Causes of darkening in the lungs on x-rays. Darkening in the upper lobe of the lung

The results of fluorography can reveal not only the onset of tuberculosis, but also many inflammatory diseases and processes affecting the lungs, bronchi and adjacent tissues.

It is advisable to undergo an examination for preventive purposes once a year. If there is a history of a disease of the respiratory system or there is a threat to the respiratory system due to professional activities, additional examinations may be prescribed - this is not dangerous to health.

Types of blackouts in the lungs

What is it - darkening in the lungs on fluorography, and how can they be classified?

Depending on the lesion, you can see the blackout of the following character in the picture:

• focal;
• segmental;
• equity;
• focal;
• indicating the presence of liquid;
• indefinite shape with blurry contours.

All changes in the lung tissue are reflected in the picture and change the clinical picture.

The causes of darkening in the lungs can be:

• pulmonary tuberculosis in various stages and forms;
• oncological processes;
• collapse of the lung - the formation of an impassable area for air;
• purulent-inflammatory processes - abscesses;
• problems with the pleura - the membrane that separates the respiratory system from other organs located in the chest;
• accumulation of fluid in the pleural region.

Dark spots in the picture also appear with problems in the organs, which also fall into the focus of the x-ray machine. This happens with an increase in lymph nodes caused by inflammatory processes in any parts of the body, neoplasms on the spine or ribs in the chest, with problems with the esophagus - for example, with its pathological expansion.

If a blackout is detected in the x-ray during fluorography, this does not mean that they will immediately “lock” into a tuberculosis dispensary and begin to “force” feed them with pills for tuberculosis. As you can already see, the dark area in the picture does not always indicate problems with the respiratory system.

First, a detailed x-ray examination will be prescribed, in which the chest will be photographed in several projections. It is very important that the image is then read by an experienced radiologist, in order to avoid errors that can seriously affect the patient's health.

If there is a darkening in the lungs, the diagnosis is already made according to the detailed X-ray data.

Reasons for blackouts

Focal blackouts look like small nodules in the lungs - up to 10 mm in diameter. They are caused by vascular disorders, the initial stages of oncological processes and diseases of the respiratory organs. In order to accurately identify the cause, in addition to X-rays, it is necessary to do a computed tomography and pass general tests, which, in addition to the “on duty” - urine and blood, also include sputum.

Sputum sampling for examination is a common procedure for lung diseases.

Despite the patient's complaints of coughing and chest pain, a blood test may not show any changes. Such a clinical picture is typical for focal tuberculosis, so routine examinations will continue to accurately establish the diagnosis.

Focal blackouts also occur in the picture with myocardial infarction or with lung cancer. Symptoms of a heart attack in many ways can resemble the acute development of tuberculosis.

Additional symptoms: pain in the chest, shifted to the left side and extending to the side and back, hemoptysis. With myocardial infarction, thrombophlebitis of the lower extremities develops.

Lung cancer is detected by blood tests.

Segmental blackouts are visible in the picture as segments with clear contours - in most cases they have a triangular shape. If the segment is single, this may be due to: traumatic damage to the lung tissue, the presence of an endobronchial tumor of various etiologies, the presence of a foreign body - children often inhale small parts of toys.

If there are several segments, then the patient can be diagnosed with:

• inflammation of the lungs of varying severity in acute or chronic form;
• tuberculosis;
• narrowing of the central bronchial branch due to stenosis;
• the presence of metastases in surrounding organs;
• accumulation of fluid in the pleural region.

Lobar shading has clear contours that are clearly visible in the picture. This picture indicates the presence of chronic lung diseases - purulent tissue lesions, bronchiectasis or others. If an obstruction of the bronchus is visible in the picture, the presence of a malignant process can be suspected.

Focal obscurations appear with the following problems in the lungs and surrounding tissues:

• inflammation of the lungs;
• accumulation of fluid in the pleural tissue - effusion;
• the occurrence of eosinophilic infiltrate - helminthic invasion;
• bronchial asthma;
• abscess.

They cause focal blackouts in the picture of a tumor of various etiologies, bone calluses that have grown on the ribs after fractures.

Causing increasing edema of the organ, accumulates with an increase in intravascular pressure during ischemia or general intoxication of the body.

Pathologies expressed by blackouts of an indefinite form can be signs of many diseases:

• inflammatory processes caused by staphylococcal infection;
• accumulation of pleural fluid;
• heart attack;
• exudative pleurisy.

Therefore, you should not make a diagnosis yourself if, upon receipt of a form from the fluorography room, it will have an inscription on the presence of changes. Next, they will take a detailed picture and only then, according to the description of the specialist, a decision will be made on further diagnostic measures in order to determine how to treat the disease that has arisen.

Image interpretation

Conclusions from a radiologist with a presumptive diagnosis may look like this:

1. The roots are compacted and expanded - possible: bronchitis, pneumonia, bronchial asthma.
2. The presence of stringy roots in the picture is typical for exacerbations of chronic bronchitis and may indicate smoking abuse.
3. Strengthening of the vascular pattern can be a symptom of: problems of the cardiovascular system, inflammation, bronchitis, cancer in the initial stage.
4. The presence of fibrous tissue indicates a history of respiratory disease.
5. If the conclusion of the radiologist says: focal shadows, this is a signal for the doctor: to appoint additional examinations. Such symptoms indicate the presence of pneumonia in the upper or middle sections or tuberculosis.
6. With clear spots in the picture, caused by the presence of calcifications, the patient does not require treatment. The subject came into contact with patients with tuberculosis or bacterial pneumonia, but his body defeated the disease on its own. The infection was isolated by deposits of calcium salts.

Pictures can be described as follows.

There are aperture changes. Such anomalies develop for genetic reasons, due to adhesive processes in the chest, chronic diseases of the digestive organs - the liver, esophagus, stomach, intestines.

Fluorography is a method of X-ray examination, which involves photographing an image of an object from the screen Darkening in the lungs on fluorography - what is it? This question is asked by many people whose fluorographic image is ambiguous.

An eclipse can mean a lot or nothing at the same time, so if the radiologist gave such a conclusion, you should not be nervous - because such patients are prescribed a pre-examination. Darkening on fluorography can be both a sign of pathology and a simple defect in the picture.

Darkening in the lungs can be due to: pneumonia, bronchitis, tuberculosis, tumors, cancer, trauma, foreign objects, abscesses, fluid accumulation and prolonged smoking. In medicine, these are the most common causes of eclipses.

Numerical codes used in the evaluation of the fluorogram

Darkening in the picture is not necessarily a pathology

Darkening in the picture is not necessarily oncology or tuberculosis, although this, of course, can also indicate a serious pathology. In addition, an eclipse may appear in the picture when smoking cigarettes for a long time (see).

From here, it is difficult to immediately determine what the blackout in the right or left lung on fluorography could mean. Maybe a foreign object got there?

This often happens with curious children. Note that the types of eclipses are not directly related to pathologies, and the problem cannot be immediately identified by the shape of the spot.

The dark spot on the lung on fluorography is divided by number and size. Single spots indicate tumors; they can be malignant and benign.

If there is more than one blackout in the lungs on fluorography, then this indicates the presence of several pathologies. The location of the spots is also important.

So, if a lesion of the apex of the organ is visible on the darkening in the lungs on fluorography, then this may indicate tuberculosis, but the doctor must prescribe, in addition to tests, a second picture.

Deciphering a fluorography image

In the presence of blackouts, the doctor writes out the proposed diagnosis.

Strengthening of the vascular pattern

Usually, the increased vascular pattern is caused by the shadow of the pulmonary arteries or veins. Its increased appearance is a sign of bronchitis, the initial stage of cancer or pneumonia. Also, this may indicate shortcomings in the work of the cardiovascular system.

Compaction and expansion of the roots

Compaction and expansion of the roots are characteristic of: pneumonia, bronchitis and other, chronic and inflammatory pathologies.

Pleural sinus

The pleural sinus is a cavity that is formed by the pleural folds. The sinus is free with normal lungs, and, conversely, sealed with pulmonary pathology.

fibrous tissue

The presence of fibrous tissue indicates that the patient has already had pneumonia.

spikes

The presence of adhesions suggests that in the past a person had inflammation of the pleura.

Calcifications

Safe dense round shadows. They say that a person had contact with a sick person: or pneumonia.

In other words, that an infection got into the lungs, but it was localized and did not develop, and was isolated by deposits of calcium salts.

White is calcifications in the lungs (focus picture)

Aperture changes

Changes in the diaphragm indicate an anomaly in its sheets. Usually this pathology develops due to poor genetics, adhesions deformity, overweight, past diseases.

Focal shadows

Focal shadows are dark spots about 1 centimeter in size. Can talk about what it is or tuberculosis disease.

Displacement of the mediastinal shadow

The mediastinum is the space between the lungs and other organs. The expansion indicates increased pressure, an increase in the size of the heart, myocarditis or CHF.

Types of dimming

Blackout in pneumonia

Pneumonia caused by Pseudomonas aeruginosa is characterized by an acute onset, severe general condition, high body temperature, shortness of breath, cyanosis, tachycardia, signs of intoxication, focal dullness of percussion sound, crepitus, and the presence of wheezing. Pneumonia can be complicated by pleurisy.

On fluorography of the chest organs, focal lesions (foci of inflammatory infiltration) are detected, in the case of abscessing, cavities with a horizontal level are found, and in the presence of exudative pleurisy, intense homogeneous blackout. Pseudomonas aeruginosa is sown from sputum, the contents of the pleural cavity, and discharge from wounds.

Darkening with paragonimiasis

The initial stage of paragonimiasis proceeds as an acute allergic disease. Detect changes in the lungs ("volatile" infiltrates, pneumonia, pleurisy).

Allergic myocarditis, meningoencephalitis is quite often observed. Basically, the initial stage of the disease is asymptomatic. With the transition to the subacute, and then to the chronic stage, changes in the lungs predominate: chest pain, cough with sputum, effusion in the pleural cavity, fever.

Later, fibrotic changes in the lungs develop, the fluorogram reveals foci with characteristic radiar shading and light vacuoles in the center, areas of infiltration in the lung tissue, calcifications, and sometimes diffuse pneumosclerosis.

Darkening with candidiasis

With a mild course of the disease, candiosis resembles the clinical picture of bronchitis. On the radiograph, an increase in the bronchovascular pattern is found. In the later stages and in severe cases, candidiasis of the lungs manifests itself as focal or lobar pneumonia, unstable "volatile" infiltrates are possible.

On fluorography, there will be a spotted eclipse, which means small pneumonic foci, atelectasis. Sometimes there are miliary shading ("snow flakes"). Candida pneumonia can be complicated by pleurisy.

Darkening with diffuse pneumosclerosis

Features of the clinical course of diffuse pneumosclerosis. Complaints of patients cough with sputum (as a result of concomitant bronchitis), shortness of breath, which first occurs during exercise, later at rest and finally becomes permanent, general weakness, sometimes fever appears in case of activation of the inflammatory process. On examination, cyanosis (as a result of hypoventilation of the alveoli), swelling of the jugular veins, shortness of breath (symptoms of pulmonary heart failure) are revealed.

The chest can be compacted, however, more often, the presence of pathological airiness is determined by expanded intercostal spaces - an emphysematous form of HA. Respiratory excursion of the lungs and the mobility of the lower pulmonary edge is limited. On percussion, as a result of concomitant emphysema, a box sound is detected.

On auscultation of the lungs, hard, sometimes weakened, vesicular breathing (with emphysema), dry and moist rales are heard. With the help of x-rays, increased transparency of peripheral lung fields is determined in combination with heaviness, focal shading and increased vascular pattern, sometimes signs of bronchiectasis.

Features of the clinical course of diffuse pneumosclerosis

A biochemical blood test reveals an increase in the content of alpha-2 and gamma globulins, fibrinogen; in urine the moderate proteinuria is noted. X-ray of the respiratory organs allows you to identify the eclipse of the corresponding segment/lobe of the lung, areas of infiltration. With gangrene of the lungs, pronounced signs of respiratory failure and intoxication are observed.

Blackout with fever

Complaints (remitting fever, chest pain, shortness of breath, cough with purulent sputum with an unpleasant odor in the amount of 200 ml to 1-2 liters per day, sweating). X-ray of the chest organs (large-focal eclipse with uneven edges and fuzzy contours - in the infiltration phase and the presence of a syndrome of cavity formation with a horizontal fluid level in another period).

Darkening in Cancer

Lung cancer is more common in men over 40 years of age who smoke for a long time. Against the background of an eclipse of a part of the lungs, there is mainly enlightenment, which indicates the collapse of the lung tissue, as well as bronchogenic focal metastasis to neighboring areas.

Blackout exudative pleurisy

Very often, exudative pleurisy in the early stages of detection is considered as inflammation of the lungs, since they have many of the same signs. A small amount of fluid in the pleural cavity is often very difficult to determine from a fluorographic image.

In this case, complications are very simply solved by ultrasound examination of the lungs, which determines 150-200 ml of effusion in the pleural cavity. In addition, exudative pleurisy is characterized by a specific cough with the release of mucous and purulent sputum.

If spots are found on the x-ray, do not despair. Not always the presence of blackouts or glimpses indicates the development of serious diseases. Often the reason for the formation of spots is the poor quality of the fluoroscope. And even the incorrect position of the patient during the procedure also shows spots on the lungs in the picture. To find out the exact cause, you need to contact your doctor.

White spotted formations on an x-ray of the lungs may be the result of such diseases:

• Inflammation of the lungs.
• Bronchitis.
• Tuberculosis.

If a patient in the recent past has been ill with pneumonia or bronchitis, and the x-ray showed spots on the lungs, this means that residual effects of the disease are occurring in the body. With proper treatment, the nodules will soon resolve.

When diagnosing tuberculosis, light formations will be located in the upper sections of the lungs. With proper treatment, the area of ​​​​inflammation is reduced. In the recovery stage, dark spots will appear in the lungs on the x-ray, which indicates scarring of the tissues.

Blackouts

If fluoroscopy shows dark or black spots, this may indicate a chronic form of pneumonia. As a rule, blackouts appear in the acute stage. In the process of recovery, blackouts pass.

Black spots on an X-ray of the lungs may indicate the development of cancer. However, it is impossible to draw any conclusions based only on fluoroscopy. To confirm or refute the diagnosis, the doctor prescribes a series of tests and additional examinations. If a lung cancer is suspected, a complex analysis of lung tissue is prescribed, which is carried out in a hospital.

Dark formations on the X-ray of the lungs, provided that the patient feels relatively normal, can confirm the fact of many years of smoking. In children, dark areas on the image indicate the presence of a foreign body in the organ. In this case, surgical intervention is required.

Unfortunately, not always a bright spot on an x-ray of the lungs is a sign of the residual effects of the disease.

Often, white formations in the picture indicate the development of such ailments:

• Inflammation.
• Atelectasis.
• Pathological processes in pleurisy.
• The development of diseases associated with the professional activity of a person.

If light spots are detected in the picture, the doctor must prescribe a number of additional studies. Since any deviations from the norm must be clarified through a comprehensive examination of the patient. An experienced specialist will never make a diagnosis based on one result of the analysis. To identify the true cause, the radiologist can determine repeated fluoroscopy in different projections.

In the initial stage of tuberculosis, white formations also appear in the picture. This process indicates the primary damage to tissues by pathogenic bacteria. An eloquent sign of tuberculosis in the first stage is a characteristic light path from the site of inflammation to the root system.

Pneumonia spots

To understand that the picture showed the presence of pneumonia, the specialist must know what this pathology looks like. Spotted formations in pneumonia can have a different location and dimensions:

• Small with limited margins up to 3 mm.
• Segmental - located within the boundaries of the segment.
• Subtotal - all fields, except for the upper lobes.
• Total formations covering the entire surface of the lungs.

In the process of development of inflammation, white spots with fuzzy, blurry contours form in the lungs. In this case, the brightness of the severity depends on the degree of development of the disease. The more neglected the disease, the more pronounced the spots in the picture.

Summing up

If there are black or white spots on the x-ray image, an additional examination is necessary. It is important to understand that with poor-quality work of the radiograph, white and dark formations are only a side effect of the functioning of the apparatus. To establish an accurate diagnosis, the specialist will definitely prescribe a series of examinations and tests. Only after receiving all the results, the doctor has the opportunity to assess the picture of the patient's condition.

Preventive medical examinations are required annually. One of the mandatory activities of a periodic medical examination is - this is done for the early detection of diseases. Pathological blackouts in the lungs will serve as an alarm signal. The causes of such manifestations can be different, and in order to identify them accurately, the doctor will definitely prescribe an additional examination. The symptom of darkening of the lungs, established during the passage of fluorography, is not a diagnosis of the disease, but an indicator of the presence of a variety of diseases.

What is lung obstruction?

Pulmonary diseases are mainly accompanied by seals in the tissues of the lungs, this occurs due to a decrease or lack of air permeability in certain parts of the organ, which is manifested by dark spots on x-ray examination. A similar symptom may indicate pathological processes both in the lung itself and beyond.

Blackouts, the causes of which lie in pulmonary pathologies, may differ in their intensity, clarity, quantity and size. Dimming may show:

• and tissue compaction.
• Nodes.
• An area impassable for air is a collapse of the lung.
• Development .
• Finding fluid in the pleural region of the lungs (the pleura is the membrane that covers the lungs and chest cavity).
• Inflammation in the pleural region, possibly purulent ().

Pulmonary opacities, which are influenced by problems with other organs, may also be seen on x-rays and may include:

• Enlarged lymph nodes.
• Formations on the ribs or spine.
• Problems with the esophagus, for example, its expansion.

Dimming Types

The location of the blackouts, their size and shape depend on the developed pathological lesion of the lung. Classify several types of blackouts of the body:

• Focal.
• Focal.
• Segmental.
• Darkening of an indefinite form.
• Equity.
• Darkening with the presence of liquid.

Focal opacity in the lungs

Focal blackouts are small, up to one centimeter, spots-nodules. They manifest themselves in inflammatory and tumor processes, as well as in connection with vascular disorders. This may well be the beginning of some kind of lung disease. From one picture it is impossible to accurately determine the cause of the outbreak and its nature, therefore, additional examinations are prescribed, in particular, and additional. Laboratory tests are prescribed, in which urine and blood are examined.

If focal blackouts are accompanied by fever, weakness, headache, wet or dry cough, chest pain - these signs may indicate bronchopneumonia.
If the blood test showed no changes, this may be a sign of focal tuberculosis, while the patient complains of loss of appetite, weakness, dry cough, irritability and chest pain. If this diagnosis is suspected, targeted studies are prescribed.

Most often manifested by thrombophlebitis of the lower extremities, cardiac pathology, pain in the side and even hemoptysis.
"Small" peripheral lung cancer is usually immediately identified on a fluorography image.

These are the most common diseases, the onset of which can be indicated by focal shadows, but they can also indicate other pulmonary pathologies.

Circular (focal) shading

Single focal shadows of round shapes and larger than one centimeter can also be signs of various diseases. They require a more thorough examination to establish an accurate diagnosis.

The causes of round spots can be acquired or congenital. They can be filled with air or liquid.

Similar blackouts may indicate tumor formations:

• - fibromas, adenomas, lipomas, hamartochondromas;
• malignant -,.

Callus (spherical) - this may be a fracture of the rib or insular areas on it. This factor also needs to be taken into account when deciphering an image with focal shadows.

Segmental dimming

Darkening can be localized in separate segments of various shapes, mainly in the form of a triangle. There may be several such areas on the lung, and the diagnosis is made after a comprehensive examination. Darkening of individual segments on one or both lungs may indicate diseases such as:

Single segments:

• endobronchial tumors (benign or malignant);
• foreign body or mechanical damage to lung tissue.

The presence of several darkened segments:

• acute or chronic pneumonia (pneumonia);
• tuberculosis or other inflammatory processes;
• central cancer;
• stenosis (narrowing) of the central bronchus;
• accumulation of a small amount of fluid in the pleura;
• metastases of malignant tumors in other organs.

Blackouts of indefinite shape

These shadows on radiographs do not form geometric shapes and do not have defined boundaries.

These pathological changes in lung tissue are most often staphylococcal pneumonia. This disease has primary and secondary forms:

• The primary form occurs as a result of inflammatory processes in the bronchi or lung tissues.
• The secondary form of the disease is manifested due to hematogenous entry from some kind of purulent focus in the body (this may be osteomyelitis, adnexitis, or other similar diseases). Recently, staphylococcal pneumonia has become quite common.

Such darkening may indicate tissue edema, pulmonary infarction, hemorrhage, tumor, accumulation of pleural fluid and other diseases that can be accurately determined after laboratory tests.

Such darkening can occur due to inflammation of the lung (pneumonia) or effusion of fluid into the pleura (exudative pleurisy). These diseases are accompanied by fever, cough, weakness, headaches.

Lobar dimming

In the case of partial darkening in the lung, its contours are clearly visible and clearly defined in the images. They can be convex, concave, straight and other shapes.

• Lobar obscuration can be signs of any chronic lung disease. With tomography, it is easy to identify diseases such as cirrhosis, bronchiectasis (expansion of part of the bronchus when its wall is damaged), purulent lesions and other diseases.
• All these pathological processes on tomographic images are easy to distinguish from cancerous formations. Therefore, the need to accurately determine a malignant tumor arises if bronchial obstruction (inflammatory or cicatricial formation) is detected.

Malignant and benign tumors usually form in the intermediate bronchus. At the same time, the lower and middle lobes of the organ are darkened.

Darkening with the presence of liquid

Darkening of the lungs of this type may indicate a developing organ edema. This can occur with an increase in pressure in the pulmonary capillaries or with a reduced content of protein in the blood. Water in the lungs interferes with the normal functioning of the body. Edema can be of two types and depends on the reasons that caused it.

• Hydrostatic edema can occur when intravascular pressure increases, which increases the risk of fluid leaving the vessel, which enters the alveolus (the end part of the respiratory apparatus), fills the lung. Such a pathology can occur in the presence of coronary heart disease or other cardiovascular diseases.
• Membranous edema occurs under the influence of toxins that can disrupt the wall of the same alveoli and exit the extravascular space of the lung.

A lot in establishing the diagnosis depends on the qualifications and experience of the radiologist who will describe the fluorographic image. The machine used to take the X-ray is also important. Therefore, it would be useful to double-check by doing, if possible, fluorography on a more advanced device and with another radiologist.

Hello! During the passage of fluorography, a blackout was found in the left lung. There are no symptoms, no pain, no cough, no weight loss, no sweating, nothing. X-ray direct and lateral confirmed the presence of darkening in the left lung. The doctor prescribed treatment for pneumonia. After drinking antibiotics for 10 days, there was no change. Repeated x-ray again showed the same spot. He was sent to the TB dispensary. After passing the examination (tomogram, blood tests, sputum tests, Diaskintest), an accurate diagnosis cannot be made. All analyzes are good. except for elevated SOE - 20. Sputum tests are negative. The tomogram shows a round spot. Diaskintest showed papule 25, apparently some kind of inflammatory process is going on in the body. Yes, I also had a consultation with a cockroach surgeon, he recommended an additional examination in the cockroach department and an operation to remove this neoplasm of unknown origin. The phthisiatrician gave me a trial treatment for... tuberculosis. There were side effects literally from the second day of treatment (pain and numbness in the arm, dizziness and almost fainting, pain in the pancreas, constant nausea). Further, I doubt whether it is possible to prescribe treatment blindly? Either from pneumonia, or from tuberculosis. Where can I get qualified assistance in diagnosis and treatment? I live in Primorsky Krai.

Hello!
Darkening in the lung indicates a compaction of the lung tissue and several dozen lung diseases can be accompanied by this symptom and the appearance of single or multiple rounded shadows on radiographs. The most important of these diseases are: acute pneumonia; tuberculous infiltrate; tuberculoma; primary lung cancer; tumor metastases to the lungs; retention cyst of the lung; echinococcus lung; encysted pleurisy; eosinophilic infiltrate; mediastinal cyst; tumor of the mediastinum, etc. Since DIASKINTEST showed you a papule of 25 mm, this indicates a hyperergic reaction, tuberculosis cannot be ruled out, since this test does not cause positive reactions in healthy and BCG-vaccinated individuals.
To clarify the diagnosis in your case, additional examination is necessary: ​​computed tomography of the lungs, and diagnostic bronchoscopy of the lungs. Since all diagnoses are made on the basis of a complex of clinical, laboratory, radiological data. You can also additionally take tests for oncomarkers, although they are not used for primary diagnosis, they can still be useful in this situation. According to them, the diagnosis is not established, but they help to further monitor the dynamics of the process, for example, after surgery, the effectiveness of treatment can be monitored by their level. In oncological processes in the lungs, the following tumor markers are informative: No. 1005 Cancer embryonic antigen, No. 1013 Neuron-specific enolase, No. 1014 SCCA (if squamous cell carcinoma is suspected). These examinations will help the doctor diagnose your disease.
As for the question of where you can get qualified assistance in diagnosis and treatment, it may be Vladivostok City Clinical Hospital No. 1, where the pulmonology center is located.