[Diagnostic difficulties in patients with disseminated processes in lungs]

Pulmonary disseminations are frequently encountered in the practical work of a multi-disciplinary hospital and require differential diagnostics by join efforts of specialists in different fields of medicine. The aim of this study was to estimate the frequency and clinical picture of these conditions. We analysed clinical records of 154 patients admitted to the department of pulmonology and intensive therapy. Most patients in need of intensive therapy (n=54) presented with disseminations of infectious origin, such as disseminated tuberculosis (32%), pulmonary problems associated with sepsis and infectious endocarditis (14%), HIV-associated disseminations (23%). Canceromatosis and idiopathic interstitial pneumonia occurred in 18 and 13% of the cases respectively. Patients in the department of pulmonology had pulmonary dissemination syndrome of unclear origin or no overt clinical symptoms (n=100). The leading cause of their disease was sarcoidosis (60%) and idiopathic interstitial pneumonia (20%). 27 patients had this syndrome associated with HIV/AIDS. Clinical examples and difficulties of early diagnostics of pulmonary dissemination syndrome are discussed with reference to underlying diseases (sepsis, infectious endocarditis, HIV/AIDS, Goodpasture's syndrome). Special attention is given to the management of this condition based at a multidisciplinary hospital.