Scintigraphy role in planning of extensive combined resections for spread destructive pulmonary tuberculosis in clinical case of a 9 y.o. child

Scintigraphy role in planning of extensive combined resections for spread destructive pulmonary tuberculosis in clinical case of a 9 y.o. child

Giller D.B., Koroev V.V., Martel I.I., Kesaev O.Sh., Enilenis I.I., Nikiforova T.V., Glotov A.A.

Purpose. To show scintigraphy role in the preoperative planning of extensive combined resections for spread pulmonary tuberculosis and to demonstrate the functional viability of the remaining "small lung" parts using radiological methods.

Materials and methods. Right lower lobe caseous pneumonia complicated with intrathoracic lymph nodes (ITLN) tuberculosis and III degree lower lobe bronchi fibrous stenosis was diagnosed in 9 y.o. patient after a complete examination. To assess the pulmonary blood flow in the affected lung and determine the surgery volume in the preoperative period, radioisotope lung scans with Tc-99 were performed. The patient successfully passed video-assisted right lower bilobectomy with S2, partial S1 and partial S3 resection with mediastinal lymphadenectomy. The postoperative period was uncomplicated. At control examination 4 months past surgery, the patient is in a satisfactory condition. After gaining radioisotope scan data, there was a microcirculation increase in the operated lung compared with preoperative indicators.

Results and discussion. Application of combined pulmonary resections in tuberculosis treatment remains limited, and extensive combined resection with over half lung volume removal is extremely rare. The majority of authors emphasize the high risk of postoperative complications, death and postoperative relapses for this category of surgeries, and also emphasize functional inexpediency of leaving a small lung. According to several researchers data, the vicar emphysema inevitably developing after extensive pulmonary tissue resection makes remaining sections defective and emphysematous lung vessels modification leads to a sharp decrease or absence of capillary blood flow. However, in childhood the negative effects of extensive resections do not appear or may be absent.

Conclusion. Scintigraphy showed the functional viability of leaving insignificant areas of pulmonary tissue after extensive combined lung resections performed in destructive pulmonary tuberculosis.

I.M. Sechenov First

Moscow State Medical University

Moscow, Russia

 

Keywords: Destructive tuberculosis, caseous pneumonia, pulmonary resection, VATS, XDR.


Corresponding author:  Koroev V.V., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript .

 

For citation: Giller D.B., Koroev V.V., Martel I.I., Kesaev O.Sh., Enilenis I.I.,

Nikiforova T.V., Glotov A.A. Scintigraphy role in planning of extensive combined resections for spread destructive pulmonary tuberculosis in clinical case of a 9 y.o. child. REJR 2019; 9(1):248-255. DOI:10.21569/2222-7415-2019-9-1-248-255.

Received:        20.02.19 Accepted:       06.03.19