Differential diagnosis of acute pneumonia with acute abscess and gangrene of the lung using angiopulmonography with a nitroglycerin test

Objective. To present the possibilities of angiopulmonography with a nitroglycerin test in the differential diagnosis of acute pneumonia with acute abscess and gangrene of the lung.

Material and methods. А pulmonary angiogram with a nitroglycerin test was performed in 51 patients with suppurative inflammations of the lungs and pleura in cases where it was difficult to interpret computed tomography data.

Results. Acute gangrenous lung abscess was diagnosed in 27 (53%) patients (absence of the parenchymal phase of contrast, including after administration of nitrospray, of which in 4 cases it was due to thrombosis of the segmental branches of the pulmonary artery). In 14 (27%) cases there was lung gangrene (absence of the parenchymal phase of contrast, including after administration of nitrospray, of which 5 were associated with thrombosis of the segmental branches of the pulmonary artery). With preserved main blood flow along all branches of the pulmonary artery and a pronounced parenchymal phase or its restoration after a nitroglycerin test, a conclusion was made about the functional nature and reversibility of the identified microcirculation disorders, the absence of necrotic changes in the pulmonary parenchyma and the presence of acute pneumonia in the patient - 4 (8%) cases. In case of deformation of the pulmonary artery branches with preservation of blood flow through them and the parenchymal phase, a conclusion was made about compression of the pulmonary parenchyma by pleural effusion, on the basis of which pleural empyema was suspected in 6 (12%) patients.

Conclusion. The developed method for the differential diagnosis of acute pneumonia with acute abscess and gangrene of the lung by means of angiopulmonography with a nitroglycerin test makes it possible to supplement and improve the early and differential diagnosis of purulent-inflammatory diseases of the lungs in difficult clinical situations. Nitroglycerin preparations improve microcirculation in the inflammation of the pulmonary parenchyma.

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