Clinical and radiological variants of lung damage in the infection caused by staphylococcus aureus

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Abstract

Despite the high level of modern technologies in the field of laboratory methods and imaging of the respiratory system, the problem of early and accurate differential diagnosis of inflammatory lung diseases remains important in practical medicine. It leads to improved treatment results and a reduction in the number of complications (pleural empyema, fistulas, mediastinitis, sepsis, etc.), and in some cases allows suspecting the presence of a primary purulent source in the body, such as that in the case of septic pulmonary embolism. The review covers the Staphylococcus aureus specifics as a pathogen of lung diseases, relevant epidemiology, pathogenesis, clinical features and imaging diagnostics of various types of inflammatory changes in the lungs with a focus on destruction.

About the authors

Anton S. Vinokurov

The Russian National Research Medical University named after N.I. Pirogov; Demikhov City Hospital of Moscow City Health Department; Vorokhobov City Hospital № 67

Author for correspondence.
Email: antonvin.foto@gmail.com
ORCID iD: 0000-0002-0745-3438
SPIN-code: 3029-2652
Russian Federation, 1, Ostrovityanova street, 117997, Moscow; Moscow; Moscow

Aleksandra D. Smirnova

Central State Medical Academy of Department of Presidential Affairs

Email: alexa199503@yandex.ru
ORCID iD: 0000-0002-5470-0999
SPIN-code: 6888-5058
Russian Federation, Moscow

Olga I. Belenkaya

The Russian National Research Medical University named after N.I. Pirogov; Demikhov City Hospital of Moscow City Health Department

Email: Olga-belenkaya@mail.ru
ORCID iD: 0000-0003-1121-8040
SPIN-code: 5358-4792

Cand. Sci (Med.)

Russian Federation, 1, Ostrovityanova street, 117997, Moscow; Moscow

Andrey L. Yudin

The Russian National Research Medical University named after N.I. Pirogov

Email: prof_yudin@mail.ru
ORCID iD: 0000-0002-0310-0889
SPIN-code: 6184-8284

Dr. Sci. (Med.), Professor

Russian Federation, 1, Ostrovityanova street, 117997, Moscow

Elena A. Yumatova

The Russian National Research Medical University named after N.I. Pirogov

Email: yumatova_ea@mail.ru
ORCID iD: 0000-0002-6020-9434
SPIN-code: 8447-8748

Cand. Sci (Med.)

Russian Federation, 1, Ostrovityanova street, 117997, Moscow

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2. Fig. 1. Chest CT, axial projection (а–г). Bilateral bronchopneumonia and bronchiolitis (with the etiology of S. pneumoniae and S. aureus confirmed by a sputum test). On both sides, more in the lower lobes against the background of bronchial sputum obturation (arrows), there are peribronchial nodules of various sizes, including a “tree in bud” sign (frame). In the upper lungs areas the nodules formed infiltrates. [Images from the authors’ archive].

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3. Fig. 2. Chest CT, axial projection (а–г). Bilateral polysegmental pneumonia. On both sides in the lungs, more to the right, there are infiltrates and cavities of various sizes without liquid content. Minor pneumomediastinum. [Images from the authors’ archive].

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4. Fig. 3. Chest CT, axial projection (а, б). Pneumonic infiltration in the upper lobe on the left with destructions. There are areas of a «crazy paving» sign in combination with consolidation, against the background of which one can see destructive cavities of various sizes without content, their outer contour is not traced. [Images from the authors’ archive].

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5. Fig. 4. Chest CT, axial projection (а, б). Septic embolism in a patient with infectious endocarditis of the tricuspid valve. In the picture of the lung damage, one can see predominance of both completely formed rounded cavities and those formed from subpleural opacities with clear contours (arrows). [Images from the authors’ archive].

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6. Fig. 5. Chest CT, axial projection (а–г). Septic embolism in a patient with infectious endocarditis. In both lungs, with a predominance in the peripheral parts, foci, small cavities, as well as opacities of a mixed type (consolidation in combination with «ground glass») are determined, reflecting the areas of infarcts. Minor pleural effusion on the left. [Images from the authors’ archive].

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7. Fig. 6. Chest X-ray. Acute abscess in the upper lobe of the right lung. In the upper lobe on the right there is a ring-shaped shadow with a small horizontal level of fluid, which indicates almost complete drainage of the abscess. In S3, next to the cavity, there is a non — uniform shading and thickening of the pulmonary pattern. [Images from the authors’ archive].

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8. Fig. 7. Chest X-ray. Acute abscess in the upper lobe of the right lung. The cavity in the upper lobe on the right is filled with liquid by 1/3 with a horizontal level that corresponds to the position of the patient during the image acquisition (arrows). [Images from the authors’ archive].

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9. Fig. 8. Axial (а–г) and sagittal (д) chest CT images. Forming abscesses in the extensive infiltrate of the upper lobe of the left lung. After an intravenous contrast enhancement, there are areas of reduced density (arrows), which correspond to purulent delimited foci, likely to turn into abscesses. Along the border of these areas, the contrast is somewhat enhanced, which may indicate the formation of a pyogenic membrane. [Images from the authors’ archive].

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10. Fig. 9. Chest CT, axial projection (а–г). A typical picture of an acute abscess. In the upper lobe on the right there is a filled cavity the outer and inner wall of the cavity having fairly clear contours, pericavitic infiltration is poorly expressed. [Images from the authors’ archive].

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11. Fig. 10. Axial (а, б) and sagittal (в) chest CT images. Multi-chamber «ladder» acute abscess in the upper lobe of the left lung. There is a small amount of fluid in the abscess, and there is no infiltration around the cavity. [Images from the authors’ archive].

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12. Fig. 11. Chest X-ray. Abscess in the upper lobe of the right lung, communicating with the pleural cavity on the right with the formation of a single combined space (confirmed by CT). There are drains both in the cavity of the abscess and in the cavity of the empyema. In the pleural cavity — a certain amount of fluid. [Images from the authors’ archive].

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13. Fig. 12. The same patient one presented in Fig. 11. Chest CT, axial projection from 14.12.2020 (а–в), 23.12.2020 (г–е) and 18.01.2021 (ж–и) at the corresponding levels. A typical course of staphylococcal pneumonia. Against the background of a massive infiltrate in the upper lobe on the right (with «sagging» of the pleura; arrow), multiple destructions were formed, which later merged into a single abscess cavity, also complicated by pleural empyema (arrow head). [Images from the authors’ archive].

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14. Fig. 13. Chest CT, axial projection (а, б). Chronic abscess of the upper lobe of the left lung in the period without exacerbation. There is an irregular cavity with clear outer and inner edges, the inner contour is bay-shaped. The contents in the cavity are absent, the lung tissue around it is deformed by strands and fibrous areas. [Images from the authors’ archive].

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15. Fig. 14. Axial (а–г) and sagittal (д) chest CT images. Gangrene of the upper lobe of the left lung. There is a total infiltration of the upper lobe with the presence of multiple irregular-shaped destructive cavities, as well as little areas of infiltration in other parts of the lungs. A small pleural effusion is seen on the left. [Images from the authors’ archive].

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16. Fig. 15. Axial (а–г) and sagittal (д) chest CT images. Gangrene of the upper and middle lobes of the right lung at its initial stage. There is a total infiltration of the lobes in the form of ground glass opacity and consolidation, against which there are oddly shaped cavities that tend to merge. [Images from the authors’ archive].

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17. Fig. 16. Chest CT, axial projection from 14.09.2020 (а, б) and 22.09.2020 (в, г). Negative dynamics of lung gangrene. Small cavities confluence into larger ones, irregular shapes, the contents in the cavities are absent. [Images from the authors’ archive].

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18. Fig. 17. Axial (а–г) and sagittal (д) chest CT images. Gangrenous abscess in the upper lobe of the left lung. On both sides, there is infiltration in the upper lobes, against the background of which there is a large cavity with clear contours on the left, and a sequester is forming inside. [Images from the authors’ archive].

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19. Fig. 18. Chest X-ray of the same patient one presented as in Fig. 17. In the upper lobe on the left, a non-uniform limited opacity is clearly visible, however, it is difficult to reliably judge the formation of the sequester against this background. [Images from the authors’ archive].

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Copyright (c) 2021 Vinokurov A.S., Smirnova A.D., Belenkaya O.I., Yudin A.L., Yumatova E.A.

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