Abstract: Aim: was to demonstrate possibilities of timely radiological diagnosis and treatment of spinal tuberculosis in a patient with a single lung after pleuropneumonectomy for fibrocavernous pulmonary tuberculosis. Materials and methods: patient, 26 y.o. female, country inhabitant, grocery store clerk. She was hospitalized to the National Medical Research Center for Phthisiopulmonology and Infectious Diseases of the Ministry of Health of the Russian Federation with a diagnosis: “Tuberculosis spondylitis Th12-L2, focal tuberculosis S2 of the single right lung in the infiltration phase. M.Tb(-). Pleuropneumonectomy for fibrocavernous tuberculosis of left lung (December 18, 2018)”. To clarify etiology and lesion volume and to determine surgical treatment tactics, multispiral computed tomography (MSCT) of lungs and thoracolumbar spine and subsequent percutaneous trephine biopsy of the L1 vertebra were performed. Results: according to MSCT data, destruction of Th12-L1-2 vertebral bodies was revealed; in single right lung, medium-intensity focal lesion with a diameter of 5 mm in C1, a small calcinate in C2, and a subpleural focal lesion in C4 were visualized. Small-focal dissemination was observed throughout the entire length of single lung. Bacteriological study of biological material taken during trephine biopsy revealed the growth of Mycobacterium tuberculosis, confirmed by diagnostics of polymerase chain reaction (PCR). Taking into account the pulmonary pathology, operation was performed in the volume of resection of Th12-L1-2 bodies and antero-lateral spinal fusion with a Mesh body replacement implant with bone autoplasty from left-side access, transpedicular fixation (TPF) of Th11-L3 with a four-screw structure under intraoperative radiation control. As a result of treatment, patient was discharged in a satisfactory condition. Conclusions: presented case report demonstrates the importance of timely radiological diagnosis in patients with combined infectious lesions of lungs and spine for obtaining of complete information about the state of respiratory and bone systems, using MSCT and interventional radiology methods and for determination of pathological process etiology. It made it possible to perform timely diagnosis and complex surgical intervention with the most sparing and light surgical access to affected vertebrae in tuberculosis spondylitis from the side of previous pleuropneumonectomy. References 1. Giller DB, Martel’ II, Imagozhev YG, et al. An experience of single lung resection and pneumonectomy after contralateral lung resection in treatment of tuberculosis. Khirurgiya (Mosk). 2021; (1): 15-21 [In Russ]. https://doi.org/10.17116/hirurgia2015935-42 2. Giller DB, Giller GV, Imagozhev YG. Surgical collapse in the treatment of single lung tuberculosis. Khirurgiia. 2021; (1): 15-21 [In Russ]. https://doi.org/10.17116/hirurgia202101115 3. Mushkin AYu, Vishnevskiy AA, Peretsmanas EO, et al. Infectious Lesions of the Spine: Draft National Clinical Guidelines. Khirurgiya pozvonochnika. 2019; 16(4): 63-76 [In Russ]. https://doi.org/10.14531/ss2019.4.63-76 4. Sovetova NA, Vasileva GYu, Soloveva NS. Tuberculous spondylitis in adults (clinical and radiographic manifestation). Tuberkulez I bolezni legkikh. 2014; (10): 33-37 [In Russ]. 5. Dunn RN, Ben Husien M. Spinal tuberculosis: review of current management. Bone Joint J. 2018; 1(100-B(4)): 425-431.
Abstract: Development of multilayer digital tomosynthesis technology allows you to get a more accurate imaging of internal organs and tissues in comparison with other traditional radiological methods of investigation, and that is achieved by the possibility of layered imaging of selected anatomical region. Aim: was to analyze possibilities of digital tomosynthesis in the assessment of lung structure in normal anatomy of organs of chest cavity Materials and methods: study include patients without lesions of the chest cavity, who underwent digital tomosynthesis in frontal and lateral projections. Results: basing on analyzed data, we identified features of normal radiological anatomy of the chest cavity using a technique of digital tomosynthesis. Schematically clarified lobar and segmental structure of lungs, as well as airways according to layered imaging. Advantages and disadvantages of the method in imaging of lungs and mediastinal structures are shown. Conclusion: the use of digital tomosynthesis in the evaluation of chest organs allows to determine main anatomical structures of lungs in more detail, through layered imaging and a high spatial resolution. References 1. Galea A. et al. Practical applications of digital tomosynthesis of the chest. Clinical radiology. 2014; 69(4): 424-430. 2. de Koste J. R. S. et al. Digital tomosynthesis (DTS) for verification of target position in early stage lung cancer patients. Medical physics. 2013; 40(9): 091904. 3. Dobbins III J. T. et al. Digital tomosynthesis of the chest for lung nodule detection: interim sensitivity results from an ongoing NIH-sponsored trial. Medical physics. 2008; 35(6): 2554-2557. 4. Vikgren J. et al. Comparison of Chest Tomosynthesis and Chest Radiography for Detection of Pulmonary Nodules: Human Observer Study of Clinical Cases 1. Radiology. 2008; 249(3): 1034-1041. 5. Quaia E. et al. Digital tomosynthesis as a problemsolving imaging technique to confirm or exclude potential thoracic lesions based on chest X-ray radiography. Academic radiology. 2013; 20(5): 546-553. 6. Jung H. N. et al. Digital tomosynthesis of the chest: utility for detection of lung metastasis in patients with colorectal cancer. Clinical radiology. 2012; 67(3): 232-238. 7. Nikitin M. M. Possibilities of digital tomosynthesis in the diagnosis of various forms of pulmonary tuberculosis. REJR. 2016; 6 (1): 35-47. [In Russ]. 8. F.Kovach F., Zhebek Z. X-ray anatomical basics of lungs’ examinations. Budapest, 1958; 364 p. [In Russ]. 9. Trofimova T. N. ed. Human X-ray anatomy. SPb.: Publishing house SPbMAPO. 2005; 496 p. [In Russ]. 10. Sapin M. R. ed. Human Anatomy. Moscow, M.: Medicine. 2001; 640 p. [In Russ]. 11. Sinelnikov R. D., Sinelnikov Ya. R. Atlas of human anatomy. M.: Medicine. 1996; 344 p. [In Russ]. 12. Kokov L. S., ed. X-ray Atlas of comparative anatomy. M.: Radiology-Press., 2012; 388 p. [In Russ].
