RU2277376C2 - Method for visualizing pleura injuries - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves introducing water-soluble radiopaque substance into pleural cavity and examining it. 40.0 ml of 20% trazograph solution is introduced between pleural sheets into the pleural cavity and computer tomography study is carried out.

EFFECT: high accuracy of diagnosis; high contrast of pleura sheet images.

Description

The invention relates to medicine, namely to radiology.

There is a method of double contrasting of the gastrointestinal tract, which consists in the fact that the patient is given a drink of barium suspension to outline the organ wall that is invisible when x-rayed. This method does not allow to contrast the pleural cavity, since barium is not used for computed tomography due to the high natural x-ray density. During computed tomographic scanning, due to the high density, barium causes pronounced artifacts that do not allow the analysis of the obtained research data. In addition, barium is not absorbed in the body, making the next CT scan impossible (until it is independently excreted from the gastrointestinal tract) (1).

A known method of using intravascular administration of a water-soluble contrast medium (intra-arterial and / or intravenous administration) in computed tomography studies of various human organs and tissues. This method does not allow contrasting the pleura and the pleural cavity, since the contrast medium physiologically cannot enter the pleural cavity introduced into the vascular (arterial or venous) channel, the gastrointestinal tract (2).

To improve the accuracy of diagnosis of diseases of the pleura, which are not differentiated by computed tomography, 40.0 ml of a 20% water-soluble radiopaque substance are introduced into the pleural cavity located between the pleural sheets.

The method is as follows.

In the process of diagnosis and treatment of patients, computed tomography is performed before, during and after treatment. After performing the initial native computed tomography scan and analysis of all obtained computed tomographic scans ("slices") of the organs of the chest cavity, the optimal, most informative computed tomographic "slice" with the most pronounced pleural changes is selected on the monitor screen.

On the patient’s skin (on the affected side), a point in the “slice” projection of the maximum pathological changes detected during scanning is noted. Then, in the projection of the points previously noted on the patient’s skin, the pleural cavity is punctured with a thick needle.

Fluid from the pleural cavity is aspirated through a needle (if one is available) both for therapeutic purposes and for subsequent cytological examination. Then 40.0 ml of 20% of any available water-soluble radiopaque substance is introduced. As a result, the visceral and parietal pleura layers are stratified by x-ray high-density, well-visible contrast solution on computer tomograms that does not produce artifacts during computed tomographic examination. As a result of the stratification of the pleural sheets by a radiopaque substance, against the background of the contrast solution we introduced into the pleural cavity, it becomes possible to visualize the inner surfaces of the pleura sheets and accurately determine their condition. Against the background of an X-ray high-density solution of a contrast medium introduced into the pleural cavity, the pleural cavity, intrapleural adhesions, focal and diffuse changes in the pleural sheets become clearly visible on any CT scans without artifacts at the interface, regardless of the mode and type of scanning, the apparatus class.

2 days after intrapleural administration of a solution of radiopaque substance, the contrasted fluid in the pleural cavity is not determined, completely absorbed by the pleura.

Computed tomography data obtained before the start of treatment are compared with the subsequent ones to assess the effectiveness of the treatment. Consistently, as the course of treatment is completed, a computed tomographic study with intrapleural administration of a contrast agent is repeated. These tomograms are compared with those obtained before treatment. Visual and densitometric analysis of pleural sheets and pleural cavity clearly visible in the pictures shows the dynamics of changes in the pathological focus and tissues surrounding it.

The method allows you to visualize the previously inaccessible during computed tomography of the inner surface of the pleura sheets and to conduct differential diagnosis of diseases of both pleural sheets; identify structural changes in the pleural cavity. This method allows you to avoid artifacts from radiopaque substances during scanning and to combine a complete computed tomography of the chest cavity and subsequent morphological examination of the pleura and pleural cavity, to conduct a complete differential diagnosis, determine the treatment tactics and its effectiveness.

Example 1

Patient S., 87 years old (amb. Card 3036/01), was admitted to the hospital with a diagnosis of left-sided pleurisy of unknown origin. In a polypositional X-ray examination in the projection of 9 segments of the left lung against the background of hydrothorax, a round shape of a homogeneous structure with a shadow of 35 × 40 mm with fairly clear and even contours was revealed. Based on the analysis of X-ray images against the background of hydrothorax, it was impossible to exclude the presence of peripheral cancer of the lower lobe of the left lung.

In order to clarify the nature of the tumor, the patient underwent a CT scan of the chest organs. At which the presence of a projection of 9 segments of the left lung pathological formation of a round shape, soft tissue density with clear contours, which with a wide base adjacent to the interlobar pleura, was confirmed.

With a standard computed tomographic examination (before contrasting the pleural sheets) against the background of the existing fluid in the pleural cavity, it was not possible to determine the exact anatomical and topographic criteria for this formation (it is in the lung or comes from the pleura). Since both the pleura, and the detected peripheral formation, and pleural fluid had almost the same x-ray density.

The presence of close indicators of the density characteristics of body tissues determine the resolution limit of the computed tomography method. In this case, it is not possible to determine the presence of intrapleural growths against the background of the fluid during computed tomography.

After intrapleural administration of 40.0 ml of a 20% solution of a contrast medium (trasograph), multiple tumor growths became visible in the form of nodes from 6 to 60 along the inner surface of the visceral and parietal pleura sheets. The formation, originally revealed in the projection of the 9th segment of the left lung, was a node emanating from the interlobar pleura.

Thus, after intrapleural administration of 40.0 ml of a 20% solution of a water-soluble contrast medium, a picture of the diffuse-node form of mesothelioma was obtained, confirmed by morphological studies.

In a cytological study (No. 9714-19), a picture of glandular cancer was obtained. That made it possible to determine an adequate treatment tactic.

Example 2

Patient E., 64 years old (amb. Card No. 4688/98), was admitted to the clinic with a preliminary diagnosis of central cancer of the upper lobe of the right lung, right-sided hydrothorax.

An X-ray examination of the chest organs revealed signs of central cancer of the right lung and a significant amount of fluid (up to the anterior segment of the III rib) in the right pleural cavity. The heart shadow is expanded across, more to the left.

In order to clarify the prevalence of the process, determine the nature of pleurisy, computed tomography was performed with intrapleural injection of a solution of radiopaque substance.

A standard CT scan (prior to administration of a contrast medium solution) confirmed the presence of central cancer of the right lung, revealed atelectasis of 3 segments of the right lung and a significant amount of fluid in the right pleural cavity. The fluid squeezed the lung and caused a significant increase and thickening of the pulmonary pattern. It was not possible to judge the state of pleural structures against a background of fluid at this stage of the study. Since both pleura and pleural fluid had close radiological density indices. In this case, it is not possible to determine the presence of focal lesion of the pleura against the background of the fluid with computed tomography. The maximum sizes of the mediastinal lymph nodes were in the range of 10-12 mm.

In the projection of the largest accumulation of fluid, a pleural cavity was punctured. Under the control of computed tomography, 900 ml of fluid was evacuated. The resulting liquid was sent for cytological examination. After intrapleural administration of 40.0 ml of a 20% radiopaque substance (trasograph), many rounded lesions with clear contours from 5 to 10 mm were visualized on the inner surface of the parietal pleura on computed tomograms.

Thus, after the administration of 40.0 ml of a 20% radiopaque substance, a metastatic lesion of the parietal pleura was reliably (macroscopically) revealed. In addition, during the study fluid was evacuated from the pleural cavity, drainage was placed at the level of pleural metastases for subsequent local chemotherapy. The results of a cytological study (No. 15498-09) of the fluid material from the pleural cavity are cells belonging to the cancer. The patient was consulted by a chemotherapist. Local and systemic chemotherapy started.

The method allows for computed tomographic examination to clearly visualize the previously inaccessible inner surface of the pleura sheets, to clearly establish the localization of intrapleural changes and their anatomical and topographic relationships. Conduct a complete diagnosis and differential diagnosis of pleural diseases against the background of hydrothorax. As a result, the contrast of the image of the pleural sheets and the contents of the pleural cavity increases. The inner surface of the pleural sheets, structural changes in the pleural cavity (adhesions, deposits of fibrin, etc.) become clearly visible on computed tomograms. After 2-3 days, the solution of the radiopaque substance is completely absorbed by the pleura and is not visualized in a subsequent study. In the course of computed tomographic X-ray contrast study, a morphological study of the pleural sheets and the contents of the pleural cavity is possible, the installation of drainage for subsequent therapeutic measures.

The technical result of the invention consists in increasing the accuracy of diagnosis of diseases of the pleural sheets by increasing the contrast of the image of the pleural sheets and the contents of the pleural cavity against the background of hydrothorax.

Information sources

1. Rabukhina N.A. Primary and double contrasting of the gastrointestinal tract. M., "Medicine", 1985.

2. Gabunia R.I., E.K. Kolesnikova. Computed tomography in clinical diagnosis. "1995.

Claims (1)

A method for visualizing pleural lesions by introducing a water-soluble radiopaque substance into the pleural cavity and conducting a study, characterized in that 40.0 ml of a 20% solution of a trasograph are injected into the pleural cavity between the pleura sheets and computed tomography is performed.