MATERIALS AND METHODS. Preliminary clinical and morphological analysis of a group of patients with various post-COVID complications and with surgical treatment was performed. For the period 2020-2021 in the clinic of thoracic surgery of the SI “National institute of phthisiology and pulmonology named after F.G. Yanovsky of the NAMS of Ukraine” 12 patients were treated who had coronavirus disease (COVID-19) in anamnesis and underwent surgery for COVID-19 complications. RESULTS AND DISCUSSION. Data on the type of surgery, X-ray conclusion and preliminary clinical diagnoses of patients with post-COVID pulmonary complications are presented. At the time of surgical treatment, according to clinical data, 4 (22.2 %) patients were diagnosed with lung abscess, 4 (22.2 %) patients had a disseminated process in the lungs of unclear origin, 2 (11.0 %) – a solitary formation of the lung, one (5.5 %, respectively) observation – spontaneous pneumothorax and suspected tumor of the lung. The results of the histopathological conclusion on the operative material and the final clinical diagnosis in the group of patients with atypical lung lesions after COVID-19 are presented. The results of histopathological examination showed that after 3 months and more after recovery from COVID-19 in some patients there are persistent pathological changes in lung tissue of various characters, and quantitatively among them prevail cases of various pathologies associated with damage to the vascular bed of the lungs. CONCLUSIONS. In most cases of pulmonary complications after suffering COVID-19, preliminary clinical diagnoses did not fully correspond to the identified pathological process. Morphological examination of the operative material of patients with a history of COVID-19 and postcocious complications associated with the lungs, found that vascular pulmonary pathology predominates: persistent microvasculitis of small blood vessels, pulmonary infarction, metacarpal metaplasia, secondary vascular malformation.

Objective — to acquaint doctors of different profiles with thoracic pathology in patients with coronavirus infection. Materials and methods. Since the beginning of the SARSCoV-2 pandemic, on the basis of the clinical department for the surgical treatment of tuberculosis and NZL complicated by purulent septic infections 70 patients were treated, of which 39 (55.7 %) had various broncho-pulmonary purulent-inflammatory complications of coronavirus infection. Results and discussion. The distribution of treated patients with bronchopulmonary purulent-inflammatory complications of coronavirus infection by nosology is presented in Table 1. According to the table presented, pleural empyema was a frequent bacterial complication of the respiratory system — 18 (46.1 %) cases; only 6 (33.3 %) patients were diagnosed with broncho-pleural communication, while in 12 (66.7 %) patients, already at the stage of hospitalization, a functioning broncho-pleural fistula was observed.17 (94.4 %) patients with empyema underwent videothoracoscopic (VATS) debridement of the pleural cavity with polydrainage and the use of prolonged active aspiration in the postoperative period. The management of such patients was no different, except for 2 points: the need to continue GCS therapy and the obligatory long-term prescription of anticoagulants and antiplatelet drugs.In 1 (5.6 %) case, due to the extremely serious condition of the patient, only drainage of both pleural cavities was performed (this case was fatal). In another case, after 2 VATS of the pleural cavity, bronchial blocking of the upper lobe and intermediate bronchi of the right lung was performed, followed by active aspiration. Nonspecific exudative pleurisy was diagnosed in 8 (20.5 %) patients after coronavirus infection. There were 13 patients with abscess pneumonia and abscesses (33.3 %). This group of patients underwent drug therapy for a long time, which consisted in the appointment of broad-spectrum antibiotics, anticoagulants, pathogenetic therapy and symptomatic treatment.After a course of conservative treatment, 9 (69.2 %) patients underwent the following surgical interventions — sublobar resection for a sanitized lung abscess in 4 (44.5 %) cases, lobectomy in the presence of sanitized residual large cavities in 3 (33.3 %) patients, partial pleurectomy with decortication of the lung and sublobar resection of the lower lobe of the left lung in 2 (22.2 %) patients.Conservative therapy was successful only in 4 (30.7 %) patients. All 13 patients with abscess pneumonia and abscesses were discharged from the institute with full recovery or improvement (small sanitized destruction cavities up to 2 cm in diameter remained in the lung parenchyma). There were no lethal outcomes.The overall effectiveness of the treatment of this contingent of patients was 97.4 %, and the general mortality rate — 2.6 %.Videothoscopic treatment was effective in 25 (64.1 %) patients with pleural empyema and nonspecific pleurisy, and in 4 (16 %) patients it allowed to stabilize the condition and carry out resection surgery. Conclusions. Purulent-destructive complications of the respiratory system in coronavirus infection have a causal component, and therefore timely exposure to all parts of the pathogenesis can significantly reduce their level. Preference should be given to videothoracoscopic intervention in the complicated course of coronavirus infection. The high level of diagnosis (25.4 %) of concomitant pathology of the chest with the widespread use of radiological methods in the pandemic of coronavirus infection may indicate a low level of preventive medicine in the state.

BACKGROUND. In December 2019, cases of pneumonia of unknown etiology were detected in Wuhan (China), and later a new type of coronavirus was identified – SARS-CoV-2. In March 2020, spread of the SARS-CoV-2 was officially recognized as a pandemic. OBJECTIVE. To demonstrate to the doctors of the thoracic surgery and pulmonology departments our experience in the tactics of treating subpleural and intrapulmonary hematomas, which is a consequence of a coronavirus infection, and determining the need for surgical intervention. MATERIALS AND METHODS. From the beginning of the COVID-19 pandemic on the basis of the clinical department of the surgical treatment of tuberculosis and non-specific diseases complicated by purulent-septic infections of the SI “National Institute of Phthisiology and Pulmonology named after F.G. Yanovsky of the NAMS of Ukraine” treated 11 patients with spontaneous hematomas of post-COVID genesis, of which subpleural hematomas accounted for 9 cases (81.8 %), and intrapulmonary – 2 (18.2 %). The distribution by gender was as follows: 7 (63.6 %) women were treated, and 4 (36.4 %) men. The age of the patients ranged from 28 to 70 years, the average age was 45 years. This group of patients had the following associated pathologies: chronic obstructive pulmonary disease – 3 (27.3 %), hypertension – 3 (27.3 %), diabetes – 2 (18.2 %), chronic renal failure – 1 (9.0 %), ischemic heart disease – 2 (18.2 %). CONCLUSIONS. Lack of timely diagnosis and surgical treatment of subpleural and intrapulmonary hematomas often leads to the addition of secondary infection, which complicates the treatment process.

Воспалительная миофибробластическая опухоль может развиваться в любом возрасте, но чаще встречается у детей и лиц молодого возраста. Наиболее часто она поражает легкие. Прижизненная диагностика опухоли вызывает значительные трудности до ее оперативного удаления. Малый объем биопсийного материала обычно неинформативный. Основной метод лечения данной категории больных-хирургический. В статье приведен клинический случай воспалительной миофибробластической опухоли легкого, которая возникла у ребенка 10 лет. На первом этапе была выполнена VATS-ревизия и биопсия новообразования верхней доли левого легкого для уточнения диагноза. После получения гистологического заключения больной была проведена левосторонняя пульмонэктомия с медиастинальной лимфодисекцией, по скольку выполнить верхнюю лобэктомию было технически невозможно. Ключевые слова: воспалительная миофибробластическая опухоль, диагностика, хирургическое лечение.

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