Radiological diagnosis of diseases of the respiratory system includes a number of methods based on various ways of obtaining information about the state of the chest organs. Most of the applied methods are aimed at identifying structural changes in the lung parenchyma, however, with the development of lung diseases, the pathological process affects all anatomical structures of the lungs, without exception, including the vascular bed of the lungs, primarily due to its microcirculatory level, therefore, this process requires special attention of specialists to the methods detecting changes in the pulmonary microvasculature. Depending on the purposes of the study, various methods of radiologic diagnosis should be used in combination. The review provides a brief anatomical characteristic of the capillary bed of the lungs. History of the study of blood circulation in a small circle is discussed, and modern methods of radiologic research are used to detect lung diseases.

Chronic postembolic pulmonary embolism (CTEPH) is the result of chronic pulmonary artery obstruction followed by pulmonary embolism. The frequency of CTEPH in patients with pulmonary embolism is approximately 3.8 %. Despite signifcant progress of pulmonary embolism management, the diagnosis of CTEPH remains diffcult. The current review is devoted to the opportunities of radionuclide methods in patients with CTEPH. The information about ventilation­perfusion scintigraphy, equilibrium radionuclide angiography, myocardial perfusion scintigraphy as well as cardiac scintigraphy with 123I­MIBG is presented.

This review is focused on the problem of the hemodynamics in patients with total anomalous pulmonary venous connection. The article describes a structural features of the pulmonary venous return depending on the anatomical type, pulmonary and systemic hemodynamics, origin and effect of the pulmonary venous return obstruction on the hemodynamics. We presented basic diagnostic problems and principles, including prenatal level, and discussed trends, results and unsolved questions of the surgical treatment of the patients with total anomalous pulmonary venous connection.

Purpose – examine the possibilities of multislice computed tomangiography (MSCTA) in case of suspected damage to the great vessels in a chest gunshot fghting injury.

Material and methods. A radiation survey of 130 wounded with gunshot injuries of the chest to assess the nature, diagnosis of gunshot injuries of the vascular bed.

Results. Of the 130 wounded with gunshot wounds to the chest, 41 (31.5 %) of the injured had gunshot wounds to the chest were non­penetrating, and 89 (68.5 %) had penetrating injuries. In 76 (58.4 %) patients with gunshot chest injuries, the nature of the wound was fragmentation, in 54 (41.6 %), wounds were bullet wounds. In the algorithm of radiation examination of patients with gunshot wounds of the chest to identify the nature of damage to the organs of the mediastinum and vascular structures, the main method of visualization was MSCT with contrast enhancement. Damage to the bone skeleton of the chest (ribs, collarbone, sternum, scapula) by MSCT was observed in 23 (17.6 %) patients. Almost half – 66 (50.1 %) of the wounded with gunshot injuries during MSCT examination, traumatic injury (pulmonitis) of the lung was observed. In 2 (1.5 %) cases, damage to the heart was detected that was not recognized at the stage of skilled surgical care. False post­traumatic aneurysm of the thoracic aorta was diagnosed in two wounded. Accuracy, sensitivity, specifcity of MSCT angiography in imaging of the vascular bed and diagnosis of damage to the great vessels of the chest cavity was 98, 97 and 97 %, respectively.

Conclusions. MSCT made it possible to reliably assess the nature of the gunshot injuries of the chest, identify timely damage to the great vessels of the mediastinum, determine the localization of the foreign injuring bodies near the vascular structures, and determine the surgical tactics.

Introduction. Algorithms of the early detection of lung cancer remain a topic of discussion and the problem of timely assessment of the expansion of lung cancer remains unresolved.

Objective – to determine if the combined use of contrast­enhanced MDCT and 99mTc­MAA SPECT and Gallium‐67 citrate SPECT is effective in assessing the expansion of lung cancer in the determination in the intervention tactics.

Material and methods. In the study, radiologic examination was performed to 81 patients with lung cancer. Combined examinations included bolus contrast­enhanced computed tomography (n = 81 patients), 99mTc­MAA SPECT (n = 62 patients) and Gallium‐67 citrate SPECT (n = 9 patients).

Results.According to MDCT data in most cases (n = 65 patients; 80 %) this method was able to diagnose the T­stage of the tumor; in some cases, the stage of malignancy was overestimated (n = 8 patients, 10 %), or underestimated (n = 8 patients, 10 %). According to the results of 99mТc­МАА SPECT, it was possible to reliably determine the microcirculation disorders that were observed in the whole group of patients, while in 12 cases the impaired blood flow was recorded only according to the results of 99mTc­MAA SPECT and in 50 cases the severity of changes in blood flow was more signifcant than according to MDCT. When analyzing Ga­67 citrate SPECT data, in all 9 cases whole­body Ga­67 citrate SPECT showed intense hot areas at the tumor region. It was also possible to show several mildly increased foci in the hilar lymph nodes in 6 cases, but in 3 cases the result was false positive.

Conclusions. Bolus contrast­enhanced computed tomography in most cases allows to correctly determine the T­stage of lung cancer and show tumor invasion into the surrounding tissues and vessels. At the same time, an additional 99mTc­MAA SPECT study allows to clarify the degree of disturbance of the microvasculature in more detail. It is possible to supplement the assessment of regional metastasis by Gallium‐67 citrate SPECT, however, it is necessary to take into account the inflammatory nature of lymph node changes as a cause of false­positive data.

Introduction. The problem of early detection of pulmonary arterial hypertension (PAH) is closely related to the diagnosis of systemic sclerosis (SSc). It is especially important in patients with slight manifestations of the disease, making it diffcult to verify the diagnosis before the clinic of right ventricular heart failure, and low knowledge of the general practitioners of the available diagnostic opportunities.

The aim of the work was to identify the earliest clinical signs of PAH associated with SSc for its early diagnosis.

Material and methods. The study included 51 patients with limited SSc. The investigators evaluated the extent of skin lesion, levels of the level of N­terminal brain natriureticpropeptide (NT­proBNP) and uric acid, the fluorescent pattern and titer of antinuclear factor. All patients underwent an echocardiography, nailfold videocapillaroscopy, a comprehensive assessment of external respiratory functions. When there were symptoms of PAH, right heart catheterization was performed to confrm it.

Results. PAH was detected in 19 of the 51 patients included in the study. Patients with PAH were signifcantly older than those without PAH: (60±8) and (54±7) years, respectively (p=0.02); there were also differences between these groups in the signs of right cardiac remodeling (p<0.05), in the indices estimated in the six­minute walk test (p<0.05), in the assessment of lung diffusing capacity (p<0.001), in levels of NT­proBNP and uric acid (p<0.001), in the density of the nailfold capillaries (p=0.009); in a semiquantitative assessment of nailfold capillary alterations (p=0.022). Among patients with PAH associated with SSc, seven patients were diagnosed with SSc for the frst time after referring to cardiologists and verifying the genesis of PAH, while other 12 patients were previously observed by rheumatologists. Differences in the duration of the period from the onset of symptoms to the diagnosis of SSc (p=0.043) were revealed between these groups.

Conclusion. The study shows the probability of the presence of SSc in patients with suspected idiopathic PAH, that determines the necessity of additional immunological and instrumental examinations in such patients.

Introduction. Despite the continuous improvement of methods for prenatal diagnosis of fetal malformations, at present, the limitations of intrauterine verifcation of vascular lung anomalies and relevance in postnatal typing of all components of pathological pulmonary hemodynamic, especially in the case of complex, combined vascular malformations, remain. Detailed and expert assessment of the anatomy of the pulmonary vessels, intrapulmonary hemodynamic is necessary to minimize the time for the surgical correction of the defect in order to avoid the development of irreversible pulmonary hypertension. One of the most rare and diffcult to diagnose forms of a combination of vascular abnormalities is congenital pulmonary venolobar syndrome (CPVS), which combines venous, arterial, pulmonary and cardiac pathology, to one degree or another coexisting in one patient.

Objective – analysis of clinical material and data of different diagnostic methods in children with CPVS. This everything will help to optimize diagnostics and choose the most safe and informative method to visualize combination of pulmonary and cardiovascular diseases and to determine the specifcity of pulmonary circulation. Furthermore, it will allow to minimize all risks and negative consequences for patient’s body.

Material and methods. We reviewed the records of 11 children (age from 14 days to 17 years old) with intraoperative verifcation of CPVS. We systematized all variants of vascular anomalies of lungs in children with CPVS, its possible combinationswith other abnormalities. We performed the comparison of capability and diagnostic signifcance of plain radiography, echocardiography, selective angiography and CT­scan in determining the specifcity of pulmonary circulation in children with CPVS and assessment of combination of the malformation components. Results. Antenatal echocardiography and postnatal diagnostics using echocardiography, plain radiography and selective angiography is extremely limited. We suggested the diagnostic algorithm using CT­scan with the proof of the great representativeness. Obligatory components of CPVS were identifed: reduction of the right lung volume, anomalous pulmonary venous drainage (scimitar syndrome) and non­obligate components of malformation: aplasia or hypoplasia of the right pulmonary artery, systemic pulmonary arterial supply with differential pulmonary perfusion, pulmonary sequestration, other congenital heart abnormalities.

Conclusion. CPVS is a rare congenital malformation. Antenatal diagnosis of all components of CVLS is impossible. MDCTAG is the most effective diagnostic method that allows to identify all components of CPVS in postnatal period. This method does not require additional radiodiagnostics and invasive diagnostic procedures.

Introduction. In the structure of interstitial lung diseases, drug­induced lung lesions occur in approximately 3 % of cases. One of the most pneumotoxic drugs used in cardiology is amiodarone. Its toxic effect is multicomponent and affects all structures of the bronchopulmonary system.

Objective of the study was to estimate radiologic features and to follow up vascular disorders in the lungs in patients with amiodarone­induced pulmonary toxicity (AILT)

Material and methods. We included 214 CT exams of 110 patients with history of amiodaron use. AILT was confrmed in 90 cases. In 81 % of patients we repeated CT exams 2–5 times, with observation period from 1 month up to 10 years. The mean age of patients was 71 years (21 females, 69 – males). In 52 % of patients lung scintigraphy was performed, in 34 % with follow up (from 2 to 4 times). We included functional lung test and cardiac ultrasound in diagnostic plan.

Results. Three clinical and radiological forms of the disease were identifed: acute, subacute, and chronic. The acute form was observed in 3 % of cases, the subacute (in 68 %), the chronic form was determined during the frst examination (23 %) and during the transformation from the subacute form (38 %). According to SPECT­CT data 70 % of patients had pronounced diffuse microcirculation disorders, 30 % of patients developed perfusion disorders of moderate severity.

Conclusion. There are persistent and irreversible changes in the lungs with AIPT in dynamic radiological examination, there is a tendency to fbrosis and recurrence and perfusion disorders in the lungs during treatment are not fully recovered. For suspected pulmonary embolism most informative diagnostic method is SPECT.

Introduction. Optical coherence tomography (OCT) is an intravascular imaging method that allows to evaluate the structure of the vascular wall, as well as to monitor the process of stent installation and healing.

The aim of this work was to identify factors affecting neointimal vascular healing after implantation of drug­eluting stents.

Material and methods. In 35 patients with acute coronary syndrome without ST elevation, everolimus­eluted stents with permanent and biodegradable polymer were installed. After 6 months patients underwent control coronary angiography with OCT, the state of neointima of previously implanted stents was analyzed. Clinical, anamnestic and laboratory parameters were evaluated.

Results. 28750 struts of stents were analyzed and the healing score was calculated. The healing score depended on the patient’s age (r=0.60710, p=0.0003), a history of diabetes mellitus (p=0.0477), current myocardial infarction (p=0.0183), and the degree of coronary artery disease (p=0.0355). The healing score was signifcantly lower in patients with a Syntax score <22 (p=0.004).

Conclusion. The results of the research showed that main factors that impair neointimal healing are age, the presence of diabetes, the characteristics of the lesion of the coronary arteries; they may affect the duration of dual antiplatelet therapy.

Introduction. Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the most severe complications of pulmonary embolism (PE), characterized by poor prognosis and insuffcient effectiveness of standard treatment approaches. A small number of representative models of CTEPH make it diffcult to conduct preclinical studies of promising pharmacological substances.

Objective – development and validation of the experimental model of CTEPH in rats by embolization of the distal branches of the pulmonary artery with biodegradable microspheres.

Material and methods. Male Wistar rats were used for the experiments. Biodegradable microspheres (MS) based on sodium alginate and autologous blood clots (AT) were used as embolizing particles. The animals were divided into groups: control: saline solution was injected 4 times with an interval of 8 days into the tail vein; AT: according to the above protocol, 50 μL of AT was injected; MS was administered intravenously in a volume of 50 μl of MS according to two protocols: MS4: 4 times with an interval of 8 days; MS8: 8 times with an interval of 4 days. After 2 and 6 weeks after the last injection, a histological examination of the lungs was performed; after 6 weeks: echocardiographic study (TTE), right ventricular catheterization (RV) with measurement of right ventricular systolic pressure (RVSP), treadmill test, assessment of serum endothelin­1 levels by the immunoassay method.

Results. During the experiments, the survival rate in the MS8 group was 50 %. In the other groups, there were no animal losses. According to the treadmill test 6 weeks after the modeling of PE, exercise tolerance was signifcantly reduced in the MC4 and MC8 groups compared with the control group. TTE data indicate a signifcant increase in the diameter of the pulmonary trunk and the right ventricular outflow tract in the MC8 compared with the control and AT. There were signifcant increase in RVSP and the level of endothelin­1 compared with the control only in the MS8. After 6 weeks, the index of hypertrophy of vessel wall of the pulmonary artery in the MC4 and MC8 was signifcantly higher compared with the control and AT groups.

Conclusion. Based on the use of MS, administered under the MS 8 protocol, a new representative model of CTEPH has been created, which can be used to test promising pharmacological substances.

Introduction. The relevance of the work is determined by the high mortality in acute pulmonary edema (APE), the speed of development of the process, the lack of effective methods of treatment and comprehensive studies of acute pulmonary edema used in vivo methods of research.

The aim of this work was to study the pathogenesis of APE in the experiment using biomicroscopy.

Material and methods. The microcirculation of lungs was studied in the dynamics of APE by direct and indirect methods: biomicroscopy of lungs using the chamber of the rat, laser Doppler flowmetry of the lungs, morphological and histological examination of lungs.

Results. The decisive role of lymphatic microvessels in the pathogenesis of APE was shown. All studied indicators complemented each other and were the result of impaired microcirculation in the blood and lymph microvasculature of the lungs. In the surviving animals with APE, there was an initial recovery of lymph flow in the lungs. Restoration of venular tone, reduction of edema in the interstitium of the lungs and morphological manifestations occurred after restoration of lymphocirculation, which is in favor of the decisive role of the lymphatic system in the pathogenesis of APE. It is necessary to create pharmacological agents with lymph­stimulating activity.

Accomplishments in the identifcation of lymphatic endothelial cells and the ability to differentiate them from the endothelial cells of blood vessels have contributed to progress in recent decades in studying the role of the lymphatic system in the body. Preclinical and clinical studies of the last decade have shown that changes in the lymphatic vascular network are observed in almost all lung diseases. At the same time, it remains unclear whether the lymphatic vessels and lung nodes are being part of the overall process of lung remodeling or they make a defnite contribution to the pathogenesis of diseases of the respiratory system. This review presents current data on the morphology and physiology of lymphatic vessels and nodes, their role in the regulation of interstitial fluid homeostasis, lipid transportation and immune responses as well as describes the mechanisms of regulation of the transport function of lymphatic vessels. Data on the role of the lymphatic system of the lungs in the exchange of fluid in the interstitial space of the lungs are presented in the review. The results of studies of the last two decades on the formation and reabsorption of pleural fluid and the role of various lymphatic networks in regulating its volume are described. Finally, modern ideas on the mechanisms of pulmonary edema are outlined and important questions of the lymphatic biology of the respiratory system are identifed, still remaining unanswered today.