SOLITARY FOCAL PULMONARY LESIONS OF INFLAMMATORY GENESIS: DIAGNOSTIC FEATURES
DOI:
https://doi.org/10.11603/1811-2471.2022.v.i4.13198Keywords:
solitary pulmonary nodule, inflammatory process, diagnosticsAbstract
SUMMARY. In daily clinical practice, doctors are faced with incidental radiographic findings of solitary and multiple pulmonary nodules, which can be both benign and malignant. It is important to have clearly defined algorithms for the diagnostics, treatment and follow-up of these nodules of various etiologies. In modern researches, insufficient attention is paid to inflammatory solitary nodules, in particular, possibilities of their diagnostics and management.
The aim – to determine clinical and anatomical features, and etiology of solitary pulmonary nodules of an inflammatory nature.
Material and Methods. The research group consisted of patients with solitary pulmonary nodules of an inflammatory genesis, which were in the clinic of the State organization "F. G. Yanovsky National institute of phthisiology and pulmonology NAMS of Ukraine" over a five-year period, totally 107 cases. All patients had the number of pulmonary lesions that did not exceed three; their maximum size was ≤ 3 cm.
Results. Pulmonary nodules of an inflammatory genesis were represented most often by only one formation (78.5 % of patients). In most cases, the localization of nodules was in the right lung – 56.6 %, namely in its upper and lower lobes – 39.0 % and 44.2 % of cases, respectively. The size of the nodules was within 11–20 mm in 45.2 % and the round shape in 54.8 % of cases.
When radiological detection or confirmation of the presence of pulmonary nodules was carried out in 77.6 % of cases, operative interventions were immediately done with a morphological examination of the tissue of the formations.
More often, nodules were of an infectious nature, among them tuberculomas accounted for 29.9 %.
At the time of hospitalization, 74.8 % of patients with solitary pulmonary lesions of inflammatory etiology did not have a previous clinical diagnosis, in 15.9 % of cases it was necessary to carry out differential diagnosis, and only in 9.3 % of cases, the etiology of the disease was established. As a result of the performed diagnostic and therapeutic measures, the etiology of the nodules was established in 91.6 % of cases, in 3.7 % of cases there remained the need for further differential diagnosis, and in 4.7 % of cases the nature of the nodules was not established.
Conclusion. As a result of a complex examination and a series of medical and diagnostic procedures, the etiology of solitary pulmonary nodules of an inflammatory nature was established in 91.6 % of cases. And only in 4.7 % of patients the nature of the pulmonary lesions was not established.
References
Loverdos, K., Fotiadis, A., Kontogianni, C., Lliopoulou, M., & Gaga, M. (2019). Lung nodules: a comprehensive review on current approach and management. Annals of Thoracic Medicine, 14, 226-238. DOI: 10.4103/atm.ATM_110_19.
Ost, D., Fein, A. M., & Feinsilver, S. H. (2003). Clinical practice. The solitary pulmonary nodule. The New England Journal of Medicine, 348, 2535-2542. DOI: 10.1056/NEJMcp012290.
Dabrowska, M., Kolasa, A., Zukowska, M., Lesinski, J., Domagala-Kulawik, J., Maskey-Warzechowska, M., Krenke, R., Rowinski, O., & Chazan, R. (2009). Analysis of solitary pulmonary nodules found in chest radiograms. Pneumology and Allergology, 77(1), 37-42.
Sim, Y.T., & Poon, F.W. (2013). Imaging of solitary pulmonary nodule – a clinical review. Quantitative Imaging in Medicine and Surgery, 3(6), 316-326.
Skouras, V.S., Tanner, N.T., & Silvestri, G.A. (2013). Diagnostic approach to the solitary pulmonary nodule. Seminars in Respiratory and Critical Care Medicine, 34, 762-769. DOI: 10.1055/s-0033-1358559.
Cruickshank, A., Stieler, G., & Ameer, F. (2019) Evaluation of the solitary pulmonary nodule. Internal Medicine Journal, 49, 306-315. DOI: 10.1111/imj.14219.
Choi, S.M., Heo, E.Y., Lee, J., Park, Y.S., Lee, C.-H., Park, C.M., Kang, C.H., Yim, J.-J., Kim, Y.T., Yoo, C.-G., Han, S.K., & Kim, Y.W. (2016). Characteristics of benign solitary pulmonary nodules confirmed by diagnostic video-assisted thoracoscopic surgery. The Clinical Respiratory Journal, 10(2), 181-188. DOI: 10.1111/crj.12200.
Purandare, N.C., Pramesh, C.S., Agarwal, J.P., Agrawal, A., Shah, S., Prabhash, K., Karimundackal, G., Jiwnani, S., Tandon, S., & Rangarajan, V. (2017). Solitary pulmonary nodule evaluation in regions endemic for infectious diseases: Do regional variations impact the effectiveness of fluorodeoxyglucose positron emission tomography/computed tomography. Indian Journal of Cancer, 54, 271-275. DOI: 10.4103/0019-509X.219563.
Nasrullah, N., Sang, J., Alam, M. S., Mateen, M., Cai, B., & Hu, H. (2019). Automated lung nodule detection and classification using deep learning combined with multiple strategies. Sensors, 19(17), 1-19. DOI: 10.3390/s19173722.
Wang, N., Ma, H., Huang, H., & Feng, Y. (2021). Electromagnetic navigation bronchoscopy combined endobronchial ultrasound in the diagnosis of lung nodules. Medicine, 100(3), 1–8. DOI: 10.1097/MD.0000000000023979.
Ose, N., Maeda, H., Takeuchi, Y., Susaki, Y., Kobori, Y., Taniguchi, S., & Maekura, R. (2016). Solitary pulmonary nodules due to non-tuberculous mycobacteriosis among 28 resected cases. The International Journal of Tuberculosis and Lung Disease, 20(8), 1125-1129. DOI: 10.5588/ijtld.15.0819.
Vidaur, N.A., Alvarenga, O., Vidaur, E.A., Vasquez, K.M., Cordon, J. J., Flores, A.C., & Figueroa, R.M. (2017). Solitary pulmonary nodule, pulmonary actinomycosis of chronic evolution: a case report. Electronic Journal of Biology, 13 (3), 265-268.
Urer, H.N., Gunluoglu, M.Z., Unver, N., Toprak, S., & Ortakoylu, M. G. (2020). Benign solitary pulmonary necrotic nodules: how effectively does pathological examination explain the cause? Canadian Respiratory Journal, 2020, Article ID 7850750, 1-6. DOI: 10.1155/2020/7850750.
Larici, A.R., Farchione, A., Franchi, P., Ciliberto, M., Cicchetti, G., Calandriello, L., del Ciello, A., & Bonomo, L. (2017) Lung nodules: size still matters. European Respiratory Review, 26(170025), 1-16. DOI: 10.1183/16000617. 0025-2017.
Horeweg, N., van der Aalst, C.M., Thunnissen, E., Nackaerts, K., Weenink, C., Groen, H.J.M., Lammers, J.-W.J., Aerts, J.G., Scholten, E.T., van Rosmalen, J., Mali, W., Oudkerk, M., & de Koning, H.J. (2013). Characteristics of lung cancers detected by computer tomography screening in the randomized NELSON trial. American Journal of Respiratory and Critical Care Medicine, 187(8), 848-854. DOI: 10.1164/rccm.201209-1651OC.
Lindell, R.M., Hartman, T.E., Swensen, S.J., Jett, J.R., Midthun, D.E., Tazelaar, H.D., & Mandrekar, J.N. (2007). Five-year lung cancer screening experience: CT appearance, growth rate, location, and histologic features of 61 lung cancers. Radiology, 242(2), 555-562. DOI: 10.1148/radiol.2422052090.
Khan, T., Usman, Y., Abdo, T., Chaudry, F., Keddissi, J.I., & Youness, H.A. (2019). Diagnosis and management of peripheral lung nodule. Annals of Translational Medicine, 7(15), 348. DOI: 10.21037/atm.2019.03.59.
National Lung Screening Trial Research Team (2013) Results of initial low-dose computed tomographic screening for lung cancer. The New England Journal of Medicine, 368(21), 1980-1991. DOI: 10.1056/NEJMoa1209120.
Harzheim, D., Eberhardt, R., Hoffmann, H., & Herth, F.J.F. (2015). The solitary pulmonary nodule. Respiration, 90, 160-172. DOI: 10.1159/000430996.
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