approach.

The absence of any specific symptoms, variety of radiologic and histologic changes in lungs and often poor physicians experience are the reasons for difficulties in diagnostics of idiopathic pulmonary fibrosis. The diagnostic criteria are constantly being discussed. The basis of this article is The White paper of Fleischner Society (published in “The Lancet Respiratory Medicine” 2017).