Syndromes of diseases of the respiratory system. The main syndromes of the pathology of the respiratory system

The main symptoms of respiratory diseases

The main complaints include cough, shortness of breath, hemoptysis, chest pain.

Cough- a complex reflex act in the form of a sharp exhalation with a closed glottis, which occurs as a protective reaction when mucus accumulates in the larynx, trachea and bronchi or when a foreign body enters them.

dry - no sputum

Productive (wet) - with sputum (pathological secret of the respiratory tract)

Dyspnea- a feeling of difficulty breathing, accompanied by a change in its frequency (normal 16-20 per minute), depth, and rhythm.

inspiratory,

expiratory,

mixed.

1. Physiological - with increased physical activity.

2. Pathological - in diseases

Hemoptysis- secretion of blood in the form of streaks during coughing.

Bleeding- pure, scarlet, foamy blood.

Chest pain- may be due to a pathological process in the chest wall, pleura, heart, aorta, as a result of irradiation of pain in diseases of the abdominal organs. Pain in lung diseases is often caused by irritation of the pleura, since the pleural sheets have the largest number of nerve endings, and the lung tissue is poorly innervated.

Often, in diseases of the respiratory system, fever is observed (primary pyrogens, being etiological factors, penetrating into the body, do not yet cause fever, but only initiate this process, stimulating their own cells to produce special protein substances (secondary pyrogens). The latter, in turn, act on the mechanisms of thermoregulation and lead to fever, thus being pathogenetic factors).

malaise, weakness, lack of appetite.

Disease history. General inspection. Examination of the chest. Percussion. Palpation. Auscultation of the lungs

Basic breath sounds:

Vesicular breathing - the sound "f", if you slightly draw in the air - is normally auscultated

Bronchial breathing - the sound "x", maybe in the area of ​​​​the handle of the sternum, the upper part of the interscapular space. In other areas, it is not normally audible.

Adverse breath sounds:

Crepitus - at the end of inhalation, the noise from the swelling of the alveoli. Kneading a tuft of hair near the ear with a finger

Pleural friction noise - noise on inhalation and exhalation, reminiscent of the creaking of snow or a leather belt

Laboratory (exploratory sputum) and instrumental methods, see Milkamanovich

The main syndromes in diseases of the respiratory system

1. Syndrome of bronchial obstruction(bronchospastic syndrome) - a pathological condition caused by a violation of bronchial patency.

Bronchial obstruction leads to:

Spasm of the smooth muscles of the bronchi;

Swelling of the mucous membrane with inflammatory or congestive phenomena in the lungs;

Blockage of the bronchi with various fluids (sputum, vomit), a tumor, a foreign body.

Clinic

shortness of breath or asthma attacks more often of the expiratory type (expiration is difficult),

paroxysmal cough, breath sounds audible at a distance (usually dry wheezing).

Auscultatory - dry wheezing against the background of an extended exhalation.

Observation and care: HR, heart rate. Oxygen therapy.

Postural (positional drainage) - raise the lower end of the bed 20-30 cm above floor level, knee-elbow position, etc.

Use of an inhaler. Breathing exercises. Expectorants. Bronchodilators: adrenomimetics, methylxanthines, anticholinergics.

2. Syndrome of infiltrative compaction- a pathological condition caused by the penetration into the tissues of the lung and the accumulation in them of cellular elements, liquids, various chemicals. Most often with pneumonia, pulmonary tuberculosis, lung cancer, lung diseases of allergic origin.

Complaints: cough, shortness of breath, possibly hemoptysis, there may be pain in the chest during the transition of infiltration to the pleura.

Percussion - dullness of percussion sound. Auscultatory - weakened vesicular breathing, wet and dry rales. Over an extensive, dense infiltrate, bronchial breathing can be heard.

X-ray- dark area.

Treatment depending on the cause, care for fever, cough, shortness of breath..

3. Syndrome of increased airiness of lung tissue- emphysema - a pathological condition characterized by the expansion of the air spaces of the lungs, resulting from a decrease in the elastic properties of the lung tissue. In this case, the alveoli are overstretched or even destroyed with the formation of small cavities (bulls).

Complaints: dyspnea.

4. Syndrome of accumulation of fluid in the pleural cavity. The presence of more than 100 ml of fluid is determined on the radiograph. More than 500 ml of fluid is determined by physical examination. The fluid in the pleural cavity can be:

exudate;

transudate;

Blood, lymph.

Exudate - is formed during inflammatory and reactive processes in the pleura (pleurisy).

A transudate is an effusion of non-inflammatory origin. The accumulation of transudate in the pleural cavities is called hydrothorax.

Causes: heart failure, hypoproteinemia.

Accumulation of blood - hemothorax. The accumulation of lymph is chylothorax.

Symptoms: shortness of breath, heaviness, a feeling of fluid transfusion in the chest, in some patients - chest pain, cough.

On percussion - a dull sound over the accumulation of fluid.

Auscultation - sharply weakened or not audible breathing.

R-RESEARCH - darkening, with an oblique upper border (line of Damoiseau)

diagnostic puncture.

Treatment depending on the cause.

5. Syndrome of accumulation of air in the pleural cavity (pneumothorax) - accumulation of air between the visceral and parietal pleura. Leads to a collapse of the lung tissue and ORF: sudden stabbing pain in the chest on the affected side, shortness of breath, dry cough, palpitations, fear of death, diffuse cyanosis. Percussion - tympanic sound, auscultation - weakening or absence of vesicular breathing. With spontaneous pneumothorax - hospitalization in a hospital, a small closed pneumothorax - rest, symptomatic, painkillers. With a large - pleural puncture.

6. Respiratory failure- a pathological condition characterized by a violation of the normal oxygenation of the blood or a violation of the release of CO2, leading to hypercapnia (increased carbon dioxide content).

Acute respiratory failure This is a special form of gas exchange disorders, in which the supply of oxygen to the blood and the removal of carbon dioxide from the blood very quickly stop, which can result in asphyxia (cessation of breathing).

RESPIRATORY SYSTEM
Symptoms
Amphoric breathing (see Breath sounds).
Asthma.
An asthma attack that develops either due to an acute narrowing of the bronchial lumen (bronchial asthma - difficult, prolonged and noisy exhalation), or as a manifestation of acute cardiac, predominantly left ventricular failure (cardiac asthma - see).
Asthmatic status.
A prolonged attack of suffocation, manifested by significant violations of the function of external respiration.
Seen in severe asthma
Asphyxia.
Progressive suffocation, which develops as a result of the closure of the lumen of the larynx, trachea and bronchi; massive pneumonia and pleurisy; prolonged convulsive contraction of the respiratory muscles in case of strychnine poisoning; damage to the respiratory center; curare poisoning; lack of oxygen.
Atelectasis.
Pathological condition of the lung, in which the alveoli do not contain air or contain it in a reduced amount and appear to be collapsed. There are obstructive atelectasis due to the closure of the lumen of the bronchus and the resorption of air below the closure of the lumen; compression atelectasis - due to external compression of the lung tissue by fluid, tumor, etc.
"Drum sticks" symptom.
Fingers with cone-shaped thickenings of the nail phalanges, similar in shape to drumsticks. They occur in chronic suppurative lung diseases, especially in bronchiectasis, pleural empyema, lung cancer, cavernous tuberculosis, as well as congenital heart defects, cirrhosis of the liver and a number of other diseases.
Bronchophony amplification symptom.
Increased conduction of voice trembling from the larynx along the air column of the bronchi to the surface of the chest wall, determined by auscultation. It is observed when lung tissue is compacted or a cavity appears in the lung (see corresponding syndromes).
Bronchiectasis.
Pathological expansion of limited areas of the bronchi with a change in the structure of their walls. Distinguish between rozhdekkke and acquired (developing after various diseases of the bronchi, lungs, pleura), as well as cylindrical, saccular, fusiform and well-shaped bronchiectasis.
Hydrothorax.
Accumulation of fluid of non-inflammatory origin in the pleural cavities.
Voice tremor weakening symptom.
Deterioration of the conduction of voice trembling from the air column ib bronchi to the surface of the chest wall, determined by palpation. It is observed when fluid or gas accumulates in the pleural cavity (see corresponding syndromes), with complete blockage of the bronchus, with a significant thickening of the chest wall.
Voice tremor amplification symptom.
Increased conduction of voice trembling from the air column in the bronchi to the surface of the chest wall, determined by palpation. Occurs over areas of lung infiltration if the afferent bronchus is not obstructed (lung tissue compaction syndrome), over an air-filled cavity communicating with the bronchus
(syndrome of the cavity in the lung).
Breath sounds.
Sound phenomena (arising in connection with the act of breathing and perceived during auscultation of the lungs. There are basic respiratory sounds - vesicular, bronchial breathing and additional - wheezing, crepitus, pleural friction noise. Both their detection and changes in properties (places of listening , strength, etc. e).

Basic breath sounds
- amphoric breathing- breathing noise of a peculiar high musical timbre. Auscultated over large (more than 5 cm in diameter) cavities in the lungs that do not contain fluid and communicate with the bronchus
- bronchial breathing- loud noise (high timbre, characterized by the predominance of the exhalation noise time over the inhalation noise time, resembles the sound "x". "It is heard over the larynx, trachea, large bronchi under physiological conditions. In pathology - compaction of the lung tissue (croupous pneumonia, tuberculosis, pulmonary infarction , compression atelectasis), replacement of lung tissue with connective
(pneumosclerosis), with the formation of a cavity free of contents and communicating with the bronchus, it is heard above the lung tissue;
- vesicular breathing- a soft noise heard over the entire surface of the lungs throughout the entire inhalation and weakening to inaudible in the first third of the exhalation, resembles the sound f
- vesicular breathing is weakened- Quieter than normal murmur, shorter audible on inhalation and almost inaudible on exhalation. Observed with emphysema, blockage of the bronchus;
- increased vesicular breathing- the noise of vesicular breathing, but louder than normal, and the increase can occur both in the expiratory phase and in both phases. It is observed in bronchitis, bronchopasm;
- vesicular saccadic breathing- the noise of vesicular breathing, characterized by intermittent jerky inspiration. It is observed with damage to the phrenic nerve, hysteria, with auscultation in a very cold room;
- hard breathing- noise, louder and deeper than vesicular breathing, often with an additional change in timbre ("rough" noise). Amplification of sound occurs both in the inhalation phase and in the exhalation phase. Observed with bronchitis, focal pneumonia.
Additional breath sounds:
- crepitus- additional respiratory noise that occurs in the alveoli in pathology. Represents multiple crackling sounds heard by a "flash" at the end of inhalation and resembling the crunch of hair when rubbing them between fingers. Sometimes it comes to light only at a deep breath, after coughing does not disappear. It is caused by the sticking of the walls of the alveoli in the presence of exudate or transudate in them. It is observed at the beginning of the exudative phase and in the phase of resorption of croupous pneumonia, with incomplete atelectasis, sometimes with congestion in the lungs due to heart failure;
- wheezing- additional respiratory noises that occur in the air space of the respiratory tract of the lungs in pathology; a ) wet rales due to the accumulation in the respiratory tract or in the cavities communicating with them
(exudate, transudate, bronchial secretion, blood). During breathing, air passes through this liquid, forming bubbles, which, when bursting, form a characteristic sound. There are small, medium and large bubbling rales, depending on the caliber of the bronchi, where rales are formed;
b) dry wheezing due to a decrease in the area of ​​the lumen of the bronchi due to edema of the bronchus wall, the accumulation of sputum in it, etc. They mainly occur in the exhalation phase. Distinguish, depending on the timbre, whistling
(high, treble) and buzzing, or buzzing (low, bass), wheezing;
- pleural rub- additional respiratory noise that occurs in the pleural cavity in pathology.
Reminds me of the creaking of leather, the crunch of snow. Perceived close to the ear. It is heard in the inhalation and exhalation phase, does not change after coughing, increases with deep breathing, and is also heard during respiratory movements with the mouth and nose closed. Caused by pathological changes in the surface of the pleura with pleurisy, cancerous or tuberculous seeding of the pleura.

Cough.
A complex reflex act that occurs as a protective reaction when mucus accumulates in the larynx, trachea, bronchi, irritation of the mucous membrane of these departments, when a foreign body enters them, as well as some diseases of the cardiovascular system.
Crepitus(see. Respiratory noises). Charcot-Leiden crystals.
Peculiar crystalline formations, determined by microscopic examination of sputum of patients with bronchial asthma. It is believed that they are formed from the proteins of eosinophils.
Hemoptysis.
Discharge of blood with sputum from the respiratory tract when coughing in the form of streaks or a uniform admixture of bright red color. Most often observed in pulmonary infarction, cancer, tuberculosis, bronchiectasis, left ventricular -heart failure.
Shortness of breath (dyspnea).
Difficult, altered breathing, (Manifested both by subjective sensations of shortness of breath, lack of air, and by objective changes in the main indicators of the function of external respiration, in particular, the depth and frequency of breathing and their ratios, minute volume and rhythm of breathing, the duration of inhalation or exhalation, increased work respiratory muscles.
Shortness of breath inspiratory- difficulty breathing
expiratory dyspnea- Difficulty breathing.
Shortness of breath mixed- Simultaneous difficulty in both inhalation and exhalation.
Percussion sound dulling symptom.
A decrease in the strength and duration of percussion sound above the lungs due to a decrease in the amount of air in the lung tissue or the appearance of fluid in the pleural cavity (see Syndrome of focal compaction of the lung tissue).
Percussion sound dull ("muscular", "hepatic").
A quiet, short high-pitched sound that is normally heard when percussion of the muscles or liver. Its appearance above the lungs "is observed with croupous pneumonia in the stage of compaction, accumulation of fluid in the pleural cavity, accumulation of pus in the pleural cavity (see the corresponding syndromes), with extensive atelectasis or tumor lesions.
Percussion sound tympanic.
A kind of percussion sound, characterized by great strength and duration, reminiscent of the sound of a drum and occurring in a healthy person during percussion of Traube's space. Above the lungs, a tympanic sound is determined with a sharply increased airiness of the lung tissue, the presence of a cavity filled with air in it, and with the accumulation of air in the pleural cavity (see Emphysema, Syndromes of cavity formation in the lung, accumulation of air in the pleural cavity).
Percussion sound box.
A type of tympanic percussion sound that resembles the sound that occurs when a box or pillow is struck. Observed over the lungs with their emphysema.
Percussion sound metallic.
A type of tympanic percussion sound, reminiscent of the sound that occurs when hitting metal.
Occurs over a very large (more than 6 cm in diameter) smooth-walled cavity in the lung.
Page 98(127)
Percussion sound - "the sound of a cracked pot."
A kind of tympanic percussion sound is a kind of intermittent rattling noise. Arises over a large smooth-walled superficially located cavity, which communicates with the bronchus through a narrow slit-like opening.

Pneumothorax.
A pathological condition characterized by accumulation of air between the visceral and parietal pleura and "Manifested by shortness of breath, cough, chest pain, decreased respiratory excursions, tympanitis, and weakened breath sounds on the affected side.
Kurshman spirals.
Whitish transparent corkscrew tortuous tubular formations formed from mucin in the bronchioles are found on microscopic examination of sputum after an attack of bronchial asthma.
Wheezing(see. Respiratory noises).
The noise of a falling drop is a symptom.
The sound of a falling drop, heard in some cases, appears in large cavities of the lungs or pleural cavity containing liquid pus and air when the patient's position changes from a horizontal position to a vertical one and vice versa.
Splashing noise is a symptom.
The splashing sound in the chest cavity is an auscultatory sign of the presence of fluid and air in the pleural cavity at the same time. Appears during turns or swaying of the patient.
Rubbing noise of the pleura (see. Respiratory noises).
Euler - Lillestrand reflex,
Reflex occurrence of hypertension of the vessels of the pulmonary circulation in response to insufficient ventilation of the lungs.
Emphysema of the lungs.
A pathological condition of the lung tissue, characterized by an increased content of air in it due to overstretching of the alveoli or their destruction. Revealed percussion box sound, weakened vesicular breathing. May be a link in the development of respiratory failure syndrome.
Syndromes
Goodpasture syndrome.
A symptom complex characterized by a combination of damage to the lungs (hemosiderosis) and kidneys (glomerulonephritis).
Includes symptoms: cough, recurrent hemoptysis, proteinuria, hematuria. In the future, shortness of breath, tachycardia, cyanosis, azotemia, cylindruria anemia join. The course is progressive. Death can occur from pulmonary hemorrhage or uremia.
Respiratory failure.
A pathological state of the body in which the normal gas composition of the blood is not maintained, or it is achieved due to more intensive work of the external respiration apparatus and increased work of the heart. Symptoms: shortness of breath, poor exercise tolerance, tachycardia, headache, etc.
Diffuse cyanosis, decrease in indicators of function of external respiration are noted. In a late stage - with the addition of heart failure - there are symptoms that are more characteristic of right ventricular heart failure (see).
Croup syndrome (croup - croak).
A symptom complex characterized by a hoarse voice, barking cough and difficulty breathing, up to asphyxia. There are true croup in diphtheria and false croup in measles, whooping cough, scarlet fever, influenza, and allergic diseases. As a rule, the cause of its development is a spasm of the muscles of the larynx due to
.irritation of its mucous membrane during inflammation or the appearance of rejected fibrinous films.
Leffler syndrome.
A symptom complex characterized by a combination of rapidly transient lung infiltrates with high blood eosinophilia (sometimes up to 70%) - Symptoms: a slight dry cough, weakness, sweating, low-grade fever.

Pulmonary heart.
Pathological state of the body, characterized by hypertrophy and (or) dilatation of the right ventricle of the heart due to pulmonary arterial hypertension caused by primary diseases of the bronchopulmonary apparatus, pulmonary vessels. Symptoms: before the onset of decompensation - accent of the second tone over the pulmonary artery, percussion, x-ray, electrocardiographic signs of hypertrophy of the right heart; after the onset of decompensation, symptoms of venous congestion in the systemic circulation are revealed (see.
Syndrome of chronic right ventricular heart failure). In the pathogenesis of the syndrome, the Euler-Liljestrand reflex plays a role. (See).
Cavity formation in the lung syndrome.
A symptom complex caused by the appearance of a large cavity in the letnus, free of contents and communicating with the bronchus. Symptoms: increased voice trembling, percussion sound is loud or tympanic (with a large cavity located peripherally), sometimes with a metallic tinge, auscultatory: increased bronchophony, often medium and large bubbling rales, sometimes amphoric breathing. It occurs with an abscess or tuberculous cavity, the collapse of a lung tumor.
Focal compaction of lung tissue syndrome.
A symptom complex characterized by the presence in the lung tissue of an area of ​​increased density, which is formed due to the filling of the alveoli with inflammatory fluid (exudate) and fibrin in case of pneumonia, blood in case of a lung infarction, or when a lobe of the lung grows with a connective tissue or tumor. Symptoms: shortness of breath, increased voice trembling, percussion sound - dull or dull, auscultatory: bronchial breathing, increased bronchophony, in the presence of liquid secretion in the small bronchi - wheezing.
Accumulation of air in the pleural cavity syndrome.
Symptom complex characterized by accumulation of air between the visceral and parietal pleura
(pneumothorax). Symptoms: weakening of participation in the act of breathing of half of the chest, in which there was an accumulation of air. In the same place, voice trembling is sharply weakened or absent, percussion sound is tympanic, auscultatory: weakening, up to disappearance, of vesicular breathing and bronchophony.
Sometimes chest asymmetry is determined.
Accumulation of fluid in the pleural cavity syndrome.
Symptom complex that develops with hydrothorax or with exudative pleurisy. Symptoms: shortness of breath, lag in the act of breathing half of the chest, in which fluid has accumulated. In the same place, the voice trembling is sharply weakened, the percussion sound is dull, auscultatory: vesicular breathing and bronchophony are sharply weakened or not heard.
Middle lobe syndrome.
A symptom complex, which is a manifestation of either a chronic (inflammatory process limited to the middle lobe of the right lung, or atelectasis due to compression by the lymph nodes or obliteration of the middle lobe bronchus by a tumor process, or tuberculous infiltrate. Symptoms characteristic of the lung tissue compaction syndrome (see), in this case, are detected over the middle lobe of the right lung.
Hamman-Rich syndrome.
A symptom complex characterized by the development of respiratory failure, hypertension of the pulmonary circulation, cor pulmonale due to progressive diffuse pneumofibrosis.
bronchospastic syndrome.
A symptom complex that develops as a result of narrowing of the lumen of small bronchi and bronchioles. Symptoms: shortness of breath with prolonged expiration, increased tone of the respiratory muscles, dry rales, acrocyanosis and cyanosis of the mucous membranes (see Asthma). It can occur in various diseases of the respiratory system as a manifestation of an allergic reaction, in case of damage by toxic substances, and also as an independent complication in surgical and bronchoscopic interventions.
Wegener's syndrome (Wegener's granulomatosis).
Hyperergic systemic panvasculitis, combined with the development of necrotizing granulomas in the tissues.
The upper respiratory tract, lungs, and kidneys are predominantly affected. Symptoms: epistaxis, lesions of the accessory cavities of the nose, hemoptysis, small-focal pathology of the lungs (infiltration and cavities). With kidney damage: proteinuria, hematuria, cylindruria, pyuria, uremia.

Different methods of physical research capture different aspects of the same pathological process. A single method rarely provides sufficiently characteristic data to substantiate the diagnosis. Therefore, the totality of data obtained by various research methods is extremely important. All methods must be combined and applied on the same place of the chest, comparing one with the other. Below we present a comparison of data obtained by various methods of physical examination with the following typical syndromes: different air content in the lungs (normal, increased, decreased), with the formation of cavities in them, the development of tumors, and, finally, with the accumulation of air fluid in the pleural cavity, and also liquid and air at the same time.

Syndrome of normal content of air in the lungs
Inspection, palpation (voice trembling) and percussion give normal data. Auscultation under these conditions can detect either normal, or weakened, or hard (increased) vesicular breathing, depending on the condition of the lungs, but bronchial breathing is never audible. Wheezing may be heard - dry or wet, but not sonorous. A pleural friction rub may be present. Bronchophony is not increased. If at the same time breathing is normal, wheezing and friction noise are absent, then there are no pathological changes in the lungs. Harsh breathing and wheezing indicate bronchitis, normal vesicular breathing and pleural friction rub indicate dry pleurisy.

Syndrome of increased content of air in the lungs
Inspection indicates the expansion of the chest, limitation of its mobility and difficulty in exhalation. Voice trembling is weakened. Percussion reveals a box tone percussion tone, lowering of the lower borders of the lungs and a decrease in their respiratory mobility. On auscultation - weakened vesicular breathing with prolonged exhalation. This combination of research data occurs in acute bloating (volumen pulmonum acutum) during attacks of bronchial asthma and in emphysema. If during auscultation, in addition, rales (dry, wet) are heard, then we have a very common combination of emphysema with bronchitis.

Syndrome of reduced air content in the lungs
The decrease in the amount of air in the lungs depends either on the insufficient expansion of the lung during inhalation, on its collapse - the so-called lung atelectasis - or on the filling of the airways and pulmonary alveoli with liquid or dense substance (exudate, fibrin, cellular elements) - compaction of the lung, or the so-called its infiltration.

With atelectasis, the physical signs will be different depending on whether or not we pass the bronchus for air. tympanic tone on percussion, weakened or bronchial breathing on auscultation, and persistence of bronchophony on listening to the voice. In the second case, i.e., with a blocked bronchus, we will have the same data during examination and percussion as in the first variant of atelectasis (during percussion, however, the tone may become completely dull due to air intake and airlessness of the lung), palpation and auscultation - the absence of voice trembling, bronchophony and breathing. Atelectasis is caused by weakness of respiratory movements, blockage of the bronchus or compression of the lung (tumor, pleurisy, etc.).

With infiltration of the lung tissue, the lung is transformed into a denser, more homogeneous, and therefore more vibratory and sound-conducting body. Examination at the same time either does not give anything special, or reveals a restriction of respiratory excursions of the chest on the diseased side. Voice trembling and voice conduction (bronchophonia) are increased. With percussion - dullness of the percussion current, mostly with a tympanic tinge (due to air fluctuations in the large bronchi), or a dull tone. On auscultation - bronchial breathing and often moist and, which is especially characteristic, sonorous rales. Such a symptom complex is characteristic of inflammatory processes in the lungs - for pneumonia, especially croupous; with catarrhal pneumonia, it is clearly detected only with its confluent forms.

cavity syndrome (cavity formation in the lungs)
Since cavities or cavities are most often formed in an already compacted (infiltrated) lung, they show signs of lung compaction, on the one hand, and so-called cavity symptoms, on the other. Inspection reveals no particular abnormalities. Voice trembling and bronchophony are increased. Percussion gives a dull-tympanic tone, sometimes (in the case of large smooth-walled caverns) with a metallic tint. Under certain conditions, the “cracked pot noise”, Wintrich and Gerhardt phenomena (see above) can be obtained. On auscultation - bronchial breathing, which in the same cases in which a metallic shade of the percussion tone appears, takes on the character of an amphoric one. Sonorous moist rales are heard, sometimes with a metallic tint; the caliber of wheezing is often much larger than it corresponds to their location (their occurrence in cavities). The formation of cavities is most often observed in pulmonary tuberculosis, with gangrene and lung abscesses; abdominal symptoms can also be observed with bronchiectasis, if the lung tissue around them is infiltrated. However, it must be remembered that not all cavities that form in the lungs show themselves with the symptoms just indicated. In order for abdominal symptoms to be clearly revealed, it is necessary: ​​1) that the cavity reaches a certain size (at least 4 cm in diameter), 2) that it is located close to the chest wall, 3) that the lung tissue surrounding it is compacted, 4) that the cavity communicated with the bronchus and contained air, 5) so that it was smooth-walled. In the absence of these conditions, part of the cavities in the lungs remains "silent" and can sometimes be established only by X-ray examination.

Tumor syndrome (development of a tumor in the chest cavity)
Depending on the different localization, size and relationship to the lung (pressure on the bronchus, lung displacement, replacement of its tissue, etc.), tumors of the chest cavity give a variety of atypical combinations of objective data. The most characteristic picture is observed with large tumors reaching the chest wall. On examination in these cases, one can often note a limited protrusion according to the location of the tumor and a restriction of respiratory excursions on the affected side. On palpation, there is an increase in resistance (resistance) and the absence or sharp weakening of voice trembling. With percussion - complete dullness (femoral tone). On auscultation - a sharp weakening of breathing, weakening of bronchophony. This combination of physical examination data can be observed in lung cancer, in lung echinococcus, in lymphogranulomatosis.

The most common form of lung cancer is cancer originating from the wall of the bronchus - bronchogenic or bronchial cancer. The symptomatology of this disease, depending on the location and size of the tumor and on the accompanying phenomena, is very diverse and motley. In typical cases, with a lesion of a large bronchus, you add up the following syndrome, depending on the filling of the lumen of the bronchus by a tumor and atelectasis of the corresponding part of the lung: upon examination, there is a lag in movement during breathing, and sometimes retraction of the affected side of the chest; palpation - weakening of voice trembling; with percussion - dullness of the percussion tone; auscultation - weakening or lack of breathing; with fluoroscopy - atelectasis of the corresponding lobe of the lung and displacement of the shadow of the mediastinum to the affected side; bronchography - narrowing of the bronchus.

Syndrome of accumulation of fluid in the pleural cavity
The accumulation of fluid in the pleural cavity gives the following picture of objective data. On examination, protrusion and limitation of mobility of the corresponding side and smoothing of the intercostal spaces are determined. Palpation reveals increased resistance of the intercostal spaces and weakening or absence of voice trembling. With percussion - a dull tone above the liquid, and directly above its level (due to relaxation of the compressed lung tissue) - a dull-tympanic tone. With large accumulations of fluid, percussion can determine the displacement of neighboring organs - the liver down, the heart in the opposite direction. With the accumulation of fluid in the left pleural cavity in Traube's space, a dull tone is obtained during percussion. On auscultation, breathing is either absent or weakened; in some cases, under the condition of significant compression of the lung, bronchial breathing is heard, which usually appears to be weakened and distant. Enhanced (compensatory) vesicular breathing is heard on the healthy side. Bronchophony is absent or weakened, egophony may be observed, which usually accompanies bronchial breathing. The described symptoms can be observed: 1) with the accumulation of edematous fluid in the pleural cavities - transudate - the so-called chest dropsy (hydrothorax) - with heart failure, inflammation of the kidneys, etc .; 2) with the accumulation of inflammatory fluid - exudate - with exudative pleurisy (serous, purulent); 3) with accumulation of blood in the pleural cavity (in case of injury, scurvy, hemorrhagic diathesis).

At the same time, thoracic dropsy is characterized by a two-sided process, approaching the horizontal upper boundary of the liquid; for exudative pleurisy - one-sidedness of the lesion, the upper limit of the fluid with its moderate accumulation in the form of the Damuazo line.

Syndrome of accumulation of air in the pleural cavity
On examination, the protrusion of the diseased half of the chest and its lag during breathing, as well as smoothing of the intercostal spaces, is determined. On palpation, the intercostal spaces, if the air is not under very high pressure in the pleural cavity, retain their elasticity; voice trembling is absent. With percussion, a very loud tympanic tone is heard, sometimes with a metallic tint; however, if the air is in the pleural cavity under high pressure, the percussion tone becomes dull or even dull. On auscultation, there are no breath sounds, or weak amphoric breathing is heard; bronchophony is increased, with a metallic tint and ringing silver notes. The accumulation of air in the pleural cavity is called pneumothorax. The latter is most often observed in pulmonary tuberculosis (about 75% of all cases). In addition, the same syndrome appears with the so-called artificial pneumothorax, when air is introduced into the pleural cavity by a doctor for therapeutic purposes.

Syndrome of simultaneous accumulation of fluid and air in the pleural cavity
Pneumothorax is very often (approximately 80% of cases) complicated by effusion, and then we get signs of pneumothorax and a number of other signs during the study, indicating the presence of pleura and fluid in the cavity. The rectilinear horizontal upper limit of dullness resulting from percussion, corresponding to the level of the fluid, is especially characteristic, and due to the easy mobility of this fluid, dullness easily and quickly changes its boundary when the patient's body position changes. In addition, when changing position from standing to lying or vice versa, the height of the percussion tone changes (due to a change in the height of the air column, as well as the tension of the walls of the cavity) - in the supine position, the tone is higher than in the standing position. On auscultation, a splashing noise is characteristic, which can be heard at a distance. Sometimes the sound of a falling drop is heard. This symptom complex is also observed in the presence of serous fluid and air in the pleural cavity - hydropneuraothorax and when pus and air are present in it - pyopneumothorax.

The pathological condition of newborns that occurs in the first hours and days after birth due to the morphofunctional immaturity of the lung tissue and surfactant deficiency. The syndrome of respiratory disorders is characterized by respiratory failure of varying severity (tachypnea, cyanosis, retraction of compliant chest areas, participation of accessory muscles in the act of breathing), signs of CNS depression and circulatory disorders. Respiratory distress syndrome is diagnosed on the basis of clinical and radiological data, assessment of surfactant maturity indicators. Treatment of respiratory distress syndrome includes oxygen therapy, infusion therapy, antibiotic therapy, endotracheal instillation of surfactant.

General information

Respiratory distress syndrome (RDS) is a pathology of the early neonatal period caused by the structural and functional immaturity of the lungs and associated impairment of surfactant formation. In foreign neonatology and pediatrics, the term "syndrome of respiratory disorders" is identical to the concepts of "respiratory distress syndrome", "hyaline membrane disease", "pneumopathies". The syndrome of respiratory disorders develops in approximately 20% of premature infants (in children born before 27 weeks of gestation - in 82-88% of cases) and 1-2% of full-term newborns. Among the causes of perinatal mortality, the syndrome of respiratory disorders accounts for, according to various sources, from 35 to 75%, which indicates the relevance and in many ways still unresolved problem of nursing children with SDR.

Causes of respiratory distress syndrome

As already mentioned, the pathogenesis of the syndrome of respiratory disorders in newborns is associated with the immaturity of the lung tissue and the resulting deficiency of the anti-atelectatic factor - surfactant, its inferiority, inhibition or increased destruction.

The surfactant is a surface-active lipoprotein layer that covers the alveolar cells and reduces the surface tension of the lungs, i.e., prevents the walls of the alveoli from collapsing. Surfactant begins to be synthesized by alveolocytes from 25-26 weeks of fetal development, but its most active formation occurs from 32-34 weeks of gestation. Under the influence of many factors, including hormonal regulation by glucocorticoids (cortisol), catecholamines (adrenaline and norepinephrine), estrogens, thyroid hormones, the maturation of the surfactant system is completed by the 35-36th week of gestation.

Therefore, the lower the gestational age of a newborn, the lower the amount of surfactant in his lungs. In turn, this leads to the collapse of the walls of the alveoli on expiration, atelectasis, a sharp decrease in the area of ​​gas exchange in the lungs, the development of hypoxemia, hypercapnia and respiratory acidosis. Violation of alveolocapillary permeability leads to plasma sweating from the capillaries and subsequent precipitation of hyaline-like substances on the surface of the bronchioles and alveoli, which further reduces the surfactant synthesis and contributes to the development of pulmonary atelectasis (hyaline membrane disease). Acidosis and pulmonary hypertension support the preservation of fetal communications (open foramen ovale and ductus arteriosus) - this also exacerbates hypoxia, leads to the development of DIC, edematous-hemorrhagic syndrome, and further disruption of surfactant formation.

The risk of developing a syndrome of respiratory disorders increases with prematurity, morphological and functional immaturity in relation to gestational age, intrauterine infections, fetal hypoxia and asphyxia of the newborn, congenital heart disease, pulmonary malformations, intracranial birth injuries, multiple pregnancies, aspiration of meconium and amniotic fluid, congenital hypothyroidism, etc. Maternal risk factors for the development of respiratory distress syndrome in a newborn can be diabetes mellitus, anemia, labor bleeding, delivery by caesarean section.

Classification of respiratory distress syndrome

On the basis of the etiological principle, a syndrome of respiratory disorders of hypoxic, infectious, infectious-hypoxic, endotoxic, genetic (with a genetically determined surfactant pathology) genesis is distinguished.

Based on the developing pathological changes, 3 degrees of severity of the syndrome of respiratory disorders are distinguished.

I (mild)- occurs in relatively mature children who have a moderate condition at birth. Symptoms develop only with functional loads: feeding, swaddling, manipulation. RR less than 72 per minute; the gas composition of the blood is not changed. The condition of the newborn is normalized within 3-4 days.

II (medium-severe degree)- a child is born in a serious condition, which often requires resuscitation. Signs of respiratory distress syndrome develop within 1-2 hours after birth and persist for up to 10 days. The need for oxygen supplementation usually disappears on the 7-8th day of life. Against the backdrop of respiratory distress syndrome, every second child develops pneumonia.

III (severe)- usually occurs in immature and very premature babies. Signs of a syndrome of respiratory disorders (hypoxia, apnea, areflexia, cyanosis, severe depression of the central nervous system, impaired thermoregulation) occur from the moment of birth. From the side of the cardiovascular system, tachycardia or bradycardia, arterial hypotension, signs of myocardial hypoxia on the ECG are noted. High probability of death.

Symptoms of respiratory distress syndrome

Clinical manifestations of the syndrome of respiratory disorders usually develop on the 1-2 day of a newborn's life. Shortness of breath appears and intensively increases (respiratory rate up to 60–80 per minute) with the participation of auxiliary muscles in the respiratory act, retraction of the xiphoid process of the sternum and intercostal spaces, swelling of the wings of the nose. Characterized by expiratory noises (“grunting exhalation”) caused by spasm of the glottis, apnea attacks, cyanosis of the skin (first perioral and acrocyanosis, then general cyanosis), foamy discharge from the mouth often mixed with blood.

In newborns with respiratory distress syndrome, there are signs of CNS depression due to hypoxia, an increase in cerebral edema, and a tendency to intraventricular hemorrhages. DIC can be manifested by bleeding from injection sites, pulmonary bleeding, etc. In a severe form of respiratory distress syndrome, acute heart failure rapidly develops with hepatomegaly, peripheral edema.

Other complications of the respiratory distress syndrome can be pneumonia, pneumothorax, pulmonary emphysema, pulmonary edema, retinopathy of prematurity, necrotizing enterocolitis, renal failure, sepsis, etc. As a result of the respiratory distress syndrome, the child may experience recovery, bronchial hyperreactivity, perinatal encephalopathy, impaired immunity, COPD (bullous disease, pneumosclerosis, etc.).

Diagnosis of respiratory distress syndrome

In clinical practice, to assess the severity of the syndrome of respiratory disorders, the I. Silverman scale is used, where the following criteria are evaluated in points (from 0 to 2): chest excursion, retraction of the intercostal spaces on inspiration, retraction of the sternum, flaring of the nostrils, lowering the chin on inspiration , expiratory noises. A total score below 5 points indicates a mild degree of respiratory distress syndrome; above 5 - medium, 6-9 points - about severe and from 10 points - about extremely severe degree of SDR.

In the diagnosis of respiratory distress syndrome, lung radiography is of decisive importance. The X-ray picture changes in various pathogenetic phases. With disseminated atelectasis, a mosaic pattern is revealed, due to the alternation of areas of reduced pneumatization and swelling of the lung tissue. The disease of hyaline membranes is characterized by "air bronchogram", reticular-nadose grid. In the stage of edematous-hemorrhagic syndrome, fuzziness, blurring of the lung pattern, massive atelectasis are determined, which determine the picture of the "white lung".

To assess the degree of maturity of the lung tissue and the surfactant system in respiratory distress syndrome, a test is used that determines the ratio of lecithin to sphingomyelin in amniotic fluid, tracheal or gastric aspirate; "foam" test with the addition of ethanol to the analyzed biological fluid, etc. It is possible to use the same tests when conducting invasive prenatal diagnosis - amniocentesis, carried out after 32 weeks of gestation.

The condition of the child, caused by the syndrome of respiratory disorders, should be distinguished from congenital pneumonia, malformations of the respiratory system, etc.

A child with a syndrome of respiratory disorders needs continuous monitoring of emergency situations, respiratory rate, blood gases, CBS; monitoring of indicators of general and biochemical blood tests, coagulograms, ECG. To maintain optimal body temperature, the child is placed in an incubator, where he is provided with maximum rest, mechanical ventilation or inhalation of humidified oxygen through a nasal catheter, parenteral nutrition. The child is periodically performed tracheal aspiration, vibration and percussion massage of the chest.

With the syndrome of respiratory disorders, infusion therapy is carried out with a solution of glucose, sodium bicarbonate; transfusion of albumin and fresh frozen plasma; antibiotic therapy, vitamin therapy, diuretic therapy. An important component of the prevention and treatment of respiratory distress syndrome is endotracheal instillation of surfactant preparations.

Forecast and prevention of respiratory distress syndrome

The consequences of the syndrome of respiratory disorders are determined by the term of delivery, the severity of respiratory failure, the associated complications, the adequacy of resuscitation and therapeutic measures.

In terms of prevention of respiratory distress syndrome, the most important is the prevention of preterm birth. In the event of a threat of preterm birth, it is necessary to conduct therapy aimed at stimulating the maturation of the lung tissue in the fetus (dexamethasone, betamethasone, thyroxine, aminophylline). Premature babies should be given early (in the first hours after birth) surfactant replacement therapy.

In the future, children who have had a syndrome of respiratory disorders, in addition to the local pediatrician, should be observed by a pediatric neurologist, a pediatric pulmonologist,

1. Syndrome of focal compaction of lung tissue.
2. Syndrome of lung atelectasis.
3. Syndrome of increased airiness of the lungs.
4. Broncho-obstructive syndrome.
5. Syndrome of fluid accumulation in the pleural cavity.
6. Syndrome of accumulation of air in the pleural cavity.
7. Cavity syndrome in the lung.
8. Syndrome of disseminated processes in the lung tissue (with the syndrome of pulmonary dissem and nationality).
9. Syndrome of respiratory failure.

Syndrome of focal compaction of lung tissue.

It is based on 3 groups of reasons:
filling of part of the alveoli with inflammatory exudate, blood;
replacement of part of the alveoli with connective tissue;
germination of a part of the air tissue of the lung by a tumor.
Diseases and conditions in which this syndrome is detected:
1) pneumonia; 2) heart attack-pneumonia; 3) tuberculous infiltrate; 4) peripheral lung cancer; 5) pneumosclerosis; 6) carnification.

Complaints. Shortness of breath (of varying severity depending on the prevalence of the process), chest pain on the side of the lesion (if
pleura or large bronchus), hemoptysis (“rusty” sputum in lobar pneumonia, “raspberry jelly” in cancer, fresh
blood in case of heart attack-pneumonia); profuse night sweats, weight loss, prolonged fever, cough, hemoptysis in tuberculosis.
Persistent cough, not relieved by medicines, in lung cancer.

Anamnesis of the disease. In the anamnesis there are indications of long-term, repeated pneumonia, tuberculosis, lung abscess.

Objective symptoms. Their manifestations and severity depend on the prevalence of the process. Consider the classic manifestations of the syndrome.

Inspection. Lag in the act of breathing of the affected half of the chest.

Percussion. Dullness of percussion tone in the zone of lung tissue compaction.

Auscultation. Three variants of the main respiratory sounds, depending on the prevalence of the focus: 1) bronchial breathing
(a large focus with good patency of the ventilating bronchus); 2) bronchovesicular breathing in those cases when the foci of compaction are interspersed with air tissue; 3) weakened
vesicular breathing, when the foci are small, and around them are large areas of normal lung tissue (more often with small
areas of pneumosclerosis, carnification, lung cancer).

Adverse breath sounds. 1) consonant moist rales - a site of compaction + the presence of a liquid secret in the bronchi;
2) crepitus (pneumonia, often lobar); 3) pleural friction noise (when the pleura is involved in the pathological process, for example,
pleuropneumonia).

Bronchophony. Strengthening over the lesion.

X-ray examination. The center of shading in the lung tissue (its compaction).
Lobar
pneumonia at the height of the disease: on palpation - increased voice trembling, on percussion - a dull percussion sound,
auscultation - bronchial breathing and crepitus, increased bronchophony.

Syndrome of atelectasis of the lungs.

Atelectasis (gr. ateles - incomplete, incomplete + ektasis - stretching) - a pathological condition of the lung or part of it, in which the pulmonary alveoli do not contain air or
contain it in a reduced amount and appear to have fallen asleep.

Allocate complete and incomplete atelectasis (dystelectasis).

There is no generally accepted classification of atelectasis.
Depending on the mechanism of occurrence, 3 main variants of atelectasis are distinguished:
obstructive;
compression (compression of lung tissue);
distension, or functional (violation of the conditions for stretching the lungs on inspiration: weakness of the respiratory muscles, especially
diaphragm, depression of the respiratory center).
There is also reflex atelectasis (active contraction of the elements of the lung). Yes, long-term surgery
sometimes there is a complete collapse of the lung or both lungs with complete patency of the bronchial tree.

obstructive atelectasis. The cause of obstructive atelectasis is a violation of the patency of the bronchi as a result of blockage or compression from the outside by a tumor, scars, lymph nodes.

Complaints. Shortness of breath, palpitations, cyanosis. Cyanosis is caused by shunting (shunting) of unoxygenated blood from the small
circle in the systemic circulation.

Examination: a) the chest on the side of atelectasis sinks; b) lags behind in the act of breathing; c) intercostal spaces are narrowed.

Palpation. The resistance of the chest is reduced, voice trembling is weakened.

percussion. Comparative - above the atelectasis zone, the sound is shortened or dull (it all depends on the degree of air absorption). With complete obstruction of the bronchus, the complete absorption of O2 from the alveolar
01 about air occurs within 30 minutes, CO2 - after 2 hours, nitrogen within 6 - 8 hours.

Topographic. There is a shift in the boundaries of the heart and mediastinum as a whole towards atelectasis. This is especially noticeable with massive right-sided atelectasis, when the heart
ny push can be shifted to the right of the sternum.

Auscultation. A sharp weakening or complete absence of vesicular breathing, bronchophony is weakened.
X-ray data: a) intercostal spaces are narrowed; b) the median shadow is shifted towards atelectasis; c) in the area of ​​atelectasis - a homogeneous shadow; d) high location of the dome of the diaphragm and
subphrenic organs; e) swelling of the unchanged parts of the lungs (vicar emphysema).

Compression atelectasis develops as a result of external compression of the lung tissue due to:
1) accumulation of fluid in the pleural cavity;
2) volumetric processes of the mediastinum, pericardium, esophagus, lymph nodes;
3) accumulation of gas in the pleural cavity;
4) tumors of the pleura;
5) aortic aneurysm.

Complaints are due to the underlying disease.
Inspection. Backlog of the chest on the side of atelectasis during breathing. However, retraction of the chest and narrowing of the intercostal spaces are not observed.
Palpation. In the area of ​​atelectasis - increased voice trembling, in the area of ​​accumulation of fluid or gas - weakening.
Percussion. Comparative - dullness of percussion tone.
The zone of dullness is often determined by the main pathological process (fluid, tumor, etc.). If the lung is pressed against the root, then the percussion sound becomes dull
tympanic.
Topographic - the organs of the mediastinum are displaced, as a rule, in the healthy direction, a decrease in the mobility of the lower pulmonary edge.
Auscultation. Weakened bronchial breathing, increased bronchophony over the area of ​​atelectasis.

Syndrome of increased airiness of the lungs.

A syndrome that is caused by pathological expansion of the air spaces distal to the terminal bronchioles. This pathological expansion of the air spaces is called emphysema.

Broncho-obstructive syndrome.

Violation of bronchial patency occurs as a result of inflammation of the bronchial mucosa, its edema; clusters
in the lumen of the bronchi, an excessive amount of secretion with altered rheological properties; spasm of the smooth muscles of the bronchi.
Broncho-obstructive syndrome is polyetiological and occurs in a number of diseases, but most often in chronic obstructive pulmonary disease and bronchial asthma. Often
broncho-obstructive syndrome is combined with emphysema.
Complaints of shortness of breath (shortness of breath), more pronounced on the exhale (expiratory dyspnea). “Whistling” breathing, remote wheezing are often detected; asthma attacks,
characteristic of bronchial asthma.
Inspection. Forced position - orthopnea (with an attack of bronchial asthma); participation of accessory muscles in
the act of breathing; chest in inhalation position (raised); remote wheezing.
Palpation. With concomitant emphysema, chest rigidity is increased and voice trembling is weakened.
Percussion. In the presence of concomitant emphysema - a box sound, the lower borders and other signs of increased airiness of the lungs are lowered.
Auscultation: 1) hard breathing (rough, rough breathing that retains the features of a vesicular one, since the duration of the respiratory phases is generally preserved); 2) hard breathing with extended
exhalation; exhalation is heard throughout the entire cycle or occupies most of it; 3) dry wheezing as a characteristic sign of damage to the small bronchi (bronchospasm +
the presence of a viscous secret).
Radiography. Strengthening and deformation of the lung pattern. respiratory function.

Syndrome of accumulation of fluid in the pleural cavity.

This syndrome is polyetiological. The most common variants of the syndrome:

Hydrothorax - accumulation of non-inflammatory fluid in heart failure
exudative pleurisy (tuberculosis, pneumonia, lung cancer, | pleural tumor, etc.);
■ hemothorax (accumulation of blood) - with chest injuries;
chylothorax - accumulation of lymph in the pleural cavity.

Complaints depend on the underlying disease. With a significant accumulation of fluid - shortness of breath, cyanosis, palpitations.
Inspection. Bulging of half of the chest on the side of fluid accumulation; lagging behind when breathing; smoothness of the intercostal spaces.
Palpation: 1) the resistance of the chest is increased on the side of the lesion. The skin fold in the same place is more “thick” than on the opposite side (Wintrich's symptom); 2) voice
trembling is weakened or completely absent.
Percussion. Comparative percussion: dull or blunted percussion sound, depending on the volume of fluid. In the zone of maximum fluid accumulation, percussion reveals absolute dullness. In areas where the fluid layer is thinner, dullness of the percussion tone is determined.
It is believed that free pleural effusion can be determined by percussion if its volume exceeds 300-500 ml. An increase in its level by 500 ml corresponds to an increase in the zone of dullness of percussion sound by one rib upwards (for example, an increase in the zone of blunting from V to IV rib indicates
about an increase in the amount of free fluid in the pleural cavity by 500 ml).
Topographic percussion. Dullness of the percussion tone has an arcuate border, which rises as much as possible along the posterior axillary line (Damuazo-Franklin, Sokolov-Ellis-Damuazo line). Then this line descends anteriorly obliquely down.

Syndrome of accumulation of air in the pleural cavity.

Pneumothorax is a pathological condition that develops as a result of the appearance of a message between the bronchi and the pleural cavity, i.e., in cases where a rupture of the lung occurs
tissue and visceral pleura, which leads to the entry of air into the pleural cavity.
There are the following types of pneumothorax: and
artificial (for the treatment of patients with tuberculosis);
traumatic;
spontaneous (when lung tissue rupture occurs as a result of the presence of congenital bullae, emphysematous swellings, lung abscess, lung adhesions, etc.).
You also divide pneumothorax: 1) open, 2) closed, 3) valvular.

Cavity syndrome in the lung.

The causes of the formation of a cavity in the lungs are a number of diseases:
1) acute and chronic lung abscess; 2) pulmonary tuberculosis; 3) disintegration of a lung tumor; 4) bronchiectasis; 5) lung cysts.
Complaints of the patient depend on the nature of the disease. The classic physical symptoms of a cavity appear when
when the cavity: 1) is free of contents, 2) is communicated with the bronchus, 3) is large enough.
Inspection. Lag in the act of breathing of the diseased half of the chest.
Palpation. Increased voice tremor.
Percussion. Dull-tympanic sound (the cavity, as a rule, is formed in the zone of compaction of the lung tissue or is surrounded by a shaft of inflammation). In the presence of a superficial
large cavity - tympanitis is high or low, depending on the condition of the walls of the cavity.
A metallic percussion tone is formed in cavities that are at least 6 cm in diameter and have smooth walls. Decreased excursion of the lower pulmonary edge of the affected lung.
Auscultation. Bronchial respiration with an amphoric tinge (amphoric respiration). Bronchophony is increased.
X-ray. Area of ​​enlightenment with liquid level.

Syndrome of disseminated processes in the lung tissue

Pulmonary dissemination syndrome combines a large group of different diseases, united by 2 main manifestations:
progressive shortness of breath and characteristic x-ray changes in the lungs.

Respiratory failure syndrome.

There are 3 degrees of chronic respiratory failure:
I degree - the appearance of shortness of breath when performing moderate physical activity or exertion in excess of everyday;
II degree - the appearance of shortness of breath when performing minor physical exertion (or during everyday exertion);
III degree - the appearance of shortness of breath at rest.
Violation of external respiration occurs when:
a) ventilation as a result of obstructive or restrictive disorders; b) diffusion processes as a result of structural and morphological changes in the alveolar-capillary membrane
(fibrosing alveolitis, emphysema, etc.); c) perfusion of the lungs with blood as a result of thrombosis or embolism of the pulmonary vessels, or damage to the vascular wall (thromboembolism of the branches
pulmonary artery, pulmonary angiitis in systemic connective tissue diseases, etc.).

Respiratory and pulmonary insufficiency are unequal concepts. Pulmonary insufficiency implies changes only in the apparatus of external respiration, and respiratory insufficiency - changes
all 3 stages of respiration (ventilation, transport of gases by blood and gas exchange in tissues). But the most common cause of respiratory failure is pulmonary insufficiency.
Extrapulmonary causes of respiratory failure:
violations of the central regulation of breathing;
disorders of neuromuscular impulse transmission;
respiratory muscle damage
chest lesions (deformities, injuries, etc.);
diseases of the blood system;
diseases of the circulatory system.
Pulmonary causes of respiratory failure:
airway obstruction;
restriction of alveolar tissue;
thickening of the alveolar-capillary membrane (fibrosis, edema, etc.);
damage to the pulmonary capillaries.