Pathomorphological basis and common NLS-symptom in patients with lung abscess was the presence of intrapulmonary cavity, the main diagnostic criteria of which were related to changing of chromogeneity of internal content and a wall. Spectral-entropic analysis helped to evaluate the content and its distribution in the cavity and thus to evaluate the efficiency of abscess spontaneous drainage through bronchi and decide if it was a purulent or a gangrenous form. Virtual visualization of walls was possible at chronic course of an abscess, thickness of walls and character of a contour were taken into consideration at differential diagnostics with cavernous form of peripheral lung cancer.

We singled out 4 types of acute lung abscess depending on efficiency of its spontaneous drainage through bronchi: blocked abscess, an abscess with insufficient spontaneous drainage, an abscess with free spontaneous drainage and an abscess with air pocket. These variants represent consecutive development steps of a nidal purulent-destructive process in a lung. Offered classification is based on differences in a structure of abscesses, namely on qualitative ratio of hypechromogenic purulent exudate (6 points at Fleindler’s scale) and achromogeneity of air inclusions (1 point) and a character of their spatial distribution in the cavity.

Blocked abscess was visualized as roundish neoplasm with hypechromogenic liquid content in which we detected isochromogenic suspensions (4-5 points at Fleindler’s scale), loosely distributed throughout a cavity of destruction (suppurative detritus), without achromogenic signals of air. At acute course a capsule of an abscess was not visualized. Purulent cavity was limited by lung parenchyma itself, which along with preserved air content was of the form of hypochromogenic line (2-3 points at Fleindler’s scale), but when air content was lost because of pneumonic infiltration, it was visualized as moderately chromogenic tissue (3-4 points). A width of this line varied depending on clarity of abscess limiting and significance of perifocal changes in a lung.

Burst of purulent content into bronchi meant start of open stage of abscess development with heterogeneous structure due to appearance of achromogenic signals against the background of hyperchromogenic fluid with suspensions. The efficiency of spontaneous drainage was evaluated by a quantity and a character of achromogenic inclusions (air) distribution in a purulent exudate. The drainage was considered insufficient at single or multiple lesser achromogenic cavities, diffusely distributed throughout the whole cavity of an abscess against the background of significantly prevailing hyperchromogenic content.

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