The differential diagnosis of pulmonary diseases is extremely difficult and requires high qualifications of the radiologist and clinician. The differential diagnosis is used to distinguish different lung diseases: nonspecific inflammatory lung diseases (empyema, abscess, pneumonia), tuberculosis, sarcoidosis, benign tumors, lung cancer, lymphogranulomatosis, metastatic changes, and inflammatory changes in lung tissue. We present a clinical case, in which the differential diagnosis between tumor and inflammatory changes in lung tissue allowed the choice of optimal treatment tactics.

Treatment outcomes of stearnal osteomyelitis in a breast cancer patient were analyzed. Sternal osreomyelitis is a rare disease and is extremely difficult to treat, Osteomyelitis usually begins as an acute infection, but it may evolve into a chronic condition. When planning treatment tactics, surgical treatment is preferable. Antibiotic therapy is usually given in the pre and postoperative periods, and adequate antibiotic regimens reduce the likelihood of subsequent episodes of reactivation of the inflammatory process. The choice of monoand combination antibiotic therapy is a challenge.

Aim: the problem of postradiation lung injury is extremely topical, because of the close proximity to vital organs and the need of the significant part of tissue to receive the high dose of radiation in patients with breast cancer (BC). The aim of the analysis is to determine the frequency, severity of radiation damage to the lung tissue in women with BC, the frequency dependence on the technology of radiation therapy (RT) and the dose of radiation exposure, using 2D-conventional and 3D-conformal radiation therapy.materials and methods: we analyzed the data concerning the studies of thoracic organs (X-ray and computer tomography investigation) in 513 Tis-2N0-2M0 BC patients, receiving complex organ sparing treatment between 1996 and 2013 years. 318 patients were treated with postoperative 2D-conventional radiotherapy to a dose of 50 Gy, 195 patients - with 3D-conformal radiotherapy.results: we indicated that radiologically detected lung injury occur equally often in case of using 2D and 3D radiation therapy: 27,4 and 28,7%, respectively ( p >0,05); their frequency was significantly increased by 20-24% during radiotherapy only of the mammary gland and 37-41% - when doctors added the radiotherapy of cervical, supra - and infraclavicular regions. We showed that the risk of radiation pneumonitis in the ipsilateral lung was more than 25% and was significantly increased on the V20 increasing of the average dose to the lung more than 15 Gy.

Despite of improvement of radiotherapy techniques and increasing usage of conformal radiation therapy which provides decrease of dose for normal tissues and organs, cases of radiation-induced injuries are still registrated. The aim of this study is to determine frequency and severity of lung toxicity in 513 breast cancer patients with Tis-2N0-2M0 disease after breast conserving surgery and chemotherapy depending from radiation therapy technique and irradiation volume. It is quite clear that in breast cancer patients frequency of lung toxicity after breast conserving surgery and RT increases from 20-24% when irradiating only breast to 37-41% when irradiating breast and regional lymph nodes. In our analysis the frequency of lung toxicity was quite similar for 2D conventional therapy (27,4%) and for 3D conformal therapy (28,7%). The risk of developing radiation pneumonitis increases dramatically with extension of V20 for ipsilateral lung more than 30%, mean lung dose more than 18 Gy, in patients with initial small volume of the lung (less than 110 cm3).