Causes and symptoms of lung diseases. Signs, classification and prevention of major lung diseases. Types and methods of examination of the lungs

It showed that almost always cancer develops against the background of some chronic disease of the lung or bronchi.

Among the precancerous diseases of lung cancer are chronic bronchitis (moreover, in 90% of cases it is smoker's bronchitis), pneumonia, polypous growths on the bronchi, benign tumors, as well as focal compactions of the lung tissue.

Patients with these diseases need to undergo regular examinations with a doctor. Chronic diseases of the bronchi and lungs, as a rule, are characterized by persistent and prolonged course, are difficult to treat and require constant monitoring.

Chronic pneumonia is one of the most common precancerous conditions of the lungs. The disease is an inflammatory process, which is accompanied by irreversible structural changes in the bronchopulmonary system. The disease usually occurs after acute pneumonia, especially if it has taken a protracted course.

In the formation of the pathological process, a violation of the drainage function of the bronchi plays a special role. The inflammatory process is accompanied by changes in the epithelium of the bronchial mucosa (up to its keratinization), a violation of the activity of the bronchial glands. The inflammatory process in the bronchi supports the inflammatory process in the lungs.

Fertile ground for the development of precancerous conditions of the lungs are bronchiectasis, in which papillomatous growths appear on the mucous membranes of the bronchi. As a rule, bronchiectasis is the result of chronic inflammatory processes in the bronchi. In turn, chronic bronchitis itself can be a consequence of the occurrence of bronchiectasis. Papillomatous growths (bronchiectasias), according to many experts, can lead to the growth of atypical cells.

The nature of the changes can be examined using X-ray bronchography, cytological analysis of sputum and bronchoaspiration. The main symptom of a precancerous condition of the lungs, which is inflammatory in nature, is a hacking cough in the absence of physical changes in the lungs. Cough is usually dry at first, then - with sputum. The appearance of blood in the sputum, anemia, shortness of breath, weight loss usually indicates serious changes in the lungs.

Precancerous conditions of the lungs also include benign tumor processes in the lungs. There are epithelial tumors (bronchial adenomas, bronchial papillomas) and mesodermal tumors (cavernous vascular tumors, vascular endothelioma, capillary hemangioma, fibroma, lipoma, myoblastoma, hemartoma, teratoma, etc.). Among benign tumors of the lung, epithelial tumors are more common than others, namely, bronchial adenoma (85% of all benign tumors). Bronchial adenoma is also the most potentially dangerous precancerous condition of the lungs in terms of malignant transformation.

Symptoms of benign tumors depend on their size, localization, conditions of surrounding tissues, and many other factors. Bronchial adenomas, as a rule, manifest themselves as coughing, wheezing, hemoptysis. All benign tumors should be monitored; surgical treatment is indicated for violation of respiratory functions or when a risk of malignancy is detected. With bronchial adenomas, surgical treatment is recommended, which can be carried out through a bronchoscope, by electrocoagulation.

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Lung disease has become common. What are the most common of them, their features and symptoms?

Pneumonia (inflammation of the lungs)

As a result of a bacterial, fungal or viral infection, an inflammatory process occurs in the lungs. The causative agent of pneumonia can also be chemicals that enter the body with inhaled air. This disease can affect both all lung tissue and a separate part of the organ.

Symptoms: shortness of breath, cough, chills, fever. Characteristic features are chest pain and excessive fatigue, often there is an unexpected feeling of anxiety.

Swelling and inflammation of the pleura, that is, the outer membrane that covers the lungs. The causative agent of the disease can be an infection or injury that caused damage to the breast. Pleurisy can be a symptom of tumor development. The disease is manifested by pain during movements of the chest and with deep breathing.

Bronchitis

Bronchitis is of two types: and. Acute bronchitis occurs when the lining of the bronchi becomes inflamed. This disease is common among the elderly and young children. It occurs when the upper respiratory tract is infected, due to allergic reactions, when air containing chemical impurities is inhaled. The main symptom of acute bronchitis is a dry, sharp cough that worsens at night.

When bronchitis passes into the chronic stage, a constant cough appears, accompanied by copious secretion of mucus, breathing becomes difficult, swelling of the body is observed, the skin color may acquire a blue tint.

A chronic disease that manifests itself in the form of periodic attacks, which can be from a mild cough to severe attacks of suffocation. During an asthma attack, the bronchial tubes and chest wall constrict, making it difficult to breathe. The mucous membrane swells strongly, the cilia of the epithelium do not cope with their functions, which negatively affects the functioning of the lungs.

Over time, bronchial asthma progresses and leads to serious damage to the lung tissue. The main symptoms are coughing, heavy and noisy breathing, frequent sneezing, due to lack of oxygen, the skin may become bluish.

Asphyxia

Asphyxia can be called oxygen starvation, which occurs due to physical influences that affect breathing. The main causes: neck injuries, strangulation, tongue retraction as a result of trauma, pathology in the larynx, trauma to the abdomen or chest, dysfunction of the respiratory muscles.

In case of asphyxia, immediate resuscitation measures are necessary: ​​restoration of airway patency, artificial ventilation of the lungs, indirect heart massage. After the symptoms are eliminated, the causes of the disease are found out, and treatment is prescribed.

The causative agents of this lung disease are mycobacteria. Tuberculosis is transmitted by airborne droplets, that is, it is spread by carriers of the disease. How the initial stage of tuberculosis will proceed depends on the initial state of health of the patient, and on the number of bacteria that have entered the body.

When infected, the immune system reacts with the production of antibodies, and the protective system of the lungs envelops the affected mycobacteria in a kind of cocoons, in which they can either die or “fall asleep” for a while, in order to later manifest themselves with renewed vigor.

Usually, at the initial stage of tuberculosis, a person feels quite healthy, symptoms do not appear. Over time, the body begins to react with increased temperature, weight loss, sweating, reduced performance.

This is an occupational lung disease. The disease is common among construction workers, workers in the steel industry, miners and other workers who regularly inhale dust containing free silicon dioxide.

In the early stages, it is quite difficult to detect silicosis on your own, as it develops over many years. Only with a thorough examination can you see that there has been an increase in the airiness of the lung tissue. The later stages are characterized by: lack of air, chest pain, shortness of breath even at rest, cough with sputum, high fever.

With emphysema, the walls between the alveoli are destroyed, due to which they increase. The volume of the lungs grows, the structure becomes flabby, the respiratory passages narrow. Tissue damage leads to a decrease in the gas exchange of oxygen and carbon dioxide to a dangerous level. This lung disease is characterized by difficulty in breathing.

Symptoms begin to appear with significant damage to the lungs. Shortness of breath appears, the person is rapidly losing weight, reddening of the skin is observed, the chest becomes barrel-shaped, serious efforts are required to exhale.

An almost fatal disease. Those people who started treatment before the acute onset of symptoms have a greater chance of being cured. Unfortunately, lung cancer is very difficult to recognize. There are no symptoms that unconditionally point to this particular disease. Conditional symptoms are considered to be hemoptysis, chest pain, shortness of breath, cough. For timely diagnosis, doctors advise not to neglect regular examinations in clinics.

As you can see, the variety of symptoms does not allow you to make a diagnosis at home, therefore, if you suspect any lung diseases, you should consult a doctor and in no case prescribe treatment yourself.

Atelectasis is a pathological condition in which lung tissue loses its airiness and collapses, reducing (sometimes significantly) its respiratory surface. The result of the subsidence of a part of the lung is a decrease in gas exchange with an increase in the phenomena of oxygen starvation of tissues and organs, depending on the volume of the area that has lost its airiness.

Turning off the right or left lower lobes reduces the vital capacity of the lungs by 20%. Atelectasis of the middle lobe reduces it by 5%, and one of the segments of any of the apical lobes - by 7.5%, forcing the compensatory mechanisms to be activated, which manifest themselves in the form of symptoms characteristic of atelectasis.

At the same time, atelectasis should not be confused with zones of physiological hypoventilation of the lungs when a healthy person is at rest, which does not require active consumption of oxygen from the air.

The mechanism of formation of lung atelectasis and its causes

1. Local narrowing of the lumen of the bronchial tree:

• In cases of compression from the outside by a lung tumor located next to the bronchus;
• With a local increase in lymph nodes, which accompanies inflammatory and tumor processes;
• With processes occurring in the wall of the bronchus (with increased mucus formation or pus release, a tumor of the bronchus with growth into the lumen of the vessel);
• Ingress of foreign bodies (aspiration by vomit, with choking).

As a rule, this mechanism is realized with an additional reflex (contraction of the smooth muscles of the bronchi), which further narrows the airways.

2. Collapse of the lung tissue itself:

• With a decrease in air pressure inside the alveoli (violation of the technique of inhalation anesthesia);
• A sudden change in ambient air pressure (fighter pilot atelectasis);
• Reduced production or absence of surfactant, leading to an increase in the surface tension of the inner wall of the alveoli, causing them to subside (respiratory distress syndrome of the newborn);
• Mechanical pressure on the lung by pathological contents located in the pleural cavities (blood, hydrothorax, air), an enlarged heart or a large aneurysm of the thoracic aorta, a large focus of tuberculous lesions of the lung tissue;
• When interstitial pressure exceeds intraalveolar pressure (pulmonary edema).

3. Suppression of the respiratory center in the brain

Occurs with craniocerebral injuries, tumors, with general (intravenous, inhalation) anesthesia, excessive oxygen supply during artificial ventilation of the lungs, with an overdose of sedatives.

4. Violation of the integrity of the bronchus with a simultaneous rapid mechanical impact on it

It is observed during surgery (ligation of the bronchus as a method of surgical treatment for) or with its injury (rupture).

5. Congenital developmental anomalies

Hypoplasia and aplasia of the bronchi, the presence of tendon septa in the form of intrabronchial valves, esophageal-tracheal fistulas, defects in the soft and hard palate.

With all equal opportunities, the following people have an increased risk of lung atelectasis:

• smokers;
• Having increased body weight;
• Suffering from cystic fibrosis.

Classification of lung atelectasis

Depending on the sequence of involvement of the lungs in the pathological process:

Primary (congenital)

Occurs in children, often immediately after their birth, when there is no complete expansion of the lungs with the first breath. In addition to the already described intrauterine anomalies in the development of the lungs and insufficient production of surfactant, the cause of its occurrence can be aspiration of amniotic fluid, meconium. The main difference of this form is the initial absence of air from the environment entering the collapsed area of ​​lung tissue.

Secondary (acquired)

This form of atelectasis occurs as a complication of inflammatory, neoplastic diseases of the organs of both the respiratory and other systems, as well as chest injuries.

Various forms of lung atelectasis

According to the mechanism of occurrence, among the acquired forms of atelectasis, there are:

Obstructive atelectasis

It is observed with a decrease in the cross-sectional area of ​​\u200b\u200bthe bronchus for the reasons indicated above. Obturation of the lumen may be complete or partial. Sudden closure of the lumen when a foreign body enters requires immediate action to restore the patency of the bronchial tree, for the reason that with every hour of delay, the probability of straightening the collapsed area of ​​the lungs decreases. Restoration of lung ventilation in cases where complete bronchial obstruction lasted more than three days does not occur.

Compression atelectasis

Occurs with a direct impact on the lung tissue itself. A more favorable form in which full recovery of lung ventilation is possible even after a fairly long period of compression.

Functional (distensional) atelectasis

Occurs in zones of physiological hypoventilation (lower segments of the lungs):

1. In bedridden patients;
2. Having undergone severe and prolonged surgical interventions;
3. With an overdose of barbiturates, sedatives;
4. With an arbitrary limitation of the volume of respiratory movements, which is due to a pronounced pain syndrome (fractured ribs, peritonitis);
5. In the presence of high intra-abdominal pressure (ascites of various origins, chronic constipation, flatulence);
6. With paralysis of the diaphragm;
7. Demyelinating diseases of the spinal cord.

Mixed atelectasis

With a combination of different mechanisms of origin.

Depending on the level of bronchial obstruction and the area of ​​lung collapse, there are:

• Atelectasis of the lung (right or left). Clamping at the level of the main bronchus.
• Lobar and segmental atelectasis. Defeat at the level of the lobar or segmental bronchi.
• subsegmental atelectasis. Obturation at the level of the bronchi 4-6 orders.
• Discoid atelectasis. Discoid atelectasis develops as a result of compression of several lobules that are within the same plane.
• Lobular atelectasis. Their cause is compression or obstruction of the terminal (respiratory) bronchioles.

Signs of the presence of atelectasis of the lungs

The brightness of the symptoms, due to which it is possible to suspect the occurrence of atelectasis in the lungs, depends on a number of reasons:

1. The rate of compression of the lung tissue (there are acute and gradually increasing atelectasis);
2. The volume (size) of the respiratory surface of the lungs turned off from ventilation;
3. Localizations;
4. The mechanism of occurrence.

Dyspnea

It is characterized by an increase in the frequency of inhalation and exhalation per minute, a change in their amplitude, and arrhythmia of respiratory movements. Initially, a feeling of lack of air occurs during physical exertion. With an increase or initially large area of ​​atelectasis, shortness of breath appears at rest.

Chest pain

Optional attribute. It appears most often when air enters the pleural cavities.

Change in skin color

Caused by excess carbon dioxide in the tissues. In children, first of all, the nasolabial triangle turns blue. In adults, cyanosis of the fingers of the extremities (acrocyanosis), the tip of the nose appears.

Changes in the performance of the cardiovascular system

• The pulse quickens (tachycardia);
• After a short-term increase in blood pressure in the initial stages, it decreases.

In children, the indicated symptoms are also observed, which is most pronounced in newborns with primary atelectasis. They are joined by easily observed retractions of the intercostal spaces when inhaling from the side of the affected lung, as well as retraction of the sternum when air enters the lungs.

Diagnostics

With medical diagnosis, in addition to the symptoms noticeable to the patient, the following signs of the presence of atelectasis can be detected:

1. The sound when tapping the chest (percussion) in the area of ​​atelectasis becomes shorter and less sonorous (dulling) in contrast to the more "box" in the surrounding areas.
2. Weakening or complete absence of breathing during auscultation in the projection of atelectasis, asymmetry in the movements of the diseased and healthy half of the chest.
3. With atelectasis, covering all or almost all of the lung, the heart shifts towards the collapsed organ. This can be detected by percussion of the borders of the heart, by a change in the localization of the apex beat zone, and by auscultation of the heart.

You should also remember:

• Signs of atelectasis occur against the background of an already existing underlying disease, sometimes aggravating the already critical general condition of the patient.
• The collapse of a segment (in some cases even a lobe) of the lung for the patient may go unnoticed. However, it is these small collapsed areas that can become the first foci of pneumonia that are severe in such patients.

X-ray examination of the chest organs helps to clarify the presence of atelectasis, its localization and volume to determine the tactics of treatment. It is carried out in at least two projections. In more difficult cases, for the diagnosis of cases resort to the help of tomography.

X-ray signs suggesting the presence of atelectasis:

1. Change in the density (darkening) of the shadow of the compressed area of ​​​​the lungs in comparison with the tissues surrounding it, often repeating the contours of the segment, lobe;
2. Change in the shape of the dome of the diaphragm, displacement of the mediastinal organs, as well as the roots of the lungs towards atelectasis;
3. The presence of functional signs of bronchoconstriction (optional if the mechanism of atelectasis is not obstructive);
4. Convergence of the shadows of the ribs on the side of the lesion;
5. Scoliosis of the spine with the direction of the bulge towards atelectasis;
6. Stripe-like shadows against the background of unchanged areas (disc-like atelectasis) of the lungs.

Atelectasis of the middle lobe of the right lung on x-ray

Prognosis for atelectasis of the lungs

Sudden simultaneous total (subtotal) atelectasis one or two lungs, developed as a result of trauma (entry of air into the chest) or during complex surgical interventions in almost all cases ends in death immediately or in the early postoperative period.

obstructive atelectasis, developed with sudden blockage by foreign bodies at the level of the main (right, left) bronchi - also have a serious prognosis in the absence of emergency care.

Compression and distension atelectasis, developed with hydrothorax, with the removal of the cause that caused them, do not leave any residual changes and do not change the volume of the vital capacity of the lungs in the future.

Significantly change the prognosis for the restoration of the functions of a compressed lung can be joined, which in these cases leaves scar tissue that replaces the collapsed alveoli.

Treatment

1. Elimination of the mechanism of atelectasis with the restoration of ventilation in these areas

With obstructive atelectasis:

For compression atelectasis:

1. Pleural puncture with the removal of effusion and air from the cavities with the elimination of the causes of effusion and communication with the environment;
2. Surgical treatment of tumors of the lungs and lymph nodes, elimination of cavity formations (cysts, abscesses, some forms of tuberculosis).

With distension atelectasis:

• Breathing exercises with the creation of high intrabronchial pressure (inflating balloons);
• Inhalation with a mixture of air and 5% carbon dioxide to stimulate the respiratory center.

2. Artificial ventilation of the lungs with the addition of oxygen

It is carried out with the development of severe symptoms.

3. Correction of violations of the acid-base balance in the blood

It is carried out by the appointment of infusion intravenous therapy based on the patient's biochemical blood data.

4. Antibiotic therapy

Aimed at the prevention of purulent complications.

5. Posyndromic therapy

It includes the elimination of the pain factor, if any, the correction of cardiovascular activity (normalization of the pulse, blood pressure).

6. Physiotherapy

Chest massage is one of the methods of treatment of lung atelectasis.

It is carried out to prevent the formation of scars in the lung, improve blood circulation in the area of ​​atelectasis. To do this, UHF irradiation is used in the acute phase, and during the recovery period, electrophoresis with drugs (platifillin, eufillin, etc.) is used.

7. Therapeutic and preventive physical education and chest massage

Designed to improve the functioning of the respiratory muscles. Light vibration massage promotes the discharge of sputum and mucus from the bronchoalveolar tree.

Video: lung atelectasis in the program “Live great!”

Most often, cancer is preceded by such precancerous conditions of the lungs: chronic, often recurrent nonspecific pneumonia and bronchitis, bronchiectasis, pneumosclerosis, as well as diseases associated with dust irritation (anthracosis, silicosis).

bronchiectasis

Fertile ground for the emergence of the respiratory tract are bronchiectasis, since at the same time papillomatous growths develop on the bronchial mucosa, which are the result of chronic inflammatory processes in the bronchi. On the other hand, chronic bronchitis can cause bronchiectasis. By themselves, chronic inflammatory processes in the bronchi create favorable conditions for epithelial metaplasia, and papillary growths can further lead to atypical growth. There is still no consensus on inflammatory diseases as precancerous conditions of the lungs. Some authors categorically deny the role of chronic inflammatory processes as precancers, others, and most of them, believe that chronic inflammatory processes are one of the etiological factors of lung cancer.

Pneumonia

Chronic pneumonia should be considered as a precancerous condition of the lungs. According to the author, chronic inflammatory changes in the lungs are endobronchitis and panbronchitis with the formation of ectasias and polypous growths of the bronchial mucosa. This process is accompanied by metaplasia of the epithelium and even its keratinization. The inflammatory process in the bronchial mucosa, in turn, supports the inflammatory process in the lung parenchyma. To diagnose such changes is possible only with the help of X-ray bronchography followed by the study of the bronchial tree. With such a study, it is possible to observe bronchiectasis, as well as changes in the size and shape of the branches of the bronchi.

A very significant role in such studies is played by a cytological examination of sputum, and especially by the method of broncho-aspiration biopsy. The most common early symptom of a precancerous condition of the lungs is initially dry, and then with sputum production, a hacking cough for a long time in the absence of physical changes in the lungs. This symptom alone should alert. The appearance of streaks of blood in the sputum, shortness of breath, and emaciation indicate significant changes in the lungs and raise the suspicion of cancer.

Tumors

In addition to precancerous conditions of a mild inflammatory nature, benign tumor processes can undergo malignant transformation. Benign lung tumors are relatively common. According to the classification of Hochberg and Shaster, such tumors are distinguished:

Epithelial tumors: papillomas of the bronchus, adenomas of the bronchus;

mesodermal tumors:

1) vascular tumors: cavernous vascular tumors, capillary, vascular endothelioma;

2) intrabronchial tumors:

• myoblastoma,
• plasmacytoma,
• lymphoma;

3) peripheral tumors of the lung: neurogenic tumors, xanthoma and all types of tumors of the second group;

Congenital tumors: hemartoma, teratoma.

The most common precancerous conditions of the lungs are epithelial tumors. Bronchial adenoma accounts for 80-90% of all benign tumors. It is also the most threatening in terms of precancerous condition of the lungs and malignant transformation, although some authors deny this fact, arguing that benign tumors of the bronchi, including adenoma, are practically not a precancerous process.

The symptomatology of benign tumors is diverse and depends on the location, size of the tumor, the state of the surrounding tissues and complications. Often, the tumor does not manifest itself in any way and is an incidental finding on chest x-ray. As for adenomas of the lungs, which are more often located endobronchially, as they grow, they manifest themselves with cough, wheezing and hemoptysis. In this case, the symptoms are more pronounced, the more proximal they are localized in the bronchial tree.

Along with the described precancerous conditions of lung cancer, which play a certain role in the etiology of tumors, one should dwell on the role of external factors affecting the mucous membrane of the respiratory tract. In the occurrence of lung cancer, an important role is played by the inhalation of dust and gases from motors, tarmac roads, products of incomplete combustion of coal and oil, as well as tobacco smoke. In this case, the active principle is the derivatives of coal, which are contained in large quantities in the air of industrial cities. Entering the respiratory tract, they cause chronic recurrent inflammatory processes, which can result in malignant transformation of tissues. The fight against smoking, air pollution in cities and industrial enterprises is one of the important links in the fight against malignant neoplasms of the lungs.

• Alveolar, interstitial pulmonary edema on chest x-ray
• Venous stasis of blood in the lungs. Pulmonary hypertension. X-ray diagnostics
• Hypoventilation syndrome of the lungs. Diagnosis with x-ray
• Pulmonary infarction on chest x-ray. Detection of blood clots in the vessels of the lungs using methods of radiation diagnostics

Obstructive lung disease on x-ray. Cicatricial changes in the lungs on x-ray ( pneumosclerosis). X-ray of a smoker's lungs

Diseases that include an obstructive component include:

• Chronical bronchitis ;
• bronchial asthma and some others.

Chronic obstructive pulmonary disease. Diagnosis with x-ray

Chronic obstructive pulmonary disease is characterized by a number of radiological signs:

• in the initial stage of the disease, significant changes in the lungs and bronchi may be absent, but a slight increase in the pulmonary pattern is determined;
• subsequently there is a narrowing of the lumen of the bronchi and a simultaneous thickening of their walls;
• lungs increase in volume x-ray this is reflected in the enlightenment of the lung fields;
• the diaphragm occupies a lower position - at the level of the seventh or eighth rib;
• the difference in the area of ​​the lung fields in the picture during inhalation and exhalation is almost imperceptible;
• the diameter of the pulmonary arteries in the region of the lung root is increased ( right artery - more than 17 mm, left - more than 27 mm);
• the pulmonary pattern acquires a mesh character due to the pronounced fibrosis of the walls of the vessels;
• in the late stage of the disease, deformations of the walls of the bronchi are found ( so-called bronchiectasis).

Emphysema on chest x-ray

There are the following types of pulmonary emphysema:

• acinar emphysema- the alveolar part of the lung is affected ( acinus);
• uneven ( irregular) emphysema- appears in the area of ​​cicatricial changes in the lungs;
• bullous emphysema- combines several acini into large saccular extensions - bullae.

X-ray signs of bronchial asthma

Bronchial asthma is diagnosed using a set of procedures, of which the main one is the study of the function of external respiration. Unlike chronic obstructive bronchitis, in bronchial asthma, the functional volumes of the lungs increase when the allergic component is removed by inhalation of medications. In addition, a series of allergy tests is carried out to determine allergens.

X-ray examination in bronchial asthma is carried out, first of all, to exclude other diseases, mainly of an inflammatory nature ( pneumonia, acute bronchitis). In patients with bronchial asthma, x-rays show an increase in the transparency of lung fields on x-rays. If an x-ray is taken during or immediately after an asthma attack, shadows may be found on the x-ray, which quickly disappear. They are accumulations of mucus in the narrowed areas of the bronchi.

pneumosclerosis ( fibrosis) on chest X-ray. Cicatricial changes in the lungs on x-ray

Pneumosclerosis can develop due to various reasons:

• pneumonia;
• inhalation of toxic and toxic substances;
• violation of hemodynamics in the pulmonary circulation;
• some hereditary diseases.

The main signs of diffuse pneumosclerosis are the strengthening and deformation of the pulmonary pattern. Strengthening of the lung pattern looks like an increase in the number of mesh and linear shadows corresponding to the vessels and cords of the connective tissue in the area of ​​the lung field. The deformation of the pulmonary pattern consists in the unevenness of the contour of the vessels, its expansion and change in their direction. It is necessary to distinguish between age-related changes in the lungs and pathological pneumosclerosis, since with the aging of the body, similar changes can be observed on x-rays.

Calcifications in the lungs. Identification of calcifications using x-rays

Calcifications appear at the site of the following formations:

• tuberculous granuloma;
• lung abscess;
• cysts containing worms or their larvae;
• pneumonia;
• tumor process;
• congenital calcifications.

X-ray of lungs of smokers

On an x-ray of a smoker's lungs, the following changes are noted:

• strengthening of the lung pattern;
• the appearance of additional shadows up to 2 millimeters, which correspond to mucous plugs and small inflammatory infiltrates in the lungs;
• deformation of the contours of the root of the lung;
• thickening of the walls of the bronchi.

• Chronical bronchitis;
• pneumonia;
• emphysema;
• chronic obstructive pulmonary disease;
• pneumosclerosis;
• cancer of the lungs, larynx and upper respiratory tract.

Sarcoidosis on chest x-ray

There are four variants of sarcoidosis of the lungs when using the x-ray diagnostic method:

• mediastinal variant ( lat. mediastinum - mediastinum). It is characterized by uniform bilateral expansion of the roots of the lung. The roots of the lung are tuberous, non-uniformly colored, granulomas in the region of the root of the lung look like denser rounded shadows.
• disseminated variant. Differs in the dispersion of granulomas over the entire area of ​​the lung field. They look like shadows ranging in size from 2 millimeters to 1 centimeter. The foci are located mainly in the upper and middle sections of the lungs. The pulmonary pattern is also deformed; loops and networks can be found in it.
• parenchymal variant. It is characterized by the simultaneous presence of areas of enlightenment and shading in the lungs. This is due to the fact that simultaneously with the phenomenon of fibrosis, expanded areas are formed, as in emphysema.
• interstitial option. It is characterized mainly by a change in the pulmonary pattern. Fibrosis occurs around the partitions between the alveoli, in the wall of the bronchi and blood vessels.

Radiation diagnosis in urgent conditions of the lungs. Edema, pulmonary infarction. Hydrothorax, pneumothorax

Urgent conditions caused by lung pathology include:

• pulmonary edema;
• lung infarction;
• pneumothorax;
• hemothorax;
• lung atelectasis;
• shock lung.

Alveolar, interstitial pulmonary edema on chest x-ray

There are two types of pulmonary edema:

• Interstitial edema. It is characterized by the accumulation of fluid leaving the vascular bed in the intercellular space. Interstitial edema occurs when pressure in the pulmonary veins rises above 25 mm Hg. Art. Patients complain of the inability to take a deep breath, deterioration in the horizontal position.
• Alveolar edema. With alveolar edema, fluid from the intercellular space enters the alveoli. At the same time, breathing becomes bubbling, abundant foamy sputum is released.

The X-ray picture of alveolar edema is somewhat different from interstitial. With alveolar edema in the lungs, rounded shadows are found, multiple, merging with each other. Shadows in the lower parts of the lung are combined with the shadow of the root of the lung, which creates a characteristic x-ray picture of "butterfly wings". When eliminating pulmonary edema, it is necessary to act on the cause of this condition.

Venous stasis of blood in the lungs. Pulmonary hypertension. X-ray diagnostics

There are the following causes of pulmonary hypertension:

• congenital pulmonary hypertension ( primary);
• valvular heart disease;
• insufficiency of the left ventricle of the heart;
• chronic lung diseases;
• sarcoidosis;
• the action of certain drugs.

Pneumothorax on x-ray

Pneumothorax is of the following types:

• Open pneumothorax. This type of pneumothorax occurs when the chest is injured, due to which the atmospheric pressure in the pleural cavity is compared with the external environment. The collapsed lung is completely switched off from breathing.
• closed pneumothorax. It is characterized by the ingress of a limited amount of gas into the pleural cavity. Over time, it can resolve and the lung will return to normal.
• Valvular pneumothorax. The most severe type of pneumothorax, which differs in that air enters the pleural cavity in a unilateral direction and its amount gradually increases.

• detection of thin dense ( light shade) lines corresponding to the inner pleura;
• displacement of the mediastinum in the opposite direction from the site of the lesion;
• a slight increase in the amount of pleural effusion, which is characterized by a horizontal level in the lower lung field;
• extensive or local enlightenment of the lung field.

Hydrothorax on lung x-ray

Normally, the thickness of the pleural fluid layer is no more than a millimeter. The minimum volume of fluid for hydrothorax is 50 ml, but it can be more than 1.5 liters. Hydrothorax can appear due to trauma, cirrhosis of the liver, ascites, renal failure, tumor processes and a number of other reasons. Hydrothorax looks different on x-rays, depending on the amount of fluid and the cause.

X-ray with hydrothorax is performed in direct projection. The picture shows a shadow of medium intensity, in which the outer edge is higher than the lower one due to the difference in pressure in the pleural cavity. The dome of the diaphragm, the costophrenic angle are indistinguishable with hydrothorax. With the localization of fluid in the region of the posterior wall of the chest cavity, the lung fields appear blurred. The amount of fluid in the pleural cavity is determined only approximately.

Hydrothorax must be distinguished from pleurisy, pneumonia, pulmonary edema. For this, an x-ray in the lateral projection and computed tomography are additionally performed. On computed tomography, you can see the exact position of the fluid and measure its volume, since with this method the resolution and contrast are higher than with x-rays. Surgeons perform a hydrothorax puncture, only guided by computed tomography data.

Lung atelectasis. X-ray picture

The following causes of atelectasis are distinguished:

• obstructive atelectasis- occurs due to the complete closure of the lumen of the bronchus;
• functional atelectasis- violation of the expansion of the lungs on inspiration;
• compression atelectasis- the most common variant, caused by increased pressure on the lung from the outside by a gas or liquid;
• mixed atelectasis- combines various reasons from the above.

• reduction in chest volume;
• upward displacement of the diaphragm;
• the mediastinum and trachea are displaced towards the lesion;
• uniform darkening of the entire lung field with total atelectasis;
• focal atelectasis has a disk-like shape and is observed, as a rule, in the lower parts of the lung.

Hypoventilation syndrome of the lungs. Diagnosis with x-ray

Hypoventilation can develop as a result of the same causes as atelectasis. These include blockage of the lumen of large bronchi, increased pressure from the outside on the lung, the presence of foreign bodies. On x-ray, hypoventilation syndrome is manifested by a decrease in lung volume, a decrease in diaphragm mobility. Just like with pneumothorax, with this syndrome, a valve can form in the bronchi that allows air to pass in only one direction, therefore, on an x-ray, a part of the lung may have increased transparency.

Pulmonary infarction on chest x-ray. Detection of blood clots in the vessels of the lungs using methods of radiation diagnostics

In a lung infarction, an X-ray examination should be performed urgently. In the first 12 hours, shadows are determined in the places of embolism, corresponding to the places of blockage of the vessels. A characteristic sign of a heart attack is a shadow in the form of a wedge, corresponding to that part of the lung that was fed by the affected vessel. It has a connection with the root of the lung. In addition, other signs of a heart attack are noted on the x-ray. An x-ray shows a pleural effusion, expansion and deformation of the lung root. A pulmonary infarction may also be accompanied by interstitial edema. The best outcome of pulmonary infarction is scarring of the affected area ( so-called focal pneumosclerosis).

Unfortunately, pulmonary infarction is an irreversible condition. It is possible to prevent necrosis of lung tissue when a vessel is blocked only if it is removed within the first few hours. Therefore, in recent years, special attention has been paid to methods for detecting blood clots in the vessels of the lung. This method is computed tomography using contrast agents.

Shock lung. Diagnosis with x-ray

Radiologically, there are 5 stages of development of a shock lung:

• I stage. Uniform strengthening of the pulmonary pattern. It deforms with the formation of cells and loops.
• II stage. The deformation of the pulmonary pattern increases, however, small focal shadows appear against its background ( up to 3 millimeters). The lung field remains transparent.
• III stage. The transparency of the lung field is reduced, starting from the lower sections. In the middle and upper parts of the lung, focal shadows merge and range in diameter from 4 to 8 millimeters. Pulmonary pattern is worse visualized.
• IV stage. The condition of patients at this stage is very serious. The entire lung field is darkened; against their background, the lumen of the bronchi is well visualized. The lung pattern is not visible.
• V stage. At this stage, acute phenomena subside. As residual effects, the lung tissue is replaced by connective tissue over almost the entire area of ​​the lung, and the pattern of the lung is made up of strands of connective tissue ( diffuse pneumosclerosis observed).

Where can a lung x-ray be taken?

In Moscow

In St. Petersburg

In Kazan