Deformed roots of the left lung. The roots of the lungs have little structure, what does this mean?

In connection with the development of bronchoscopic technology in recent decades, not only segmental bronchi, but also their subsegmental branches, i.e., have become accessible to inspection. bronchi of the 4th order. Accordingly, the distal border of the central cancer has shifted: it is a tumor that affects the main, intermediate, lobar, segmental and subsegmental bronchi. A tumor, the source of which is an even smaller bronchus, in the presence of a pronounced peribronchial node, is considered as peripheral cancer.

Symptoms

The symptoms of lung cancer are not very specific at first, and this becomes the reason for contacting a doctor too late. In addition, the timing of symptoms varies greatly depending on the type of cancer.

Thus, central lung cancer develops earlier than squamous cell cancer. This is due to the typical location of the tumor, as well as the time of involvement of neighboring organs in the process - the pleura, mediastinal organs, and the metastatic activity of the type of cancer.

What symptoms should alert people at risk for lung cancer?

an increase in the volume of cough, sputum, increasing the duration of cough episodes;

the appearance of blood streaks in the sputum, any foreign inclusions, purulent discharge when coughing;

deterioration of general condition, weakness, weight loss;

pain when coughing and later when breathing;

shortness of breath, worsening with movement, in a lying position;

the appearance in blood tests of a large number of leukocytes, eosinophilia, constant or for a long time.

Forecast

Lung cancer: the prognosis is far from encouraging, as it is an almost fatal disease. But much depends on the stage at which the disease was diagnosed.

Stage 3 lung cancer is characterized by the presence of a tumor, the size of which has already reached six centimeters and has spread to the adjacent lobe of the lung. Possibly by germination of a neighboring bronchus or main bronchus. Metastases are found in bifurcation, tracheobronchial, paratracheal lymph nodes.

Patients admitted for surgical treatment with asymptomatic cancer have a more favorable prognosis. Once clinical symptoms occur, nearly seventy-five percent of patients are virtually untreatable. The prognosis is more favorable if clinical symptoms appear for no more than three months. If symptoms persist for more than nine months, the prognosis for recovery worsens significantly.

Radiation diagnostics

Radiological signs of central RL are presented in Table. 1.

Table 1. Radiological signs of central LC

Ball-shaped node in the root of the lung

Lung root expansion

Bronchial obstruction:

a) increased pulmonary pattern at the root of the lung (hypoventilation)

b) obstructive emphysema

Diagnostics of central RL

Clinical symptoms of central cancer are a dry hacking cough (in smokers its frequency and character changes), hemoptysis and shortness of breath.

On early stages For the development of the disease, radiography is ineffective, so the study should immediately begin with computed tomography (CT) and fibrobronchoscopy (FBS).

Thus, the search and improvement of organizational measures for the active detection of early forms of the disease, in which computed tomography has an absolute priority, are one of the main directions of modern medicine.

However, it should be noted that linear tomography can no longer serve as a worthy replacement for modern computer research methods, and if central LC is suspected, the patient should be guided by those diagnostic centers, which are equipped with modern technology and where the appropriate examination can be carried out.

Treatment

Treatment of central lung cancer, like other cancers, consists of three main methods - surgical treatment, chemotherapy and radiation therapy.

The diagnosis of lung cancer itself is an indication for surgical treatment. Operations can be: radical, conditionally radical and palliative, depending on the severity of the tumor process. The entire lung or its individual lobes can be removed. But, unfortunately, there are a number of contraindications to surgical treatment, among them: the presence of multiple metastases to other organs; technical complexity and impossibility of resection in the presence of metastases in the mediastinum, as well as when the diaphragm, trachea, and mediastinal formations are involved in the tumor process. Among the functional contraindications to surgery are: respiratory failure of the third degree, which does not respond to conservative therapy; severe heart failure and myocardial infarction, less than three months old; severe forms diabetes mellitus; severe liver and kidney failure.

In cases where the patient, for one of the above reasons, cannot undergo surgical treatment of central lung cancer, radiation therapy is performed.

Chemotherapy is highly effective only for small cell lung cancer. Most often, a combination of drugs of varying toxicity and mechanism of action and radiation therapy are used. Polychemotherapy most often includes platinum complex compounds, adriamycin, Vepesid or vinyl alkaloids. For non-small cell cancer, chemotherapy is symptomatic.

The prognosis is most favorable when early detection and timely treatment of central lung cancer.

Peripheral lung cancer

Peripheral lung cancer is a manifestation in the form of a node, polygonal or spherical in shape, on the mucous membranes of the bronchi, bronchial glands and alveoli. The tumor can be either benign or malignant, but the malignant form of the tumor is most common.

The disease is peripheral lung cancer, affecting the smaller bronchi. Consequently, there is usually an uneven radiance around the node, which is more typical for fast-growing, low-grade tumors. Also, there are cavitary forms of peripheral lung cancer with heterogeneous areas of decay.

The disease begins to manifest itself when the tumor rapidly develops and progresses, involving the large bronchi, pleura and chest. At this stage, peripheral lung cancer turns into central. Characterized by increased cough with sputum discharge, hemoptysis, pleural carcinomatosis with effusion into the pleural cavity.

Forms of peripheral lung cancer:

One of the main differences between the tumor process in the lungs is the variety of their forms:

Cortico-pleural form: an oval-shaped neoplasm that grows into the chest and is located in the subpleural space. This form belongs to the squamous cell type of cancer. The structure of the tumor is most often homogeneous with a lumpy inner surface and unclear contours. It tends to grow both into adjacent ribs and into the bodies of nearby thoracic vertebrae.

The cavity form is a neoplasm with a cavity in the center. The manifestation occurs due to the disintegration of the central part of the tumor node, which lacks nutrition during the growth process. Such neoplasms usually reach sizes of more than 10 cm; they are often confused with inflammatory processes (cysts, tuberculosis, abscesses), which leads to an initially incorrect diagnosis, which contributes to the progression of cancer. This form of neoplasm is often asymptomatic.

Important! The cavitary form of peripheral lung cancer is diagnosed mainly on late stages when the process becomes irreversible.

In the lungs, flat formations of a rounded shape with a tuberous outer surface. As the tumor grows, the cavity formations also increase in diameter, while the walls thicken and the visceral pleura is pulled towards the tumor.

Peripheral cancer of the left lung

Cancer of the upper lobe of the left lung: at this stage of the tumor process, the X-ray image clearly visualizes the contours of the tumor, which heterogeneous structure and incorrectly shaped. In this case, the roots of the lungs are expanded by vascular trunks. Lymph nodes are not enlarged.

Cancer of the lower lobe of the left lung: here everything happens completely opposite, in relation to the upper lobe of the left lung. There is an increase in the intrathoracic, prescalene and supraclavicular lymph nodes.

Peripheral cancer of the right lung

Peripheral cancer of the upper lobe of the right lung: has the same features as the previous form, but is much more common, like cancer of the lower lobe of the right lung.

Nodular form of lung cancer: originates from terminal bronchioles. It appears after soft tissue has grown into the lungs. At x-ray examination you can see the formation of a nodular shape with clear contours and a bumpy surface. A small depression may be visible along the edge of the tumor (Rigler's sign), this indicates the entry of a large vessel or bronchus into the node.

Important: “nutrition for lung cancer patients”: Special attention It is worth paying attention to a correct and healthy diet; you need to eat only healthy and high-quality foods enriched with vitamins, microelements and calcium.

Pneumonia-like peripheral lung cancer is always glandular cancer. Its form develops as a result of spread along the lobe of peripheral cancer growing from the bronchus, or with the simultaneous manifestation of a large number of primary tumors in the pulmonary parenchyma and their merging into a single tumor infiltrate.

This disease does not have any specific clinical manifestations. At first, it is characterized as a dry cough, then sputum appears, initially scanty, then abundant, liquid, foamy. With the addition of infection clinical course resembles recurrent pneumonia with severe general intoxication.

Cancer of the apex of the lung with Pancoast syndrome is a type of disease in which malignant cells penetrate the nerves and vessels of the shoulder girdle.

• apical localization of lung cancer;
• Horner's syndrome;
• pain in the supraclavicular region, usually intense, initially paroxysmal, then constant and prolonged. They are localized in the supraclavicular fossa on the affected side. The pain intensifies with pressure, sometimes spreading along the nerve trunks emanating from the brachial plexus, accompanied by numbness of the fingers and muscle atrophy. In this case, hand movements can be disrupted to the point of paralysis.

X-ray examination of Pancoast syndrome reveals: destruction of 1-3 ribs, and often the transverse processes of the lower cervical and upper thoracic vertebrae, deformation of the bone skeleton. In advanced stages of the disease, a doctor’s examination reveals unilateral dilatation of the saphenous veins. Another symptom is a dry cough.

Horner and Pancoast syndromes are often combined in one patient. With this syndrome, due to the tumor affecting the lower cervical sympathetic nerve ganglia, hoarseness of the voice, unilateral drooping of the upper eyelid, narrowing of the pupil, sunken eyeball, injection (vasodilation) of the conjunctiva, dyshidrosis (impaired sweating) and hyperemia of the facial skin on the corresponding the losing side.

In addition to primary peripheral and metastatic cancer lung syndrome(triad) Pancosta can also occur with a number of other diseases:

• hydatid cyst in the lung;
• mediastinal tumor;
• pleural mesothelioma;
• lymphogranulomatosis;
• tuberculosis.

What all these processes have in common is their apical localization. With a thorough X-ray examination of the lungs, the true nature of Pancoast syndrome can be recognized.

How long does it take for lung cancer to develop?

There are three courses of development of lung cancer:

• biological - from the onset of the tumor until the appearance of the first clinical signs, which will be confirmed by the data of the diagnostic procedures performed;
• preclinical - a period in which there are completely no signs of the disease, which is the exception of visiting a doctor, which means that the chances of early diagnosis of the disease are reduced to a minimum;
• clinical - the period of manifestation of the first symptoms and initial visits of patients to a specialist.

Tumor development depends on the type and location of cancer cells. Non-small cell lung cancer develops more slowly. It includes: squamous cell, adenocarcinoma and large cell lung cancer. The prognosis for this type of cancer is 5-8 years without appropriate treatment. With small cell lung cancer, patients rarely survive more than two years. The tumor develops rapidly and clinical symptoms of the disease appear. Peripheral cancer develops in the small bronchi, does not produce pronounced symptoms for a long time and often manifests itself during routine medical examinations.

Symptoms and signs of peripheral lung cancer

In the later stages of the disease, when the tumor spreads to a large bronchus and narrows its lumen, the clinical picture of peripheral cancer becomes similar to the central form. At this stage of the disease, the results of physical examination are the same in both forms of lung cancer. At the same time, unlike central cancer, X-ray examination against the background of atelectasis reveals the shadow of the peripheral tumor itself. In peripheral cancer, the tumor often spreads throughout the pleura with the formation of pleural effusion.

The transition of the peripheral form to the central form of lung cancer occurs due to the involvement of large bronchi in the process, while remaining invisible for a long time. Manifestations of a growing tumor may include increased cough, sputum production, hemoptysis, shortness of breath, pleural carcinomatosis with effusion into the pleural cavity.

Bronchial cancer, similar first symptoms appear with the addition of inflammatory complications from the lungs and pleura. That is why it is important to regularly conduct fluorography, which shows lung cancer.

Symptoms of peripheral lung cancer:

Chest pain

• shortness of breath - may be due to tumor metastasis to the lymph nodes;
• pain in chest, and can change their character along with movement;
• cough, prolonged, without any reason;
• sputum separation;
• swollen lymph nodes;
• if the tumor develops in the area of ​​the apex of the lung, then compression of the superior vena cava may occur and the neoplasm may impact the structures of the cervical plexus, with the development of corresponding neurological symptoms.

Signs of peripheral lung cancer:

Decreased vitality

• temperature increase;
• malaise;
• weakness, lethargy;
• rapid fatigue;
• decreased ability to work;
• loss of appetite;
• weight loss;
• in some cases, pain in the bones and joints is even felt.

Causes of development of peripheral lung cancer:

1. smoking is one of the most important reasons incidence of lung cancer. Tobacco smoke contains hundreds of substances that can have a carcinogenic effect on the human body;
2. conditions environment: air pollution that penetrates the lungs (dust, soot, fuel combustion products, etc.);
3. harmful working conditions - the presence of large amounts of dust can cause the development of sclerosis of the lung tissue, which has the risk of developing into a malignant form;
4. asbestosis – a condition caused by inhalation of asbestos particles;
5. hereditary predisposition;
6. Chronic lung diseases - cause constant inflammation, which increases the likelihood of developing cancer; viruses can invade cells and increase the likelihood of developing cancer.

Stages of peripheral lung cancer

Stages of prevalence of lung cancer

1. Stage 1 peripheral lung cancer. The tumor is quite small in size. There is no spread of the tumor to the chest organs and lymph nodes;

1A tumor size does not exceed 3 cm;

1B tumor size from 3 to 5 cm;

Stage 2 peripheral lung cancer. The tumor grows;

2A tumor size 5-7 cm;

2B, the dimensions remain unchanged, but the cancer cells are located close to the lymph nodes;

Stage 3 peripheral lung cancer;

3A the tumor affects adjacent organs and lymph nodes, the size of the tumor exceeds 7 cm;

3B cancer cells penetrate the diaphragm and lymph nodes on the opposite side of the chest;

Stage 4 peripheral lung cancer. At this stage, metastasis occurs, that is, the tumor spreads throughout the body.

Diagnosis of lung cancer

Important! Peripheral lung cancer is a malignant neoplasm that tends to grow and spread rapidly. When the first suspicious symptoms appear, you should not hesitate to visit a doctor, as you may waste precious time.

Diagnosis of lung cancer is difficult due to the similarity of its radiological symptoms with many other diseases.

How to recognize peripheral lung cancer?

• X-ray examination is the main method in the diagnosis of malignant neoplasms. Most often, patients perform this study for a completely different reason, and in the end they may encounter lung cancer. The tumor looks like a small lesion on the peripheral part of the lung;
• computed tomography and MRI are the most accurate diagnostic methods, which will allow you to obtain a clear image of the patient’s lungs and accurately examine all of his tumors. With the help of special programs, doctors have the opportunity to examine the received images in different projections and extract maximum information for themselves;
• biopsy - is carried out by removing a section of tissue followed by histological examination. Only by examining the tissue under high magnification can doctors say that the neoplasm is malignant;
• bronchoscopy – examination of the patient’s respiratory tract and bronchi from the inside using special equipment. Since the tumor is located in parts more distant from the center, the method provides less information than if the patient has central lung cancer;
• cytological examination of sputum - allows you to detect atypical cells and other elements that suggest a diagnosis.

Differential diagnosis

On a chest x-ray, the shadow of peripheral cancer must be differentiated from several diseases unrelated to the tumor in the right lung.

• Pneumonia is an inflammation of the lungs, which gives a shadow on the X-ray image; the accumulation of exudate provokes a violation of ventilation in the lungs, since it is not always possible to make out the pattern accurately. Accurate diagnosis placed only after a thorough examination of the bronchi.
• Tuberculosis and tuberculoma are a chronic disease that can provoke the development of an encapsular formation - tuberculoma. The size of the shadow on the radiograph will not exceed 2 cm. The diagnosis is made only after laboratory testing of the exudate to identify mycobacteria.
• Retention cyst – the image will show a formation with clear edges, but accumulation may also appear in this way cancer cells secret. Therefore, an additional examination of the bronchi and ultrasound is carried out.
• A benign tumor of the right lung - there will be no tuberosity in the image, the tumor is clearly localized and does not disintegrate. Distinguish benign tumor based on the patient’s history and complaints – there are no symptoms of intoxication, stable health, no hemoptysis.

Having excluded all similar diseases, the main stage begins - selecting the most effective techniques treatment for a specific patient, depending on the shape, stage and location of the malignant lesion in the right lung.

Informative video on the topic: Endobronchial ultrasound in the diagnosis of peripheral lung cancer

Peripheral lung cancer and its treatment

Today, the most modern methods of treating lung cancer are:

• surgical intervention;
• radiation therapy;
• chemotherapy;
• radiosurgery.

In world practice, surgery and radiation therapy are gradually giving way to best practices treatment of lung cancer, but despite the advent of new treatment methods, surgical treatment of patients with resectable forms of lung cancer is still considered a radical method with the prospect of a complete cure.

Radiation treatment gives better results when using a radical therapy program in the initial (1,2) stages.

Chemotherapy. High-quality therapy consists of the use of chemotherapy drugs for the treatment of lung cancer such as:

They are prescribed only if there are contraindications to surgical and radiation treatment. As a rule, such treatment is carried out up to 6 courses of chemotherapy at intervals of 3-4 weeks. Complete resorption of the tumor occurs very rarely, only 6-30% of patients show objective improvements.

When chemotherapy is combined with radiation treatment (simultaneous or sequential use is possible), better results are achieved. Chemoradiation treatment is based on the possibility of both an additive effect and synergism, without the addition of toxic side effects.

Combined treatment is a type of treatment that includes, in addition to radical surgery, other types of effects on the tumor process in the local-regional affected area (external beam or other methods of radiation therapy). Consequently, the combined method involves the use of two heterogeneous effects of different nature, aimed at local-regional foci: for example, surgical + radiation, radiation + surgical, radiation + surgical + radiation, etc. The combination of unidirectional methods makes up for the limitations of each of them separately. At the same time, it must be emphasized that combination treatment can only be said when it is applied according to the plan developed at the very beginning of treatment.

Peripheral lung cancer, prognosis

It is very difficult to predict the treatment of peripheral lung cancer, since it can be expressed in different structures, be in different stages and is treated different methods. This disease is curable with both radiosurgery and surgery. According to statistics, among patients who underwent surgery, the 5-year or more survival rate is 35%.

When treating the initial forms of the disease, a more favorable outcome is possible.

Prevention of peripheral lung cancer

Healthy lifestyle

To minimize lung cancer you need to:

• treatment and prevention of inflammatory lung diseases;
• annual medical examinations and fluorography;
• complete cessation of smoking;
• treatment of benign tumors in the lungs;
• neutralization of harmful factors at work, and in particular contacts with:

• nickel compound;
• arsenic;
• radon and its decay products;
• resins;

• avoiding exposure to carcinogenic factors in everyday life.

It is important to remember that your health is in your hands and in no case should you neglect it!

Video: Peripheral cancer of the upper lobe of the right lung

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Signs, symptoms, stages and treatment of lung cancer

In the structure of oncological diseases, this is one of the most common pathologies. Lung cancer is based on malignant degeneration of the epithelium of the lung tissue and impaired air exchange. Malignant cells are also called poorly differentiated (on the topic: low-grade lung cancer). The disease is characterized by high mortality. The main risk group is older men who smoke. A feature of modern pathogenesis is a decrease in the age of primary diagnosis and an increase in the likelihood of lung cancer in women. (on topic: benign lung cancer)

Lung cancer statistics

Statistics on the incidence of lung cancer are contradictory and scattered. However, the influence of some substances on the development of the disease has been clearly established. The World Health Organization (WHO) reports that the main cause of lung cancer is tobacco smoking, which causes up to 80% of all reported cases of this type of cancer. In Russia, about 60 thousand citizens fall ill every year.

The main group of patients are long-term smokers, men aged 50 to 80 years; this category accounts for 60-70% of all cases of lung cancer, and the mortality rate is 70-90%.

According to some researchers, the structure of incidence of various forms of this pathology depending on age is as follows:

up to 45 – 10% of all cases;

from 46 to 60 years – 52% of cases;

from 61 to 75 years old – 38% of cases.

Until recently, lung cancer was considered a predominantly male disease. Currently, there is an increase in the incidence of women and a decrease in the age of initial detection of the disease. Researchers attribute this phenomenon to an increase in the number smoking women(up to 10%) and people working in hazardous industries.

Number of sick women from 2003 to 2014. increased by about 5-10%.

Currently, the gender ratio of lung cancer incidence is:

in the group under 45 years old – four men to one woman;

from 46 to 60 years old – eight to one;

from 61 to 75 years old – five to one.

Thus, in the groups under 45 and after 60 years, there is a significant increase in patients of the fairer sex.

How long do they live with lung cancer?

The disease is characterized by high mortality. This feature is associated with the importance of the respiratory function for the body.

Life can continue with the destruction of the brain, liver, kidneys, and any other organs until breathing or heart stops. In accordance with the canons of modern pathophysiology, biological death is the cessation of breathing or heartbeat.

At a certain stage of carcinogenesis, the patient experiences a rapid decline in vital functions with a decrease in the respiratory activity of the lungs. It is impossible to compensate for lung function with artificial devices; the air exchange process (atmospheric air - lungs - blood) is unique.

There are statistics on the five-year survival rate of people at different stages of lung cancer. It is clear that patients who receive medical care in the early stages of cancer have a greater chance of saving their lives. However, without complete information about the features of pathogenesis, it is not ethical to give an individual prognosis.

Meanwhile, the survival rate of patients is statistically significantly higher with different localizations of the lesion on the periphery or in the center of the lung, where the main respiratory tract, many large vessels and nerve nodes are located.

High chances of long-term survival with peripheral lung disease. There are cases of life expectancy of more than ten years from the moment of diagnosis. The peculiarity of carcinogenesis of the peripheral form of cancer is its slow course and long-term absence of pain response. Patients even at the fourth stage have relatively good physiological conditions and do not feel pain. Only during the critical period does fatigue increase, weight decreases, and pain develops after metastasis to vital organs.

Low chances for central cancer. Life expectancy from the moment of diagnosis does not exceed 3-4 years. Active carcinogenesis lasts on average 9-12 months. The tumor is characterized by aggressiveness, especially in late stages, when any modern treatment is ineffective, it is characterized by the development of pain syndrome with damage to the central bronchi and metastasis to neighboring organs.

It is clear that what is written above is conditional information. Cancer is always an unpredictable disease, accompanied by explosive cell growth, or a reverse process and inhibition of carcinogenesis (on the topic: lung cancer in children).

In addition, the aggressiveness of cancer depends on the microscopic (histological) structure of the cells, for example, small cell or non-small cell (based on the shape of the tumor cells).

Doctors are less likely to prolong the lives of patients with small cell cancer, including after radical operations and relapses of carcinogenesis.

Treatment of lung cancer at Assuta

A distinctive feature of lung cancer treatment in Israel is an individual approach that takes into account the characteristics of a particular tumor in a particular patient. Depending on the type and stage of cancer, treatment may include: surgery, chemotherapy, radiation therapy, or a combination of these methods. The Israeli Assuta Clinic has the latest equipment necessary to treat this disease, including linear accelerators that allow image-guided radiation therapy. This method makes it possible to accurately and safely irradiate tumors located in moving organs, such as the lungs. Along with conventional chemotherapy, treatment is carried out with the latest biological drugs.

At Assuta, lung cancer treatment is carried out by the country's leading oncologists. Among them is Professor Ofer Merimsky, a world-famous specialist. Another advantage of Assuta for patients from abroad is rapid diagnosis. A lung cancer examination can be completed here in 4-5 days.

Symptoms of lung cancer

Lung cancer, especially its peripheral forms, is difficult to diagnose in the early stages of carcinogenesis.

The causes of diagnostic errors are due to:

similar density of normal cells and malignant formations, camouflage of affected cells as healthy ones - all this complicates diagnosis, including imaging methods;

location of the lesion under the bone tissue of the chest;

the absence of regional lymph nodes located close to the surface of the skin and most quickly responding to pathogenesis;

weak pain sensitivity in the peripheral areas of the lungs that do not have pain receptors;

a high level of compensatory protection, respectively, a long absence of dangerous clinical symptoms that confuse diagnosticians due to the similarity with diseases that can be treated with medication rather than surgery.

The diagnostic stages of determining the symptoms of lung cancer and its types include the accumulation or synthesis of clinical, morphological, histological information about the disease and their subsequent analysis.

Thus, the diagnosis of any disease, including this one, includes two areas of research (synthesis and analysis) and three stages of diagnosis (primary signs, general symptoms, differential symptoms):

Primary signs of the disease. The patient’s sensations in the form of hemoptysis, cough, fatigue, progressive emaciation, foul odor when breathing and other signs with which a person who feels sick turns to a doctor for consultation and to determine the causes of the ailment.

General symptoms. Determination of the localization of pathogenesis (in the central, peripheral, apical part of the lung). Installed:

physical methods (inspection, palpation, percussion or tapping to determine areas of altered sound, auscultation or listening to changes in respiratory sounds);

visualization methods, including ionizing - X-ray, CT and modifications, radioisotope, PET, PET-CT; non-ionizing – ultrasound, MRI and modifications;

laboratory methods (general clinical, specific, including tumor markers).

Differential symptoms. They are necessary for oncologists to clarify changes at the cellular and microphysiological level, for example, to determine non-small cell and small cell forms of cancer or their varieties. They are determined by cytological and histological methods in various modifications, sometimes supplemented by instrumental visualization methods; the most informative here are PET and PET-CT methods.

In modern oncology, the most promising method of early diagnosis is screening examinations. This is a large-scale medical examination of a relatively healthy population. Screening for some forms of cancer effectively replaces diagnosis with the classic three-step method. Unfortunately, screening studies to determine lung cancer are not carried out in our country due to the low efficiency of instrumental detection of the disease.

For widespread implementation of screening, it is necessary:

availability of efficient, highly sensitive diagnostic devices;

highly qualified medical personnel;

oncological alertness of the population.

If the first two conditions in Lately are more or less successfully carried out by the state, then our article calls for increased cancer alertness and a sense of responsibility for one’s own health.

We do not at all strive to turn everyone who reads into an oncologist. Our task is to optimize the cooperation between the patient and the doctor. After all, every ninth out of ten patients with lung cancer goes to the doctor of the district clinic.

Cough with lung cancer

Cough is a protective reaction of the respiratory organs to irritation of specific receptors. It occurs during short-term or long-term endogenous (internal) or exogenous (external, foreign) effects on receptors.

During the initial appointment, try to very accurately describe the cough reflex, if any. Although cough is not a pathognomonic symptom of lung cancer, it sometimes indicates the nature of the pathogenesis. A combination of research methods - cough, percussion and radiography can provide the doctor with valuable material for analysis during the initial diagnosis.

Pathological (long-lasting) cough sounds are characterized as:

Not typical for lung lesions the following cough sounds: strong, loud, short. Most likely they characterize lesions of the larynx and trachea, or oncology in these areas. Cough, when irritated by receptors located on the vocal cords, manifests itself as a hoarse or hoarse sound.

Characteristic sounds of coughing when irritating receptors in the lung tissue:

Weak, lingering, dull, deep - characterizes a decrease in the elasticity of the lung or dispersed in the tissues pathological processes.

Painful, turning into a gentle form - coughing, indicates the involvement of the pleura around the lung in the pathogenesis, or the localization of pathogenesis in the large bronchi of the central zone, sensitive to pain. The pain intensifies with movement of the chest. If, upon auscultation (listening) of the lung, a combination of a painful cough and splashing noise is detected, this means an accumulation of fluid between the lung and the pleura.

with good (liquid) expectoration of the contents – acute course pathogenesis in the lungs.

with viscous discharge - chronic course pathogenesis in the lungs.

A dry cough may precede the development of a wet cough, or a wet cough may develop into a dry cough. The phenomenon of dry cough is characteristic of chronic irritation of receptors without the formation of exudate in the lung. It may also be the case with a growing tumor without inflammatory and necrotic processes around the lesion.

A sudden cessation of coughing is dangerous - this is one of the possible signs of suppression of the reflex due to the development of intoxication.

We remind you that you should not draw independent conclusions. The information is given so that the patient can most fully describe his own feelings to the doctor in the presence of a cough reflex. The final diagnosis is made based on a series of studies.

Blood for lung cancer

Patients are always frightened by the release of blood from the respiratory tract. This phenomenon is called hemoptysis. This is not necessarily a sign of lung cancer. Blood released from the lungs is not specific symptom lung cancer

Discharge of blood from the nose is a manifestation of a violation of the integrity of one of the blood vessels in the respiratory tract. The discharge of blood from the oral cavity causes confusion among lay people.

Isolation of blood from:

digestive organs - dark blood (the color of coffee grounds) due to exposure digestive enzymes or gastric juice;

respiratory organs - the blood is predominantly scarlet, sometimes dark red, always foamy due to the admixture of air.

The causes of pulmonary hemoptysis are diverse and accompany diseases with pathogenesis in the human respiratory system. Among them:

internal bleeding due to chest injuries;

abscesses in the lung or airways;

There may be other reasons. Bleeding from lung cancer usually means damage to one of the vessels in the mediastinum or central part of the lung. Hemoptysis is dangerous symptom, especially with massive internal blood loss.

Signs of massive bleeding:

copious scarlet discharge, slow dark red bleeding;

progressive deterioration in health;

pallor of the mucous membranes;

The first signs of lung cancer

May differ significantly from the usual signs, such as cough, shortness of breath, hemoptysis and other symptoms characteristic of lung cancer.

A person who may be diagnosed with lung cancer, at the initial appointment, receives a referral to doctors of the following specialties:

to a neurologist, if the patient has cluster (paroxysmal) headaches and pain resembling attacks of osteochondrosis;

an ophthalmologist or neurologist if there is a violation of the mobility and size of the pupil of the eye or a change in the pigmentation of the iris;

therapist, if you suspect colds with a dry cough, possibly slight hyperthermia ( elevated temperature body);

therapist or phthisiatrician, if wet cough, wheezing in the lungs, hemoptysis, a sharp decrease in body weight, general weakness;

cardiologist, for shortness of breath, pain in the heart after slight physical activity, general weakness.

A person noticing the above symptoms should report them to the doctor or supplement the information he collects with the following information:

attitude towards smoking with pulmonary symptoms;

presence of cancer in blood relatives;

gradual intensification of one of the above symptoms (this is a valuable addition, as it indicates the slow development of the disease, characteristic of oncology);

acute intensification of symptoms against the background of chronic previous malaise, general weakness, decreased appetite and body weight is also a variant of carcinogenesis.

Causes of lung cancer

The lungs are the only one internal organ person in direct contact with external environment. The inhaled air reaches the alveoli unchanged. Microparticles present in the air are retained on the walls of the mucous membranes. Constant contact with the external environment determines the main feature of the lung epithelium - an increased rate of renewal of generations of cells in the mucous membranes of the bronchi.

The functions of a biological filter are carried out by mucous membranes through:

microvilli lining the airways;

mucus-producing epithelium;

cough reflex receptors.

Epithelial cells come into contact with aerosols of inhaled air, consisting of liquid and/or solid particles, including:

natural – dust, pollen;

anthropogenic - tobacco smoke, car exhaust gases, dust from factories, mines, thermal power plants.

In order for the reader to understand what we are talking about, an aerosol is a stable suspension in gas (air):

ultra-small liquid particles - fog;

ultra-small solid particles - smoke;

small solid particles - dust.

Fog, smoke and dust may contain aggressive inorganic and organic substances, including pollen, microscopic fungi, bacteria, viruses that negatively affect the microvilli of the epithelium.

Poorly protected epithelial cells are exposed to external pathogenic factors every second, which greatly increases the likelihood of pathological mutations and the development of tumors in the lungs.

Potential factors for lung cancer:

High rate of epithelial apoptosis - the more new cells are formed, the higher the probability cancer mutations(natural factor);

Relative vulnerability of delicate tissue from the effects of harmful aerosols of inhaled air (provoking factor).

It has been noted that the likelihood of developing lung cancer is directly related to the aging of the body, genetic prerequisites and chronic lung diseases.

Risk factors for lung cancer

People who are under the influence of physical, chemical and biological factors, as well as those with a hereditary predisposition.

Tobacco smoke. Approximately 80% of lung cancer patients are active smokers, but the harmful effects of secondhand smoke have also been observed (Facts and consequences of smoking during pregnancy).

Radon (weakly radioactive element). Alpha radiation from radon is part of the natural background radiation of the earth. The radiation power is low, however, sufficient to stimulate mutations in respiratory tract cells. Radon in the form of gas accumulates in the basements of houses, penetrates into living spaces through the ventilation system, through the cracks between the basement and the first floor.

Genetic predisposition. The presence of repeated cases of lung cancer in blood relatives.

Age. Physiological aging significantly increases the risk of developing pathological mutations in epithelial cells.

Professional risks. High probability of exposure to volatile, dust-like carcinogens in the workplace:

asbestos - used in construction, in the production of building materials, rubber products, and is part of drilling fluids;

cadmium - used as part of solders by jewelers, when soldering electronic circuit boards, anti-corrosion treatment, in the production of rechargeable batteries and solar batteries;

chromium – used in metallurgy as a component of alloy steels;

arsenic – used in metallurgy, pyrotechnics, microelectronics, paint production, leather industry;

pairs of synthetic dyes based on nitro enamel - used in construction and painting;

exhaust gases – workers of auto repair shops suffer;

ionizing (gamma, beta, x-ray) radiation - received by workers in x-ray rooms and nuclear power plants.

Endogenous factors, including chronic pulmonary diseases (tuberculosis, bronchopneumonia);

Unclear factors. In some patients it is impossible to establish the causes of the disease using modern methods.

Every day in our country, tuberculosis claims about 25 lives. And, despite the fact that this is a “state” problem, there are no significant changes for the better. The only noticeable participation of the state in solving the problem of tuberculosis is the introduction of routine fluorography. And, despite the modest capabilities of fluorography, it undoubtedly helps to identify new cases of the disease

Tuberculosis today has ceased to be a disease of the poor and hungry. Yes, it does have social characteristics, and the risk of getting sick is higher for those who live in poverty, but often it is enough to endure the disease on your feet, experience mild stress, or get too carried away with losing weight - as a result, we have an organism that is “perfectly prepared” for infection with tuberculosis. Today, among the phthisiatrician’s patients, in addition to former prisoners and homeless people, are successful businessmen and politicians, artists and representatives of the “golden youth”. Therefore, you should not rely on your social position; it is better to think about prevention, in in this case annual fluorography.

Having received the radiologist's report, we are often left alone with mysterious inscriptions in the medical record. And even if we are lucky and manage to read individual words, not everyone can understand their meaning. In order to help you figure it out and not panic for no reason, we wrote this article.

Fluorography. From general knowledge

Fluorography is based on the use of x-rays, which, after passing through human tissue, are recorded on film. In essence, fluorography is the cheapest possible x-ray examination of the chest organs, the purpose of which is mass examination and detection of pathology. The order of the Ministry of Health of Ukraine contains the phrase “detection in the early stages.” But, unfortunately, the possibility of early diagnosis of any disease on an image measuring 7x7 cm, even enlarged with a fluoroscope, is very doubtful. Yes, the method is far from perfect and quite often produces errors, but today it remains indispensable.

Fluorography in our country is carried out annually from the age of 16.

Fluorography results

Changes in the fluorogram, as in any x-ray, are mainly caused by changes in the density of the chest organs. Only when there is a certain difference between the density of the structures will the radiologist be able to see these changes. Most often, radiographic changes are caused by the development of connective tissue in the lungs. Depending on the shape and location, such changes can be described as sclerosis, fibrosis, heaviness, radiance, cicatricial changes, shadows, adhesions, and layers. All of them are visible due to the increase in connective tissue content.

Having significant strength, connective tissue allows you to protect the bronchi in asthma or blood vessels from excessive stretching. hypertension. In these cases, the image will show thickening of the walls of the bronchi or blood vessels.

The cavities in the lungs, especially those containing fluids, have a rather characteristic appearance in the image. In the image you can see rounded shadows with a fluid level depending on the position of the body (abscess, cyst, cavity). Quite often, liquid is found in pleural cavity and pleural sinuses.

The difference in density is very pronounced in the presence of local compactions in the lungs: abscess, emphysematous expansion, cyst, cancer, infiltrates, calcifications.

But not all pathological processes occur with changes in organ density. For example, even pneumonia will not always be visible, and only after reaching a certain stage of the disease will the signs become visible in the image. Thus, radiological data are not always an indisputable basis for making a diagnosis. The final word traditionally remains with the attending physician, who, by combining all the data obtained, can establish the correct diagnosis.

Using fluorography, changes can be seen in the following cases:

• late stages of inflammation
• sclerosis and fibrosis
• tumors
• pathological cavities (cavity, abscess, cyst)
• foreign bodies
• the presence of fluid or air in anatomical spaces.

The most common conclusions based on fluorography results

First of all, it is worth saying that if, having received a stamp about the fluorography you had completed, you were allowed to go home in peace, then the doctor did not find anything suspicious. Since, according to the above-mentioned order of the Ministry of Health of Ukraine, the employee of the fluorography office must notify you or the local doctor about the need for further examination. If there is any doubt, the doctor gives a referral for a survey x-ray or to a tuberculosis dispensary to clarify the diagnosis. Let's move directly to the conclusions.

The roots are compacted and expanded

What is called the roots of the lungs is actually a collection of structures that are located in the so-called hilum of the lungs. The root of the lung is formed by the main bronchus, pulmonary artery and vein, bronchial arteries, lymphatic vessels and nodes.

Compaction and expansion of the roots of the lungs most often occur simultaneously. Isolated compaction (without expansion) more often indicates a chronic process, when the content of connective tissue is increased in the structures of the roots of the lungs.

The roots can be compacted and expanded due to swelling of large vessels and bronchi, or due to enlargement of the lymph nodes. These processes can occur either simultaneously or separately and can be observed in pneumonia and acute bronchitis. This symptom is also described in more serious diseases, but then there are other typical signs (foci, decay cavities, etc.). In these cases, compaction of the roots of the lungs occurs mainly due to an increase in local groups of lymph nodes. Moreover, even on a survey image (1:1) it is not always possible to distinguish lymph nodes from other structures, not to mention a fluorogram.

Thus, if our conclusion says “the roots are expanded, compacted” and at the same time we are practically healthy, then most likely this indicates bronchitis, pneumonia, etc. However, this symptom is quite persistent in smokers, when there is significant thickening of the bronchial wall and compaction of the lymph nodes, which are constantly exposed to smoke particles. It is the lymph nodes that take on a significant part of the cleansing function. At the same time, the smoker does not note any complaints.

The roots are heavy

Another fairly common term in radiological reports is the heaviness of the roots of the lungs. This radiological sign can be detected in the presence of both acute and chronic processes in the lungs. Most often, the heaviness of the roots of the lungs or the heaviness of the pulmonary pattern is observed with chronic bronchitis, especially with smoker’s bronchitis. Also, this symptom in combination with others can be observed when occupational diseases lungs, bronchiectasis, and cancer.

If there is nothing in the description of the fluorogram other than the heaviness of the roots of the lungs, then we can quite confidently say that the doctor has no suspicions. But it is possible that another chronic process is taking place. For example, chronic bronchitis or obstructive pulmonary disease. This symptom, along with thickening and expansion of the roots, is also typical of chronic bronchitis of smokers.

Therefore, if you have any complaints from the respiratory system, it would not be superfluous to consult a therapist. The fact that some chronic diseases allow you to lead a normal life does not mean that they should be ignored. It is chronic diseases that are often the cause of a person’s death, albeit not sudden, but very predictable.

Strengthening the pulmonary (vascular) pattern

The pulmonary pattern is a normal component of fluorography. It is formed largely by the shadows of blood vessels: arteries and veins of the lungs. This is why some use the term vascular (rather than pulmonary) pattern. Most often, an increase in the pulmonary pattern is observed on the fluorogram. This occurs due to more intense blood supply to the lung area. An increase in the pulmonary pattern is observed in acute inflammation of any origin, since inflammation can be observed both in banal bronchitis and in pneumonitis (cancer stage), when the disease does not yet have any characteristic signs. That is why in case of pneumonia, which is very similar to pneumonitis in cancer, a repeat image is required. This is not only control of treatment, but also the exclusion of cancer.

In addition to banal inflammation, an increase in the pulmonary pattern is observed in congenital heart defects with enrichment of the small circle, heart failure, and mitral stenosis. But these diseases are unlikely to be an incidental finding in the absence of symptoms. Thus, increased pulmonary pattern is a nonspecific sign, and in cases of ARVI, bronchitis, pneumonia, it should not cause any particular concern. Increased pulmonary pattern in inflammatory diseases, as a rule, disappears within a few weeks after the illness.

Fibrosis, fibrous tissue

Signs of fibrosis and fibrous tissue in the image indicate a history of lung disease. Often this can be a penetrating injury, surgery, or an acute infectious process (pneumonia, tuberculosis). Fibrous tissue is a type of connective tissue and serves as a substitute for free space in the body. Thus, in the lungs, fibrosis is more of a positive phenomenon, although it indicates a lost area of ​​lung tissue.

Focal shadow(s)

Focal shadows, or foci, are a type of darkening of the pulmonary field. Patchy shadows are a fairly common symptom. According to the properties of the lesions, their localization, combination with others radiological signs it is possible to establish a diagnosis with some accuracy. Sometimes only the x-ray method can give a final answer in favor of a particular disease.

Focal shadows are called shadows up to 1 cm in size. The location of such shadows in the middle and lower parts of the lungs most often indicates the presence of focal pneumonia. If such shadows are detected and the conclusion adds “increased pulmonary pattern”, “merging of shadows” and “uneven edges” - this is a sure sign of an active inflammatory process. If the lesions are dense and more even, the inflammation subsides.

If focal shadows are found in the upper parts of the lungs, then this is more typical for tuberculosis, so such a conclusion always means that you should consult a doctor to clarify the condition.

Calcifications

Calcifications are round shadows, comparable in density to bone tissue. Often a rib callus can be mistaken for calcification, but whatever the nature of the formation, it has no particular significance for either the doctor or the patient. The fact is that our body, with normal immunity, is able not only to fight infection, but also to “isolate” from it, and calcifications are proof of this.

Most often, calcifications form at the site of the inflammatory process caused by Mycobacterium tuberculosis. Thus, the bacterium is “buried” under layers of calcium salts. In a similar way, a focus can be isolated in case of pneumonia, helminthic infestation, or when a foreign body enters. If there are a lot of calcifications, then it is likely that the person had fairly close contact with a patient with tuberculosis, but the disease did not develop. So, the presence of calcifications in the lungs should not cause concern.

Adhesions, pleuroapical layers

Speaking of adhesions, we mean the condition of the pleura - the lining of the lungs. Adhesions are connective tissue structures that arise after inflammation. Adhesions occur for the same purpose as calcifications (to isolate the area of ​​inflammation from healthy tissue). As a rule, the presence of adhesions does not require any intervention or treatment. Only in some cases during the adhesive process are observed painful sensations, then, of course, you should seek medical help.

Pleuroapical layers are thickenings of the pleura of the apexes of the lungs, which indicates an inflammatory process (usually tuberculosis infection) in the pleura. And if nothing alerts the doctor, then there is no reason to worry.

Sinus free or sealed

Pleural sinuses are cavities formed by folds of the pleura. As a rule, in a full description of the image, the condition of the sinuses is also indicated. Normally, they are free. In some conditions, effusion (fluid accumulation in the sinuses) may occur, and its presence clearly requires attention. If the description indicates that the sinus is sealed, then we are talking about the presence of adhesions, which we discussed above. Most often, a sealed sinus is a consequence of previous pleurisy, trauma, etc. In the absence of other symptoms, the condition is not cause for concern.

Another common fluorographic finding is an anomaly of the diaphragm (relaxation of the dome, high standing of the dome, flattening of the diaphragm dome, etc.). There are many reasons for this change to occur. These include a hereditary feature of the structure of the diaphragm, obesity, deformation of the diaphragm by pleuro-diaphragmatic adhesions, previous inflammation of the pleura (pleurisy), liver diseases, diseases of the stomach and esophagus, including diaphragmatic hernia (if the left dome of the diaphragm is changed), diseases of the intestines and other organs abdominal cavity, lung diseases (including lung cancer). Interpretation of this sign can only be carried out in conjunction with other changes in the fluorogram and with the results of other methods of clinical examination of the patient. It is impossible to make a diagnosis based solely on the presence of changes in the diaphragm identified by fluorography.

The mediastinal shadow is widened/displaced

Particular attention is paid to the shadow of the mediastinum. The mediastinum is the space between the lungs. The organs of the mediastinum include the heart, aorta, trachea, esophagus, thymus, lymph nodes and vessels. The expansion of the mediastinal shadow, as a rule, occurs due to an enlargement of the heart. This expansion is most often unilateral, which is determined by an increase in the left or right parts of the heart.

It is important to remember that according to fluorography, you should never seriously assess the condition of the heart. The normal position of the heart can fluctuate significantly, depending on the person’s physique. Therefore, what appears to be a shift of the heart to the left on fluorography may be the norm for a short, overweight person. Conversely, a vertical or even “teardrop-shaped” heart is a possible normal option for a tall, thin person.

In the presence of hypertension, in most cases, the description of the fluorogram will read “mediastinal widening to the left,” “heart widening to the left,” or simply “widening.” Less commonly, uniform widening of the mediastinum is observed, indicating the possible presence of myocarditis, heart failure, or other diseases. But it is worth emphasizing that these conclusions do not have significant diagnostic value for cardiologists.

A shift of the mediastinum on a fluorogram is observed with an increase in pressure on one side. Most often this is observed with an asymmetric accumulation of fluid or air in the pleural cavity, with large tumors in the lung tissue. This condition requires the fastest possible correction, since the heart is very sensitive to gross displacements, that is, in this case, an urgent visit to a specialist is necessary.

Conclusion

Despite the fairly high degree of error of fluorography, one cannot but recognize the effectiveness of this method in diagnosing tuberculosis and lung cancer. And no matter how irritated we are at times by the inexplicable demands for fluorography at work, at the institute or anywhere, we should not refuse it. Often, only thanks to mass fluorography, it is possible to identify new cases of tuberculosis, especially since the examination is carried out free of charge.

Fluorography is of particular relevance here in Ukraine, where a tuberculosis epidemic has been declared since 1995. In such unfavorable epidemiological conditions, we are all at risk, but, first of all, these are people with immunodeficiencies, chronic lung diseases, smokers, and, unfortunately, children. In addition, occupying the world's leading positions in tobacco smoking, we quite rarely correlate this fact with tuberculosis, but in vain. Smoking undoubtedly contributes to the support and development of the tuberculosis epidemic, weakening, first of all, respiratory system our body.

To summarize, we would like to once again draw your attention to the fact that annual fluorography can protect you from deadly diseases. Since timely detected tuberculosis and lung cancer are sometimes the only chance of survival from these diseases. Take care of your health!

The result of fluorography is that the roots are compacted. Should I start panicking?

Fluorography of the lungs is currently the main mechanism for mass screening of the population for the presence of tuberculosis.

This is due to the cheapness and simplicity of the method, although it does not guarantee one hundred percent results.

Through this study, it is possible to detect changes in tissues, for example, their density and the development of any tumors or cavities with fluid

Roots of the lungs on x-ray

Important! An x-ray allows you to determine not only diseases of the lungs, but also bones. In particular, scoliosis, rib injuries, and in some cases, damage to the diaphragm can be detected.

For example, a strongly raised diaphragm may mean excess gases in the peritoneum, which is one of the signs of peritonitis.

General characteristics of the roots of the lungs

First of all, doctors pay attention to the roots of the lungs - structures that are the so-called gates to the lungs.

Normally, they are not enlarged on an x-ray, and no formations are visible against their background. The location of the roots itself also matters.

The roots are divided into three sectors - upper, middle and lower. The right root resembles a curved ribbon, which is moderately pronounced and tapers downwards. The upper part of this root is located at the same level as the anterior segment of the second rib - the second intercostal space. The upper part of the left root is located one rib higher than the right one, and it itself is partially hidden by the shadow of the heart. The width of the arterial trunk of the roots, in most cases, does not exceed 15 millimeters.

The roots themselves are divided into trunk and crumbly. The first type involves a large top part(head), which is mainly represented by the pulmonary artery. Friable roots have a large branched network of vessels that turn into cords.

Important! In some cases, the picture may differ from the norm, although the patient himself feels well.

This may occur due to the developmental characteristics of the patient's body or due to previous operations or injuries. In rare cases, this indicates a poorly taken picture, when the patient moved or initially stood in the wrong position. The hardness and softness of the image matters - in the first case, the depth of the image will be too great, which does not allow you to see small details, and in the second, the image will be too blurry.

Fluorography result

In addition to the previously mentioned neoplasms, the following characteristics of the roots can be noted, which are indicated in written reports, are deviations from the norm and can be signs of pathologies: compacted, stringy and expanded roots, and the roots can also be strengthened.

Roots are compacted and expanded

This usually occurs due to swelling of the bronchi or large vessels. And in some cases, due to the fact that the lymph nodes are enlarged. Compaction and expansion of root tissue almost always occur simultaneously, but if the roots are only compacted, this indicates a chronic process. In the photo, the extended roots will appear less defined and larger than standard sizes.

Heavy and reinforced roots

This term means that both acute and chronic processes can occur in the lungs. Most often this is associated with occupational diseases (for example, asbestosis) or chronic diseases (for example, smoker's bronchitis).

On an x-ray, stranded roots look denser and uneven, this is explained by an increase in the amount of connective tissue - cords.

Of course, these are not the only characteristics that describe the lungs and their condition. There is a large layer of data relating to neoplasms, their shape, as well as the state of the remaining parts of this organ, each of which can be changed in one way or another as a result of illness or other pathological influence.

Important! Smoker's bronchitis occurs in the second or third year of smoking cigarettes. This is a chronic disease caused by the reaction of lung tissue to a constant irritant in the form of tobacco tar.

One of the possible consequences of bronchitis is tuberculosis, since much more mucus accumulates in the lungs of an active smoker than necessary, and mycobacteria of this disease can begin to develop in the latter.

Are root changes and tuberculosis related?

Some types of changes in the roots of the lungs, for example, their compaction and enlargement of nearby lymph nodes, may indicate tuberculosis. This is due to the body’s reaction to infection, which results in an inflammatory process in the tissues. In addition, with the spread of Mycobacterium tuberculosis, calcification of the lymph nodes begins, that is, the accumulation of calcium salts in them, followed by hardening.

Photo 1. Only a doctor can determine what changes in the roots of the lungs mean and whether there is a risk of tuberculosis.

However, it is worth remembering that the X-ray results themselves cannot be one hundred percent indicators of tuberculosis infection. And the pictures are decrypted by professionals. This is because all the factors present in the images must be taken into account, and many of them are not obvious to a person who does not have relevant experience.

Important! Fibrous tissue may be mentioned in the report of a chest x-ray. This is a type of connective tissue that replaces lost areas of organs.

This usually indicates a previous illness, surgery, or a penetrating wound that damaged an organ. This tissue is not functional and simply maintains the integrity of the organ.

Latest updates

If the doctor has reason to suspect a disease, appropriate tests will be ordered to confirm or refute the diagnosis.

If tuberculosis is suspected, such tests will definitely include blood, sputum (if any) and urine tests.

In some cases, either a computed tomography (CT) scan of the lungs or a bronchoscopy may be needed. A CT scan involves creating a three-dimensional image of the lungs, including all the vessels, and bronchoscopy means inserting a tourniquet with a camera and a flashlight that will help study the condition of the roots from the inside.

There are many options for tests and studies and they depend on the specific picture of the disease and the decisions of the attending physician.

Useful video

Check out the video that explains what changes can happen to the roots of the lungs and what this means.

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An online magazine about tuberculosis, lung diseases, tests, diagnostics, medications and other important information about it.

What do fluorography results say?

Statistics say that twenty-five people die from tuberculosis every day in our country. This terrible infectious disease claims many more lives than tetanus, diphtheria and influenza. The state is trying to prevent the tuberculosis epidemic by introducing routine fluorography, but so far no significant improvements have been observed. And yet, fluorography remains a study that helps to detect new cases of the disease.

Fluorography. General knowledge

Fluorography is a method that uses x-rays. It passes through the fabric and is fixed on the film. This is an inexpensive examination of the chest to detect various pathologies. Unfortunately, this method very far from perfect and questionable for the early diagnosis of diseases.

Fluorography results

What can be seen on fluorography

Fibrosis and sclerosis

Pathological cavities (cyst, cavity, abscess)

Presence of air or liquid in anatomical spaces

The most common conclusions after fluorography

The roots are expanded and compacted

Strengthening the vascular (pulmonary) pattern

Fibrous tissue, fibrosis

Foci (focal shadow)

Sinus sealed or free

Changes from the diaphragm

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  The most common fluorography results and their meaning

  Yes, those who are undernourished have a greater predisposition to this disease, but the jaded lives of the rich and successful also make them vulnerable to this infection. Social status does not protect you from tuberculosis, and you don’t have to be homeless or a former prisoner to get it.

  To somehow protect yourself from this, you need to undergo fluorography annually. Having the radiologist's findings in hand, we see mysterious inscriptions on the map and cannot decipher what it means. Individual words can still be read somehow, but their meaning is still beyond the understanding of the average person. Next we will talk about how to understand the fluorograph’s conclusion and not panic.

  Fluorography. general information

  X-ray radiation is the basis of any fluorograph. They pass through the entire person and stop at the pulmonary film. To date, this is the cheapest way to detect disease in the chest.

  What do the fluorography results say?

  Changes in the density of organs in the chest speaks volumes. The connective tissue in the lungs develops and depending on how it happens and where it is localized, all this is classified and has its own name. Connective tissue is very strong. If a person suffers from asthma or hypertension, then thickened walls of blood vessels or bronchi will be visible on the images. The cavities in the lungs have their own characteristic appearance, especially if they contain fluid. Round shadows with liquid have different positions. The pleural cavity and pleural sinuses are quite often affected by fluid as well. Local lung compactions are also very quickly detected by an experienced specialist.

  Fluorography reveals changes of the following type:

• Inflammation in the final stages.
• Various kinds tumors.
• Pathological compactions.
• Sclerosis and fibrosis.
• Presence of foreign bodies, air or liquid.

So, what are the most common diagnoses of domestic fluorographs?

They stamped your medical card and let you go without unnecessary words, then we can say with confidence that you are healthy. If suddenly something is wrong, then according to the law, a health worker must notify you that additional examination is needed.

The collection of structures located at the hilum of the lungs is usually called the roots of the lungs. From the root, bronchial arteries, lymph nodes, blood vessels, etc. are formed. In most cases, the phenomenon of compaction and expansion of the roots of the lungs occurs in pairs and occurs very often. Of course, there is an isolated compaction without expansion, but in this case, this diagnosis indicates a chronic process and a large amount of connective tissue is observed in the structures of the roots of the lungs.

Compaction and expansion of the roots occurs due to swelling of large vessels and bronchi or when the lymph nodes become enlarged. These processes can be either isolated or simultaneous and are the result of pneumonia or acute bronchitis. This diagnosis is also present in other diseases, but they are accompanied by lesions, decay cavities, etc. In this case, the roots of the lungs become denser due to the increase in local groups of lymph nodes. In the overview image (1:1), it is quite difficult to distinguish the lymph nodes from other structural elements of the lungs.

If you read a conclusion in your medical record that “the roots are enlarged, thickened,” but there are no health problems, then this indicates inflammation or bronchitis. This symptom is stable for smokers, because smoke particles constantly irritate the walls of the bronchi and contribute to the compaction of the lymph nodes. The lymph nodes are responsible for cleansing the lungs, and the smoker does not feel any discomfort.

If a person has any complaints, it is best to consult a therapist. Despite the fact that chronic diseases allow you to lead a normal life, this does not mean that you need to forget about this unpleasant nuance. Chronic diseases Although they do not lead to quick death, they become the cause of predicted and already fatal diseases in the future.

Pulmonary/vascular pattern increased

Not a single fluorography can do without a pulmonary pattern. The pulmonary pattern consists of the shadows of blood vessels, arteries and veins, so it is not surprising that many people use the term vascular instead of the term pulmonary pattern. A fairly common diagnosis, which indicates an increase in the pulmonary pattern; it is formed due to the fact that some areas in the lungs are more intensively supplied with blood. Acute inflammation of any origin leads to an increase in the pulmonary pattern and this can indicate both ordinary bronchitis and pneumonitis, and this already indicates cancer. In case of pneumonia, a repeat X-ray is often prescribed to find out whether it is pneumonitis, because in the images these two diseases are very similar. An increased pulmonary pattern also indicates problems with the heart, but such a disease usually does not go away without symptoms. In general, we can say that an increase in the pulmonary pattern indicates bronchitis, pneumonia, etc., but it disappears within a few weeks after the disease has been defeated.

Fibrous tissue on a fluorogram is a consequence of past pulmonary diseases. It replaces free space in the body. For example, a person has had a penetrating wound to the chest or has undergone surgery, this tissue plays the role of connective tissue and, in general, fibrosis is a more positive than negative diagnosis and is the result of the fact that some part of the lung tissue has been lost.

Darkening of the pulmonary field is one of the types of foci. Lesions are very common and not uncommon in medical practice. They have their own symptoms, localized in certain places, and are also quite often combined with other diseases. A shadow up to 1 cm in size is usually called a focus. A sign of focal pneumonia is the location of focal tissues in such sections of the lungs as the lower and middle. An active inflammatory process is indicated by such words in the medical card as “increased pulmonary pattern”, “merging of shadows” and “uneven edges”. Foci that are dense and even in nature eventually subside on their own. If lesions are found in the upper sections of the lungs, then this diagnosis is typical for tuberculosis and in this case additional examination is prescribed.

Calcifications appear as round shadows on a fluorogram and their density resembles bones. Rib callus is very often similar to calcitis, but regardless of the nature of this formation, it is harmless, because the body “isolates” the infection from the rest of the body with calcitis.

Pleuroapical layers, adhesions

Adhesions usually do not require any treatment or intervention. They occur after inflammation and isolate the site of inflammation from healthy tissue. In some cases, adhesions can cause pain, and in this case without medical care not enough. If the pleura of the apex of the lungs thickens, this should alert you, because very often this occurs as a result of a tuberculosis infection, but only a doctor can judge this.

Sinuses form in the folds of the pleura and when everything is fine, they are free. The liquid in these formations should definitely alert you. A sealed sinus indicates adhesions. A sealed sinus indicates former injuries, past pleurisy, etc. If there are no other symptoms in general, then it is not dangerous.

There are a large number of reasons that lead to a change in the diaphragm, and this is a very common finding of a fluorograph. Only if this anomaly combines several other changes, then we can talk about some kind of disease, so the doctor prescribes additional examinations. An accurate diagnosis based on diaphragm abnormality is not possible.

Displacement or expansion of the mediastinal shadow

The space between the lungs is called the mediastinum. Typically, widening of the mediastinum indicates an enlarged heart. It is unilateral and increases in the right or left side of the heart. Fluorography cannot judge the condition of the heart. The normal position of the heart depends on the physique of a particular person. For a short and plump person, a heart slightly shifted to the left is not bad. If a person is tall, then his heart can be in a vertical or teardrop-shaped position. For hypertensive patients, what is written in the chart is: “expansion of the mediastinum to the left,” “expansion of the heart to the left,” or simply “expansion.” The mediastinum can expand evenly, but this already indicates myocarditis, cardiac failure, etc. For cardiologists, the results of a fluorogram are not sufficient to make a specific diagnosis.

If the pressure increases on one side, then the fluorogram indicates a mixed mediastinum. This diagnosis means the asymmetric presence of fluid or air in the pleural cavity or large tumors in the lung tissue. This diagnosis is already serious, because it can cause a gross displacement of the heart and the intervention of specialists is very important in this case.

P. S. Despite the fact that fluorography in our ordinary hospitals is not without its drawbacks, it is still capable of detecting tuberculosis or lung cancer. It's worth going through it anyway. In our country, the epidemiological conditions for tuberculosis are simply excellent. The risk group is our normal state. By undergoing annual fluorography, we thereby protect ourselves from fatal diseases, because a disease detected in time significantly increases a person’s chances of survival.

Duration: 24:34

X-ray syndrome of changes in the roots of the lungs.

Video lecture by Irina Aleksandrovna Sokolina on radiation diagnostics for therapists: “X-ray syndrome of changes in the roots of the lungs.” Video from the program "".

Transcript

Transcript of a video lecture by Irina Aleksandrovna Sokolina, candidate of medical sciences, about the radiological syndrome of changes in the roots of the lungs from the series of programs Radiation diagnostics for therapists.

Igor Evgenievich Tyurin, Doctor of Medical Sciences, Professor:

– Let me immediately move on to the next lecture and ask Irina Alexandrovna to talk about the condition of the roots of the lungs and the pathology of the lymph nodes. Everything related to this problem. Please, Irina Alexandrovna.

Irina Aleksandrovna Sokolina, Candidate of Medical Sciences, Head of the Department of Radiation Diagnostics of the Vasilenko Propaedeutics Clinic of Perm State Medical University:

– Thank you very much, Igor.

Good afternoon, dear colleagues!

So, today we will talk about the x-ray anatomy of the roots of the lungs and the x-ray syndrome of changes in the roots of the lungs.

(Slide show).

From an anatomical point of view, the roots of the lungs are a set of structures that are located in a topographically specific manner at the hilum of the lungs. They include a number of anatomical elements.

These are, first of all, the pulmonary artery, pulmonary veins, bronchi accompanying the pulmonary arteries, lymphatic vessels, nodes, fiber and pleura.

It must be said that over a long distance, these formations are located extrapulmonarily and on radiographs can be hidden by the shadow of the heart, therefore, anatomically and radiographically, the concept of the lung root is somewhat different.

(Slide show).

From the point of view of radiology, the normal root of the lung on radiographs, which are performed with the patient in the correct position, is represented by the total shadow of the large pulmonary vessels.

It must be said that when analyzing the root of the lung, it is necessary to pay attention to the patient’s attitude. This must be correct installation patient, which is determined by the symmetrical distance between the spinous processes that we see and the sternoclavicular joints. Small rotations can cause changes in the display of the lung root and simulate some pathological conditions.

(Slide show).

The roots of the right and left lungs are normally located differently. The right root is represented, as we see on the x-ray, by an arched shadow of medium density. This shadow is widened in the upper part and narrows slightly downwards. The root of the right lung is located at the level of the 2nd rib and 2nd intercostal space.

Basically, the root of the right lung is represented by the lower lobar pulmonary artery and the intermediate bronchus located next to it. It is clearly visible on x-ray examination in the form of clearing.

The root of the left lung is most often covered by the shadow of the heart and is visible in a small number of patients. In accordance with the anatomical features, the root of the left lung is located one rib above the root of the right lung. This must be remembered when analyzing the radiograph.

This concerns the location of the roots of the lungs.

(Slide show).

The structure of the lung root shadow is normally heterogeneous, because it is represented mainly by vessels that branch into smaller branches. Root heterogeneity is formed. Plus, the root of the lung is also crossed by the bronchi. This normally creates heterogeneity in its structure.

(Slide show).

The outer boundaries of the lung root are represented, as I have already said, by diverging vascular shadows. The direction of the arteries, as we know, is more vertical. The veins are more horizontal. The clarity of the contour in certain areas may not be as pronounced due to the layering of clearing from the bronchi.

As for the division of the root into sections: head, body and tail. It remains relevant. The lower part of the root of the lung (tail) is formed mainly by small branching vessels of already segmental bronchi.

(Slide show).

Regarding the width of the roots of the lungs. Basically, the width of the lung root is determined by the right root. Normally, it represents the width of the arterial trunk and the intermediate bronchus. Normally, if we take these two structures, it should not exceed 2.5 centimeters.

As a rule, if we directly measure only the vascular trunk (that is, the lower lobar pulmonary artery), then its width should not exceed 1.5, maximum 2 centimeters.

(Slide show).

We talked about the criteria by which we evaluate the root of the lung during x-ray examination. Location, structure, boundaries, clarity of contours and width of the root.

In CT imaging, the roots of the lungs are represented in several scans. We analyze them sequentially. The bronchi are clearly visible here, since they contain air, and the vascular structures adjacent to them.

It must be said that it is almost impossible to differentiate vascular structures from enlarged lymph nodes, especially if the mediastinal tissue is weakly expressed (this is usually found in children and young people). Differential diagnosis between vascular pathology and enlarged lymph nodes or some pathological formations is usually carried out using intravenous contrast. It allows us to distinguish these structures.

(Slide show).

As for changes in the roots of the lungs. This means any deviations from the normal x-ray picture of the roots. This may be due to various pathological conditions. Most often this is an enlargement of the lymph nodes.

Pathological conditions of blood vessels in the form of aneurysmal dilatation or agenesis of some vascular elements can lead to changes in the roots of the lungs. These are bronchial lesions - mainly tumor ones. Changes in blood supply in the form of pulmonary edema (disorders of tissue fluid exchange). Sclerotic fibrotic processes.

All this can lead to changes in the location, size, shape, structure and density of the contours of the roots of the lungs.

(Slide show).

It must be said that the root of the lung changes in isolation and there are no changes around it - this is rare. In this case, the displacement of the roots of the lungs is usually caused by a change in the volume of the lung tissue itself.

This may be an increase in volume (we see in the right picture) due to bullous emphysema. The change is due to the bulla, which displaces the root of the right lung. Some fibrous changes can lead to a displacement of the roots in one direction or another.

As a rule, the reason for such displacement of the roots of the lungs is indicated by the changes in the lung tissue that we see.

(Slide show).

But there are situations when we do not see any changes, as in the survey X-ray in this case: practically lung tissue. But look - the root of the left lung is located at the same level as the root of the right lung. This allows us to speculate whether there is some process involved that leads to a decrease in volume.

On the lateral radiograph we see atelectasis of the lingular segments, which in this case is hidden behind the shadow of the heart. It is this process that causes displacement of the root of the lung.

(Slide show).

A change in the structure of the lung root usually manifests itself in the fact that various elements become poorly distinguishable due to edema or fibrosis. This is manifested by the appearance of uniformity of the root shadow. Normally, the root is heterogeneous. It becomes denser, the vascular structures and individual elements of the root are poorly differentiated.

In addition, the intensity of the [shadow] of the lung root increases. The lumen of the intermediate bronchus, which is normally, as we have seen, clearly visible, loses its transparency. Becomes veiled or not visible at all.

(Slide show).

Increased hilar density is usually due to calcification of the thoracic lymph nodes, which can vary in extent. It can be shell-shaped, blocky, uneven, in the form of a mulberry.

(Slide show).

Changes in the contours of the roots of the lungs can be of several types. Most often we see polycyclic contours of the roots of the lungs, which are mainly caused by enlarged lymphatic vessels.

Here we present a patient with sarcoidosis of the hilar lymph nodes. There is bilateral enlargement, expansion of the roots of the lungs and polycyclic contours, which are formed precisely by enlarged bronchopulmonary lymph nodes.

Here the so-called “backstage symptom” may occur, which is caused by the superposition of the anterior and posterior groups of bronchopulmonary lymph nodes.

(Slide show).

Lumpy contours of the roots of the lungs are found mainly in tumor processes. In this case, a predominantly unilateral expansion of the lung root is also noted.

(Slide show).

Fuzzy contours of the roots of the lungs are usually caused by edema of the peribronchovascular tissue, which can occur with various congestive changes in the lungs. They can occur reactively with inflammatory changes - due to perivascular, peribronchial edema or inflammation.

(Slide show).

Heavy contours are caused by fibrotic changes due to the development of perihilar fibrosis. The reasons for this may be various processes.

(Slide show).

Of great importance, if we are talking about root change syndrome, is the expansion and deformation of the root of the lung. A combined process with various changes in its structure and boundaries. Here great importance has - unilateral or bilateral expansion of the roots of the lungs.

Unilateral expansion and deformation of the roots of the lungs usually occurs with tuberculous bronchoadenitis. As a rule, in these cases we see an expansion of the root, a change in its structure, and unclear boundaries. These changes are best detected by computed tomography examination.

It must be said that with any suspicion of expansion of the lung root and to establish the cause of the expansion of the lung root, further clarification is required using linear tomography. Of course, currently this is a computed tomography scan (best with intravenous contrast).

(Slide show).

In a computed tomography study, tuberculosis of the intrathoracic lymph nodes is manifested by enlargement of the bronchopulmonary lymph nodes of the root of one lung and the overlying lymph nodes of the mediastinum.

Confirm the specific nature of the damage to the lymph nodes using intravenous contrast (in this case, uneven accumulation of the contrast agent occurs), along the capsule of the lymph node, in fragments. This occurs due to the fact that in the center there are caseous masses that do not accumulate the contrast agent. Infiltration of perinodular fat.

(Slide show).

Tuberculosis damage to the lymph nodes can be accompanied by various disorders in the lung tissue: in the form of compression of the bronchi, the formation of atelectatic disorders, and dissemination of dropout foci.

Of course, tuberculosis of the intrathoracic lymph nodes is primary tuberculosis. It is more common in children. But it is necessary to remember that in older people, reactivation of old tuberculosis foci can also occur under unfavorable conditions.

(Slide show).

Here is an example of an elderly patient (81 years old). He was admitted to the clinic with complaints of increased body temperature and shortness of breath during exercise.

(Slide show).

He has a fairly long history. It begins in 1947, when he suffered from pneumonia. He was then examined at tuberculosis dispensaries, where the diagnosis of tuberculosis was rejected. She has been examined and treated in hospital for bronchitis over the past few years.

The weakness and cough continued to increase. In connection with the above complaints, he was admitted for examination.

(Slide show).

From his life history, it is worth noting, of course, that he underwent subtotal gastrectomy without the use of chemotherapy. Seen by an oncologist.

(Slide show).

We see his x-rays from 2010. The root of the right lung is expanded and compacted. We see (inaudible term, 15:29) changes in the anterior segment: compaction of the lung tissue.

(Slide show).

He was further examined using linear tomography. We see the patency of all bronchi. At this stage, no evidence of tuberculosis was observed.

(Slide show).

Just against the backdrop of a deterioration in the condition and an increase in temperature, an X-ray examination was carried out. In this case, we see that the root of the lung has blurred contours and an increase in inflammatory changes in the upper lobe of the right lung.

(Slide show).

Look at the dynamics of these two pictures from 2010 and 2011. Here, of course, the negative dynamics are clearly visible in the last picture.

What could be the reason for this?

The first thing that comes to mind, given the clinic of such a picture, are these three processes. Perhaps the development of pneumonia, central cancer or metastases to the lymph nodes due to the fact that the patient had a history of tumor.

(Slide show).

When performing a computed tomography scan (we did not use contrast - the patient was quite elderly), we saw clearly enlarged lymph nodes, unilateral enlargement of the lymph nodes.

In the bifurcation group, the structure of the lymph node is heterogeneous.

In the paratracheal - a large lymph node: a cavity formation, which turned out to be a bronchomodular fistula. This was confirmed by bronchoscopic examination.

Atelectatic inflammatory changes in the upper lobe of the right lung and foci of contamination.

(Slide show).

Additional examination of the patient using computed tomography allowed us to establish the correct diagnosis of the patient.

(Slide show).

But there are difficult situations. A 32-year-old patient who was referred to us for computed tomography(he has been HIV-infected for several years) to clarify changes in the projection of the root of the left lung. We see a suspicion of a pathological formation in the root of the lung: the contours are deformed.

(Slide show).

A native study shows that there is a local expansion of the aorta in the area of ​​the arch. But along with this, look, enlarged lymph nodes are detected (they are shown here with yellow arrows) in the bifurcation group and tracheobronchial group.

Their sizes are somewhere up to 1.5 centimeters. These are borderline sizes. There is much debate about what size lymph nodes should be.

(Slide show).

After intravenous contrast, we clearly see the aneurysmal local expansion of the aortic arch.

(Slide show).

See how the lymph nodes (even slightly enlarged ones) accumulate the contrast agent: fragmentarily, capsule by capsule. This allowed us to conclude that the patient, along with local enlargement, also had tuberculosis of the intrathoracic lymph nodes.

(Slide show).

He was prescribed anti-tuberculosis therapy. In dynamics (we see here a study without contrast) - a decrease in the size of the lymph nodes and partial calcification.

(Slide show).

Unilateral expansion and deformation of the lung root, in addition to tuberculous lesions, of course, most often occurs in tumor processes. In this case, on the X-ray we see an expansion of the root of the right lung, thickening of the root of the right lung and stranded contours.

(Slide show).

Computed tomography examination revealed a large nodular formation in the root of the right lung: peribronchial nodular cancer. The presence of enlarged lymph nodes. The changes are caused by the tumor process.

(Slide show).

The use of intravenous contrast allows one to determine, first of all, the stage of a malignant tumor, the degree of invasion into large vessels and surrounding structures. This determines the patient's treatment tactics. Dynamics of observation during chemotherapy.

(Slide show).

Bilateral expansion and deformation of the lung roots are common in VLN sarcoidosis. At the same time, we see a bilateral, rather symmetrical expansion of the roots with polycyclic contours.

(Slide show).

On a computed tomography scan, the lymph nodes have very characteristic features. Systemic enlargement of lymph nodes is determined. They have a uniform structure, clear contours, and no changes in the surrounding fiber.

As a rule, lymph nodes are affected multiple times - each in its own group. They very rarely lead to compression of the bronchi and the occurrence of hypoventilation atelectatic changes.

After contrast enhancement, in contrast to tuberculosis, VGLUs, in sarcoidosis, they evenly accumulate the contrast agent in their entire volume. Their density increases slightly.

(Slide show).

It must be said that in the chronic course of sarcoidosis, the formation of calcification is observed. First, compaction of the lymph node in the center, and then calcium deposition. Previously, it was always believed that calcifications in the lymph nodes were the prerogative of tuberculosis only. No. According to our observations, all granulomatous processes can be accompanied by calcium deposition in the VLN.

Moreover, with sarcoidosis, we see that calcifications, as a rule, form and are most pronounced in the center of the lymph node, where inflammation is mainly, and away from the bronchi.

(Slide show).

Here are the calcifications of the VLN. In silicosis, shell-shaped calcifications are characteristic, in sarcoidosis and in tuberculous lesions.

(Slide show).

Bilateral expansion and deformation of the roots of the lungs can be caused not only by enlarged lymph nodes, but also by pulmonary hypertension. In this case, in the patient we see an expansion of the roots of the lungs and on the right a characteristic symptom, which, by the way, is rare - a cigar-shaped outline.

(Slide show).

With intravenous contrast, we see a massive lesion of the right branch of the pulmonary artery, dilatation of the pulmonary artery. This is a chronic course of thromboembolism, since we see recanalization of the thrombus. Severe bilateral hypertension leads to expansion of the roots of the lungs.

(Slide show).

Narrowing of the root of the lung is extremely rare. It is mainly caused by pulmonary artery agenesis. In this case, the X-ray shows an increase in the transparency of one of the pulmonary fields, the absence of a normal pulmonary pattern and the absence of its own shadow of the lung root. This is confirmed (previously with angiopulmonography) with CT angiography.

(Slide show).

This is the case with scintigraphy. We see complete absence blood flow in the right lung.

(Slide show).

In conclusion, I would like to say that the [shadow] of the roots of the lungs is radiographically formed by bronchi and lobar segmental branches of the pulmonary artery, lobar and segmental bronchi, and large veins.

The morphological basis of changes in the roots of the lungs is enlarged lymph nodes, pathological conditions of blood vessels, lesions of the bronchi, disorders of tissue fluid exchange, sclerotic fibrotic processes.

Lung hilar syndrome includes any deviation from the normal pattern of the lungs.

Computed tomography with intravenous contrast is currently the leading diagnostic method pathological changes lung root.

Thank you for your attention.

Tuberculosis kills thousands of people around the world every day. In our country, they do not pay much attention to this disease, and mandatory fluorography has not changed this sad trend for the better, but it is still better than it was before. Today, the poor and hungry are not the group that suffers from tuberculosis; an increasing number of wealthy people are diagnosed with this diagnosis.

Yes, those who are malnourished have a greater predisposition to this disease, but the saturated lives of the rich and successful also make them vulnerable to this infection. Social status does not protect you from tuberculosis, and you don’t have to be homeless or a former prisoner to get it.

To somehow protect yourself from this, you need to undergo fluorography annually. Having the radiologist's findings in hand, we see mysterious inscriptions on the map and cannot decipher what it means. Individual words can still be read somehow, but their meaning is still beyond the understanding of the average person. Next we will talk about how to understand the fluorograph’s conclusion and not panic.

Fluorography. general information

X-ray radiation is the basis of any fluorograph. They pass through the entire person and stop at the pulmonary film. To date, this is the cheapest way to detect disease in the chest.

What do the fluorography results say?

Changes in the density of organs in the chest speaks volumes. The connective tissue in the lungs develops and depending on how it happens and where it is localized, all this is classified and has its own name. Connective tissue is very strong. If a person suffers from asthma or asthma, then thickened walls of blood vessels or bronchi will be noticeable in the pictures. The cavities in the lungs have their own characteristic appearance, especially if they contain fluid. Round shadows with liquid have different positions. The pleural cavity and pleural sinuses are quite often affected by fluid as well. Local lung compactions are also very quickly detected by an experienced specialist.

Fluorography reveals changes of the following type:

• Inflammation in the final stages.
• Various types of tumors.
• Pathological compactions.
• Sclerosis and fibrosis.
• Presence of foreign bodies, air or liquid.

So, what are the most common diagnoses of domestic fluorographs?

They stamped your medical card and released you without further ado, which means we can say with confidence that you are healthy. If suddenly something is wrong, then according to the law, a health worker must notify you that additional examination is needed.

Expanded/densified roots

The collection of structures located at the hilum of the lungs is usually called the roots of the lungs. From the root, bronchial arteries, lymph nodes, blood vessels, etc. are formed. In most cases, the phenomenon of compaction and expansion of the roots of the lungs occurs in pairs and occurs very often. Of course, there is an isolated compaction without expansion, but in this case, this diagnosis indicates a chronic process and a large amount of connective tissue is observed in the structures of the roots of the lungs.

Compaction and expansion of the roots occurs due to swelling of large vessels and bronchi or when the lymph nodes become enlarged. These processes can be either isolated or simultaneous and are the result of pneumonia or acute bronchitis. This diagnosis is also present in other diseases, but they are accompanied by lesions, decay cavities, etc. In this case, the roots of the lungs become denser due to the increase in local groups of lymph nodes. In the overview image (1:1), it is quite difficult to distinguish the lymph nodes from other structural elements of the lungs.

The roots are heavy

If you read a conclusion in your medical record that “the roots are enlarged, thickened,” but there are no health problems, then this indicates inflammation or bronchitis. This symptom is stable for smokers, because smoke particles constantly irritate the walls of the bronchi and contribute to the compaction of the lymph nodes. The lymph nodes are responsible for cleansing the lungs, and the smoker does not feel any discomfort.

If a person has any complaints, it is best to consult a therapist. Despite the fact that chronic diseases allow you to lead a normal life, this does not mean that you need to forget about this unpleasant nuance. Chronic diseases may not lead to quick death, but they become the cause of predicted and already fatal diseases in the future.

Pulmonary/vascular pattern increased

Not a single fluorography can do without a pulmonary pattern. The pulmonary pattern consists of the shadows of blood vessels, arteries and veins, so it is not surprising that many people use the term vascular instead of the term pulmonary pattern. A fairly common diagnosis, which indicates an increase in the pulmonary pattern; it is formed due to the fact that some areas in the lungs are more intensively supplied with blood. Acute inflammation of any origin leads to an increase in the pulmonary pattern and this can indicate both ordinary bronchitis and pneumonitis, and this already indicates cancer. In case of pneumonia, a repeat X-ray is often prescribed to find out whether it is pneumonitis, because in the images these two diseases are very similar. An increased pulmonary pattern also indicates problems with the heart, but such a disease usually does not go away without symptoms. In general, we can say that an increase in the pulmonary pattern indicates bronchitis, pneumonia, etc., but it disappears within a few weeks after the disease has been defeated.

Fibrosis

Fibrous tissue on a fluorogram is a consequence of past pulmonary diseases. It replaces free space in the body. For example, a person has had a penetrating wound to the chest or has undergone surgery, this tissue plays the role of connective tissue and, in general, fibrosis is a more positive than negative diagnosis and is the result of the fact that some part of the lung tissue has been lost.

Focal tissues

Darkening of the pulmonary field is one of the types of foci. Lesions are very common and not uncommon in medical practice. They have their own symptoms, localized in certain places, and are also quite often combined with other diseases. A shadow up to 1 cm in size is usually called a focus. A sign of focal pneumonia is the location of focal tissues in such sections of the lungs as the lower and middle. An active inflammatory process is indicated by such words in the medical card as “increased pulmonary pattern”, “merging of shadows” and “uneven edges”. Foci that are dense and even in nature eventually subside on their own. If lesions are found in the upper sections of the lungs, then this diagnosis is typical for tuberculosis and in this case additional examination is prescribed.

Calcifications

Calcifications appear as round shadows on a fluorogram and their density resembles bones. Rib callus is very often similar to calcitis, but regardless of the nature of this formation, it is harmless, because the body “isolates” the infection from the rest of the body with calcitis.

Pleuroapical layers, adhesions

Adhesions usually do not require any treatment or intervention. They occur after inflammation and isolate the site of inflammation from healthy tissue. In some cases, adhesions can cause pain and in this case, medical help cannot be avoided. If the pleura of the apex of the lungs thickens, this should alert you, because very often this occurs as a result of a tuberculosis infection, but only a doctor can judge this.

Sealed/free sinus

Sinuses form in the folds of the pleura and when everything is fine, they are free. The liquid in these formations should definitely alert you. A sealed sinus indicates adhesions. A sealed sinus indicates former injuries, past pleurisy, etc. If there are no other symptoms in general, then it is not dangerous.

Aperture anomaly

There are a large number of reasons that lead to a change in the diaphragm, and this is a very common finding of a fluorograph. Only if this anomaly combines several other changes, then we can talk about some kind of disease, so the doctor prescribes additional examinations. An accurate diagnosis based on diaphragm abnormality is not possible.

Displacement or expansion of the mediastinal shadow

The space between the lungs is called the mediastinum. Typically, widening of the mediastinum indicates an enlarged heart. It is unilateral and increases in the right or left side of the heart. Fluorography cannot judge the condition of the heart. The normal position of the heart depends on the physique of a particular person. For a short and plump person, a heart slightly shifted to the left is not bad. If a person is tall, then his heart can be in a vertical or teardrop-shaped position. For hypertensive patients, what is written in the chart is: “expansion of the mediastinum to the left,” “expansion of the heart to the left,” or simply “expansion.” The mediastinum can expand evenly, but this already indicates myocarditis, cardiac failure, etc. For cardiologists, the results of a fluorogram are not sufficient to make a specific diagnosis.

If the pressure increases on one side, then the fluorogram indicates a mixed mediastinum. This diagnosis means the asymmetric presence of fluid or air in the pleural cavity or large tumors in the lung tissue. This diagnosis is already serious, because it can cause a gross displacement of the heart and the intervention of specialists is very important in this case.

P. S. Despite the fact that fluorography in our ordinary hospitals is not without its drawbacks, it is still capable of detecting tuberculosis or lung cancer. It's worth going through it anyway. In our country, the epidemiological conditions for tuberculosis are simply excellent. The risk group is our normal state. By undergoing annual fluorography, we thereby protect ourselves from fatal diseases, because a disease detected in time significantly increases a person’s chances of survival.

Root compaction is one of the most common radiological syndromes, which a radiologist determines on a plain X-ray of the chest cavity. What does this mean: What diseases and pathological conditions are hidden under this phrase?

Lung root: what is it?

The root of the lung is a complex of structures located at the hilum of the lung. These include the pulmonary artery, vein, main bronchus, as well as nerves, lymphatic vessels, pleura, fatty tissue. All these structures are located in a strictly defined order, but some of them on the left side are not visible on the x-ray, hiding behind the shadow of the heart.

In plain radiography and fluorography, the term “root of the lung” refers only to large vessels (artery, vein) and bronchus.

Main characteristics of the roots of the lungs

To determine a symptom such as compaction of the roots of the lungs on an x-ray, you first need to know the normal characteristics of these formations.

The root of both the right and left lungs consists of three parts: the head, the body and the tail. The tail includes terminal small branching vessels.

In radiology, the width of these structures is also determined. It is usually determined by the width of the right root and includes the arteries and intermediate bronchus. Normally its width is 1.5-2 cm.

It is also worth noting that the arteries in the roots of the lung are located more vertically, and the veins - horizontally. Sometimes their structure may be heterogeneous due to the fact that in some areas clearing of air in the bronchi is visible.

Differences in the location of the roots of the lungs

The placement of the roots of the right and left lungs is slightly different. Thus, the root of the right lung normally corresponds to the level of the 2nd rib and intercostal space and has the shape of an arc, curved downwards. Starting wide at the top, the root tapers at the bottom. The left root, in turn, corresponds to the level of the 1st rib and intercostal space, that is, it is located above the right one.

Differences in the structure of the roots of the lungs

It is necessary to understand that the left root is poorly visible on the x-ray, as it is covered by the heart, so sometimes it is difficult to see when the root of the left lung is compacted.

It should also be remembered that the root of the left lung normally has a heterogeneous structure, since it consists of almost only vessels, branching into small branches and intertwining with the left bronchus. While the right root has a more uniform structure.

Main causes of root compaction

There are many different diseases and syndromes that cause the roots of the lung to become denser. The main reasons include:

1. bronchitis).
2. Enlargement of the mediastinal lymph nodes (paratracheal, parabronchial) with the development of petrification (deposits of calcium salts) in them.
3. Dilatation and protrusion of the vessel wall or aneurysm of the vessel.
4. Changes in the structure of the bronchus under the influence of the tumor process.
5. Pulmonary edema (fluid penetration into the lung parenchyma).
6. An increase in connective tissue with the development of fibrosis, which occurs after prolonged inflammatory pulmonary diseases, lung injuries, and surgical interventions on the organs of the chest cavity.
7. Tuberculous lesions of the bronchi (tuberculous bronchoadenitis), primary tuberculosis complex. The last two forms belong to primary tuberculosis, most common in preschool children.
8. Occupational diseases (asbestosis, metalloconiosis).

Chronic obstructive pulmonary diseases

This group of diseases is one of the most common reasons, along which the roots of the lungs are compacted and expanded. As a rule, this process is two-way, affecting both the left and right roots. Most often, the disease develops in long-term smokers and is characterized by alternating periods of exacerbation with periods of remission.

The main clinical manifestations are cough, which especially bothers the patient in the morning - with viscous, sometimes purulent sputum. With a prolonged course of the disease, shortness of breath develops, which is first noted when physical activity, and then in peace.

In addition to conducting a survey X-ray of the chest cavity, which is characterized by the fact that the roots in the lungs are compacted and stringy, sputum culture is also performed to determine the causative agent of the disease (viral or bacterial).

That is, treatment of the cause depends on the pathogen that caused the exacerbation. If the cause is a bacteria, then taking antibiotics will be effective; if it is a virus, taking antiviral drugs will be effective.

Symptomatic therapy includes taking mucolytics, drugs that dilute sputum, and expectorants to make it easier to clear. They also take drugs that dilate the bronchi - adrenergic receptor agonists, corticosteroids.

Oncological diseases

A dangerous, but, fortunately, infrequent reason that the roots of the lungs are compacted and expanded is the oncological process in the bronchi and mediastinal organs. This process is usually one-sided, so changes in the root of the lung are observed only on one side.

Oncology implies a long-term chronic process with a gradual deterioration of the patient’s condition. A slight cough and heavy breathing are replaced by pain behind the sternum at the site of the tumor projection onto the chest wall (with compression of the nerves), hemoptysis, and severe shortness of breath. In addition to dysfunction of the pulmonary system, the entire body suffers. The patient loses weight, becomes exhausted, and fast fatiguability and weakness.

After conducting a survey X-ray of the chest cavity in two projections, the radiologist makes a conclusion: “The roots of the lungs are compacted and have little structure.” Next, the attending physician issues a referral for a biopsy of the formation suspicious on the x-ray, which will determine not only the type of tumor (benign or malignant), but also its histological structure (from what tissue it was formed).

Therapy depends on both the stage of the tumor process and its type. Basic therapeutic methods: surgical, radiation and chemotherapy. Surgery alone is used for initial stages tumor development, in later stages it is combined with other methods of therapy.

Occupational diseases

People in professions such as miners, metal welders, builders, that is, those who constantly interact with harmful environmental substances, are most susceptible to developing occupational diseases. This leads to the fact that on the radiograph the roots in the lungs are fibrously compacted and stringy. This picture develops due to the accumulation of harmful particles in the bronchi and alveoli, which settle on the respiratory tract. As a rule, root damage is not isolated, but is combined with the presence of focal shadows and heterogeneity of the lung parenchyma.

The symptoms of these diseases are not specific; When making a diagnosis, first of all, pay attention to the professional history (place of work, length of service). And the main method of treatment is changing qualifications and changing jobs.

Root damage due to tuberculosis

A situation where the roots of the lungs are compacted usually occurs in children with primary pulmonary tuberculosis. These are forms such as primary tuberculosis complex and tuberculosis of the intrathoracic lymph nodes. However, these forms can also occur in older people during reinfection of an old lesion.

Tuberculosis is a chronic disease, so symptoms develop over a long period of time and gradually. Characteristic symptoms include a dry cough or with a small amount of sputum, possibly mixed with blood, chest pain, fatigue, lethargy, and weight loss.

After performing radiography in two projections, sputum culture and microscopy are performed to identify Mycobacterium tuberculosis, and a tomogram of the lungs is performed to more accurately localize the source of infection. After sowing the tuberculosis bacillus, its sensitivity to anti-tuberculosis drugs is determined, which is necessary to select the most effective treatment.

Drug therapy is based on the principles of continuity and long-term duration (minimum 6 months). It is also necessary to use a combination of at least 4 anti-TB drugs. Only if these principles are followed will the treatment be effective.

The roots of the lungs are heavy and compacted: what does this mean?

As noted above, this radiological syndrome most often occurs when chronic bronchitis smoker and occupational lung diseases. However, this symptom can also be detected in acute inflammatory diseases of the respiratory tract and cancer.

These strands are connective tissue fibers that stretch from the root to the periphery. Heaviness is usually combined with expansion and compaction of the root.

Although not highly specific, this syndrome allows the doctor to suspect a certain pulmonary pathology and refer the patient for further examination.

The roots of the lungs have little structure and are compacted: what does this mean?

Violation of the structure of the lung root, that is, the inability to distinguish a vessel from a bronchus, the appearance of darkening on the root, usually occurs in primary tuberculosis and oncological processes.

On an x-ray with extensive tuberculosis or central lung cancer, instead of a root, a shadow of various contours may be visualized, representing a focus (up to 10 mm in diameter) or an infiltrate (more than 10 mm). This symptom may also be combined with compaction, which usually occurs with the deposition of calcium salts or calcification (petrification). Calcification is a sign of a chronic, long-lasting process.

Thus, just one radiological symptom (in the lungs the roots are fibrously compacted and tractable) can help to suspect many diseases: from ordinary bronchitis to lung cancer. Of course, we should not forget that radiography should be complemented by other examination methods: computed tomogram, biopsy, sputum culture, bronchoscopy and so on. Additional examination methods are performed as prescribed by the doctor, depending on the path of his diagnostic search. It must be remembered that only a comprehensive examination will help make the correct diagnosis.