PMC7490556_01
Roentgenological examination.. A - Chest X-ray on admission. Bullae and giant bullae are evident in both lungs. With the fluid is presented in the right lung.. B - Chest CT on admission. Giant bullae occupies upper parts of both lung. In the upper lobe of the right lung there are some cavities containing fluid.. C - Chest CT on admission. In the middle sections, the lung tissue is preserved, emphysema is less pronounced, single medium-sized "bullae" on the right and the continuation of the system of giant bullae on the left are visible.
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The lung tissue was emphysematous in the epiphrenic regions, but did not contain bullae (Fig. 1).
Cross -section of the removed parts of the right lung.. A - The lobe contains multiple cavities with purulent contents.. B - Stage of the second operation: removal of the lung - I, II, III segments of the left lung upper lobe.. C - Removed lung in the second operation. I, II, III segments of the left lung upper lobe.
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Histological samples.. A - forming bulla of lung tissue, next to cysts in a common zone of exacerbation of chronic inflammation and the presence of an adjacent vascular malformation, magnification x. 40, stained with hematoxylin and eosin);. B - area of organizing hemorrhagic infarction next to lung tissue cysts and vascular malformation, presence of foci of nonspecific inflammation, magnification x. 100, stained with hematoxylin and eosin;. C - Fresh hemorrhage near vascular malformation with perifocal inflammatory reaction, magnification x. 100, stained with hematoxylin and eosin;. D - Next to the infarction area, an area of organizing pneumonia, magnification x. 100, Mallory stain;. E - Fibrotic tuberculosis granuloma in a zone of a fibrocystic modified lung, on the periphery of an organizing hemorrhagic infarction in the lung tissue. Visible accumulations of hemosiderophages. The granuloma is characterized by indiscriminate fibrosis, the presence of a giant cell reaction and a small number of leukocytes. On the periphery, an epithelioid cell reaction with an admixture of leukocytes remains and accumulations of lymphocytes are formed, magnification x 100, stained with hematoxylin and eosin;. F - Acid resistant mycobacterium tuberculosis in the area of necrosis with severe tuberculous inflammation, magnification x1000, Ziehl-Neelsen stain);. G - Section of the wall of cystic dilated bronchus with a fibro-altered wall after healing of the focus of tuberculous inflammation, a round. section of a slightly vascular coarse fibrous fibrosis, with significant fibrous changes in the adjacent lung tissue having the presence of epithelioid cell infiltration with an admixture of leukocytes and an area of adjacent vascular malformation, magnification x 100, stained with hematoxylin and eosin;. H - Fragmentation and disappearance of elastic fibers in the zone of formed cysts and fibro-altered lung tissue, magnification x 100, stained with acidic orcein;. I - The disappearance of the elastic framework in the interalveolar septa and its preservation only in the vascular walls during the formation of bullous changes in the lung tissue in the area of inflammation, magnification x 100, stained with acidic orcein.
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At the control examination of the patient, 10 years after surgical treatment: A - a survey radiograph of the lungs; B - a photography of the patient.
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A chest X-ray did not demonstrate new bullae (Fig. 4).