What does cold spots in the lungs mean? Rheumatoid factor test

Gon's lesion in the lungs is a manifestation of tuberculosis. Without the presence of a path to the root, tuberous formations extending beyond the contours of the mediastinum (lymph nodes), it is difficult to identify the tuberculous affiliation of focal shadowing syndrome.

When analyzing formations up to 1 cm in diameter, you should pay attention to calcification, density, fibrosis, morphological structure, and intensity of darkening. The prevalence of more than 2 ribs is a sign of dissemination.

Digital image: multiple fibrotic foci of both lungs against the background of chronic bronchitis

Ghon's lesion and calcified lesions in the lungs - what is it?

Ghon's lesion is a formation at the apex or upper segments of the lungs, caused by damage to the lung tissue by mycobacteria. Morphological examination of the material reveals a large number of granulation cells and macrophages. The body constantly fights the causative agent of pulmonary tuberculosis, so the dynamics increase slowly. Only when viewing a series of images of organs chest Over the course of 3-6 months, some changes can be identified.

At long-term storage Tuberculosis lesions can be traced to the possible formation of a calcified focus. Calcium salts are deposited in places of caseous destruction. This is how mummification of the pathogen occurs, which prevents reinfection lung tissue.

Calcified lesions in the lungs are not only manifestations of tuberculosis infection. Occurs in chronic pneumonia, helminthic infestations, fibrosing alveolitis (Hammen-Richie).

Digital radiograph: miliary tuberculosis, lesions on both sides

Gon's outbreak is a rare form of infection in the current period of time. Due to the uncontrolled use of antibiotics, microorganisms have become resistant to antibiotics. When treating other diseases with these drugs, a certain activity is provided chemical compound on Mycobacterium tuberculosis. The bacteria are not completely killed. If microorganisms do not have multidrug resistance, under the influence of antibiotic therapy for pneumonia, bronchitis, and other diseases, a person stops the active progression of tuberculosis without knowing it.

Only when performing the next fluorography is a specific focus at the apex revealed (calcified, dense, fibrous, intense, calcified).

Dense lesions in the lungs with focal opacification syndrome

Limited focal shadowing syndrome includes single (up to 5), multiple shadows (more than 6), the size of which does not exceed 1 cm. With a limited location (up to 2 intercostal spaces), a diagnosis is made focal tuberculosis, pneumonia.

If the area extends beyond the two intercostal spaces, they speak of a disseminated process. Focal darkening is differentiated into primary and secondary. In diseases with damage to lung tissue, the pathogenesis of the syndrome is accompanied by the following pathogenetic mechanisms:

Displacement of air by exudate, transudate;
Resorption of alveolar air with lobular atelectasis;
Expulsion of air by the substrate outside the alveoli;
Hematogenous metastases due to edema, infarction, tuberculosis;
Lymphogenic metastases (primary tuberculosis, blood diseases);
Contact damage to lung tissue (peripheral cancer, aneurysm).

Ghon's lesion syndrome, polymorphic, fibrous, intense, calcified, can be observed in tumors, inflammation of the lung tissue, and vascular anomalies.

Determining a focal shadow in an image does not always allow one to verify the morphology or etiological factor.

At various diseases focal opacification syndrome has radiological similarities. The specific gravity of the tumor, fibrous, necrotic, inflammatory focus differs slightly. To differentiate gradations, computed tomography is used to study the density of the shadow. The study allows you to clearly verify calcified, calcified, intense and weak darkening.

Gon's lesion in the lungs x-ray in the classic state it is clearly visualized. Other nosological forms are not accompanied by accompanying signs that allow verification of the nosology.

Dense lesions in the lungs - what are they?

Dense foci on an x-ray of the lungs indicate either a chronic infection or a healed inflammatory or traumatic process. Accumulates at the site of prolonged inflammation scar tissue, pneumosclerosis is formed, carnification occurs in pneumonia. In all these nosologies, the x-ray shows dense (intense) shadows.

If these changes are present in the image clinical picture not accompanied by pronounced changes. The syndrome of calcification, calcification, scarring can be a manifestation of the following nosological forms:

Tumor;
Aneurysm;
Retention cyst;
Primary cancer;
Focal tuberculosis.

Only with dissemination do signs of severe intoxication appear:

1. Temperature over 39 degrees;
2. General weakness;
3. Cough with sputum;
4. Chest pain.

During the inflammatory process one can trace laboratory changes: leukocytosis, accelerated erythrocyte sedimentation rate. Focal tuberculosis is characterized by specific clinical symptoms:

Pain in the chest;
Cough;
Irritability;
Loss of appetite;
Weakness.

With tuberculosis infection, a blood test is not accompanied by inflammatory changes. To diagnose the disease, the determination of Mycobacterium tuberculosis in the washing waters of the bronchial tract is required. At low peripheral cancer, solitary metastases, changes in blood tests can be traced.

At pulmonary infarction focal darkening syndrome is observed, which occurs with thrombophlebitis lower limbs. Clinic – hemoptysis, complaints of pain in the side.

Dense lesions in the lungs in most cases do not require treatment, but before stopping treatment of the patient, a full diagnosis is required to confirm the true focal shadow syndrome. Make sure that the image shows a really large formation that occupies the acini. A similar picture is formed by the interweaving of blood vessels and interstitial cords. A polypositional (multi-axial) examination provides a lot of information. Even traditional radiography of the chest organs in frontal and lateral projections reveals the round nature of the darkening. On a lateral image, it is possible to identify calcified foci of the pleura. With a multiprojection study, it is possible to distinguish between intrapulmonary and pleural calcifications.

If a focal syndrome is detected on an x-ray, a differential diagnosis should be made between tumors, tuberculosis, and pneumonia.

Fibrous lesions in the lungs - what are they?

With inflammatory changes, the focal shadow has medium intensity, uneven, blurred boundaries. At chronic inflammation, fibrous tuberculosis the shadows are intense with jagged, sharp edges.

Fibrous deposits impair the ventilation of the bronchial tract. Degree respiratory failure determined by the volume of the lesion.

If fibrosis is provoked by a tumor, a “belt” or accumulation of small lesions due to the enhanced pulmonary pattern.

In tuberculosis, a vascular “path” departs from the fibrous focus, directed towards root of the lung. Several convoluted thin strips of vessels directed towards the root are often found in chronic tuberculosis.

Enlarged lymph nodes, a track, a round shadow in the pulmonary parenchyma - this is most often radiological signs cancer.

Fibrous polymorphic foci can be observed in focal pneumonia with long course. With the constant destruction of cells, the sites of destruction are scarred by connective tissue, which persists throughout the rest of a person’s life.

In conclusion, I would like to remind you that polymorphic lesions in the lungs are not always a manifestation of pulmonary pathology. If the syndrome is detected on direct radiographs, there is a possibility of pleural involvement. Pleurisy can be not only exudative, but also dry. After healing, calcifications and fibrous foci remain.

Focal opacification syndrome in the lungs is an x-ray manifestation of many nosological forms. Several methods are used for differential diagnosis.

Focal formations in the lungs - tissue thickening caused by various diseases. Usually they are detected as a result of x-ray examination. Sometimes an examination by a specialist and diagnostic methods are not enough to make an accurate conclusion. For final confirmation, you need to special methods examinations: blood tests, sputum,. This happens with malignant tumors, pneumonia and impaired fluid exchange in the respiratory system.

A lesion is a small, round or irregularly shaped spot that is visible on X-rays and is located in the lung tissue. They are divided into several varieties: single, single (up to 6 pieces) and multiple.

There is a certain difference between the internationally established concept of focal formations and what is accepted in domestic medicine. Abroad, these include compactions in the lungs measuring about 3 cm. Domestic medicine sets limits to 1 cm, and classifies other formations as infiltrates.

Computed tomography is capable of more likely establish the size and shape of the lung tissue compaction. This study also has a margin of error.

Focal formations in the respiratory organs are presented as degenerative changes in the tissues of the lungs or the accumulation of fluid in the form of sputum or blood. Many experts consider their establishment one of the important tasks.

Cancer factors

Up to 70% of single lesions in the lungs are classified as malignant neoplasms. Using CT (computed tomography), and based on specific symptoms, a specialist can assume the occurrence of dangerous pathologies such as tuberculosis or lung cancer.

However, to confirm the diagnosis it is necessary to undergo the necessary tests. In some cases, a hardware examination is not enough to obtain a medical opinion. Modern medicine does not have a single algorithm for conducting research in all possible situations. The specialist considers each case separately.

The imperfection of the equipment does not allow a clear diagnosis of the disease using the hardware method. Difficult to detect on chest x-ray focal changes, the size of which does not reach 1 cm. The interposition of anatomical structures makes larger formations invisible.

The specialist offers patients to undergo examination using computed tomography. It allows you to view fabrics from any angle.

Computed tomography to diagnose the location of the lesion

Causes of focal formations in the lungs

The main factors of pathology include the occurrence of compactions on the lungs. Such symptoms are dangerous conditions, which in the absence proper therapy may cause death. Diseases that provoke this condition include:

• oncological diseases, the consequences of their development (metastases, neoplasms themselves, etc.);
• focal tuberculosis;
• pneumonia;
• caused by poor circulation or as a result of an allergic reaction;
• myocardial infarction;
• bleeding;
• severe bruises to the chest;

Most often, compactions occur due to inflammatory processes ( acute pneumonia, pulmonary tuberculosis) or cancer.

A third of patients have minor signs of respiratory damage. A feature of pulmonary tuberculosis is the absence of symptoms or their minimal manifestation. It is mainly detected during preventive examinations. The main picture of tuberculosis is given by chest radiography, but it differs depending on the phase and duration of the process.

Basic diagnostic methods

To determine focal changes, it is necessary to undergo special examination(radiography, fluorography or computed tomography). These diagnostic methods have their own characteristics.

When undergoing an examination in the form of fluorography, it is impossible to detect a compaction smaller than 1 cm in size. It will not be possible to analyze the entire picture completely and without errors.

Many doctors advise their patients to undergo a CT scan. It's a way of research human body, allowing to identify various changes and pathologies in internal organs sick. It is one of the most modern and precise ways diagnostics The essence of the method is to influence the patient’s body x-rays, and subsequently, after passing through it, computer analysis.

With its help you can install:

• V minimum terms and with particular precision the pathology that affected the patient’s lungs;
• accurately determine the stage of the disease (tuberculosis);
• correctly establish the condition of the lungs (determine tissue density, diagnose the condition of the alveoli and measure tidal volume);
• analyze the condition of the pulmonary vessels of the lungs, heart, pulmonary artery, aorta, trachea, bronchi and lymph nodes located in the chest area.

This method also has weaknesses. Even with CT examination, focal changes are missed. This is explained by the low sensitivity of the device for lesions up to 0.5 cm in size and low tissue density.

Experts have found that with initial CT screening, the probability of not detecting pathological disorders in the form of focal formations is possible with a size of 5 mm in 50% of cases. When the diameter is 1 cm, the sensitivity of the device in this case is 95%.

The conclusion indicates the likelihood of developing a particular pathology. The location of lesions on the lungs is not given of decisive importance. Special attention pay attention to their contours. If they are uneven and fuzzy, with a diameter of more than 1 cm, then this indicates the occurrence of a malignant process. In the case of diagnosing clear edges of focal changes, we can talk about the development benign neoplasms or tuberculosis.

During the examination, pay attention to the density of the tissues. Thanks to this sign, the specialist is able to distinguish pneumonia from changes caused by tuberculosis.

Another of the nuances of computed tomography should include the definition of a substance that collects in the lungs. Only body fat make it possible to determine pathological processes, and the rest cannot be classified as specific symptoms.

After obtaining CT images of the lungs, on which seals are visible, they are classified. Modern medicine distinguishes the following varieties according to size:

• small, components in diameter from 1 to 2 mm;
• medium – size in diameter 3-5 mm;
• large, components from 1 cm.

Focal formations in the lungs are usually classified by density:

• dense;
• medium density;
• loose.

Classification by quantity:

Single seals. May be a factor in a serious pathology (malignant tumor) or refers to the usual age-related changes that do not pose a threat to the patient's life.

Multiple seals. Mostly characteristic of pneumonia and tuberculosis, however, sometimes numerous and rarely diagnosed oncological diseases are also caused by the development of a large number of seals.

In humans, the lungs are covered with a thin film called pleura. Seals in relation to it are:

• pleural lesions;
• subpleural lesions.

Modern medicine has several methods for diagnosing tuberculosis and other lung diseases. Computed tomography is widely used to establish subpleural lesions, while fluorography and radiography are not completely effective ways to determine the patient's condition. They are located under the pleura, their location is typical for tuberculosis and cancer. Only this diagnostic method allows you to correctly determine the disease that has arisen.

Conclusion

Focal changes are caused not only by diseases that are easily treatable (pneumonia), but sometimes by more serious pathologies - tuberculosis, malignant or benign neoplasms. Modern diagnostic methods will help to detect them in a timely manner and prescribe correct and safe therapy.

I.E. Tyurin

Foci in the lung tissue are defined as areas of compaction of a round or similar shape up to 10 mm in size. Foci can be found in numerous infectious, tumor, interstitial and other lung diseases, total number which reaches several dozen. The most well-known representatives of focal changes are metastases of malignant tumors to the lungs and disseminated pulmonary tuberculosis.

Characteristics of focal disseminations. Focal changes in the lungs form the anatomical basis of the large radiological syndrome - focal dissemination. Foci often serve as the only manifestation pathological process, however, in a significant proportion of patients they are combined with other manifestations of pulmonary pathology, for example, with reticular changes, an increase or decrease in the airiness of the lung tissue.

Focal changes can be local if they occupy up to two segments of one lung, or diffuse if they spread to three segments or more. The predominant localization of lesions in the lungs is very diverse. Focal disseminations are divided into unilateral and bilateral; in the latter case, the pathological process can be symmetrical or asymmetrical, with a predominance of changes in one lung or part of it. Relatively rarely, foci are distributed evenly throughout the entire lung fields (for example, with miliary tuberculosis).

Much more often, dissemination predominates in the upper or lower parts lungs, in radical or cortical departments. These features have a known differential diagnostic value. Thus, more pronounced changes in upper lobes typical for chronic course hematogenous tuberculosis, and an increase in changes towards the diaphragm is characteristic of hematogenous metastases. Hilar localization of lesions is often found in sarcoidosis, while the predominance of lesions in the cortical parts of the lungs is often observed in the subacute course of hypersensitivity pneumonitis.

Lesions in the lung tissue vary widely in size, density (shade intensity during radiography), structure, and contour patterns. In the domestic literature, it is customary to divide lesions by size into small and miliary (up to 2 mm), medium-sized (3-5 mm) and large (6-10 mm). On radiography, lesions often have an average shadow intensity, which on computed tomography (CT) corresponds to soft tissue density. However, in a number of pathological processes, lesions are displayed on axial sections as areas of low-density compaction - ground-glass lesions. As a rule, they are not visible with traditional X-ray examination and are detected only with thin-slice CT. Such changes in the lungs are observed, for example, with respiratory bronchiolitis or hypersensitivity pneumonitis.

The contours of lesions in the lungs can be clear or unclear, which characterizes the degree of delimitation of the changed area from the surrounding lung tissue. The structure of the lesions can be homogeneous or heterogeneous - due to the presence of calcifications, areas of ossification or decay cavities. Examples include calcified tuberculosis foci, high density metastases osteosarcoma with pathological bone formation in them or disintegrating foci in septic embolism of the pulmonary vessels.

Despite the well-known patterns of the location of lesions in the lungs and the nature of focal shadows, the capabilities of conventional x-ray examination in the differential diagnosis of such changes are small. As a rule, they are limited to typical manifestations of the most frequent illnesses in the presence of reliable clinical data. The advent of high-resolution CT (HRCT) in the 1980s led to the emergence of new group symptoms, which significantly simplified the differential diagnosis of focal changes in the lung tissue and significantly increased its effectiveness. Thin-layer CT has great potential in
delineating the nature of focal disseminations in the lungs and determining a method for their verification.

All of the above symptoms of focal disseminations are applicable both to traditional X-ray examination and to CT. However, if with radiography the most important characteristics are the localization of lesions in the lungs and the characteristics of the lesions themselves (their size, shape, contours and structure), then with HRCT a more important characteristic of the pathological process becomes the relationship of the lesions in the lung tissue to the anatomical elements of the secondary pulmonary lobe (SPL) and to the visceral pleura.

Anatomy of the secondary pulmonary lobule. The secondary lung lobule is the smallest structural unit lung, completely surrounded by a connective tissue septum. The lobule usually has an irregular polygonal or round shape and sizes from 10 to 25 mm. In the structure of the secondary pulmonary lobule on CT, three components can be distinguished: interlobular septum, root and parenchyma. Each secondary pulmonary lobule is equipped with a separate bronchus and lobular artery, which are located together in the center of the lobule. The lobular artery and bronchus at this level have an outer diameter of about 1 mm. The diameter of the intralobular arteries and terminal bronchioles decreases to 0.7 mm, and the arteries and bronchioles in the acini - to 0.3-0.5 mm.

On axial CT sections, small vessels are located at a distance of at least 3-5 mm from the surface visceral pleura, in the cross section they look like points, and in the longitudinal section they look like short Y-shaped or V-shaped lines. Venous vessels have a similar image, but at a slightly greater distance from the pleura. Intralobular bronchus and bronchioles are normally not visible on HRCT, since it is impossible to distinguish the air in their lumen from the surrounding air-containing lung tissue. An image of bronchioles can be obtained with HRCT only if their lumen is filled with pathological contents, their walls are thickened, or the lumen is significantly expanded with the formation of bronchiolectasis.

The interlobular septum contains lymphatic vessels and veins. Normally, HRCT can detect only the largest septa - they are located in the anterior and outer parts of the upper, middle and lower lobes, as well as paramediastinal in the lower lobes of the lungs. When the septa thicken due to any pathological process, they become clearly visible on HRCT.

Types of pulmonary lesions. With thin-slice CT, it is customary to distinguish three main types of lesions in the lung tissue, each of which is focused on the anatomical structures of the VLD: chaotic, perilymphatic and centrilobular. The latter are usually divided into two subtypes depending on the presence or absence of visible changes in the bronchioles.

A chaotic distribution of foci is observed in the absence of changes in the pulmonary interstitium. Usually the lesions are displayed against the background of unchanged lung tissue, so their location turns out to be random. Individual elements of the VLD are not visible; it is not possible to establish a connection between such foci and the pulmonary interstitium. A mandatory element is a small number of lesions along the interlobar, costal and mediastinal pleura. This type of distribution of foci is characteristic of hematogenous processes, primarily hematogenously disseminated tuberculosis and hematogenous metastases. In some cases, for example, with hematogenous metastasis, it is possible to establish a connection between the foci and small pulmonary vessels - the “feeding vessel” symptom is most typical for hematogenous metastases and multiple septic embolisms.

Perilymphatic foci are localized along the lymphatic vessels and therefore are found on CT scans mainly in the walls of the bronchi, blood vessels, in the interlobular septa and in the layers of the interlobar pleura. Changes in the walls of blood vessels and bronchi create a picture of uneven, “jagged” contours of these anatomical structures, as well as a distinct thickening of the interlobular septa. Such changes are observed primarily in sarcoidosis and lymphogenous carcinomatosis. The lesions, as a rule, are small in size - within 2-5 mm. Their morphological basis is granulomas or metastatic nodules that arise along the lymphatic vessels in the pulmonary interstitium and pleura.

Centrilobular foci reflect pathological changes in or around intralobular arteries and bronchi. A distinctive feature of such lesions is the absence of changes in the pulmonary interstitium (thickening of the interlobular septa, bronchial walls, layers of the interlobar pleura), as well as the absence of lesions under the visceral pleura. Foci of this type can be represented by two main options.

In the first option, centrilobular lesions are displayed as fairly dense, clearly visible, well-defined structures of round or irregular shape. Their characteristic manifestation is the symptom of “tree-in-bud” (“tree-in-bud”, synonym: “blooming or blossoming tree”) - in the cortical parts of the lung, at a distance of 3-5 mm from the surface of the visceral pleura, Y-shaped or V --shaped structures 1-2 mm thick with thickenings at the ends. The base of these structures always faces the visceral pleura.

The “tree in the buds” symptom is a tomographic display of dilated intralobular bronchioles filled with pathological contents in a longitudinal section. Centrilobular changes of this type are observed with endobronchial spread of pulmonary infections, including tuberculosis, as well as with various forms of non-infectious bronchiolitis, occupational diseases(silicosis, anthracosis), etc.

The second variant of centrilobular lesions is represented by small, ill-defined compactions of low-density lung tissue of the “ground glass” type. Such lesions most often arise as a result of cellular infiltration of peribronchiolar lung tissue and are observed in hypersensitivity pneumonitis and some forms of bronchiolitis. Significant amount Such foci, if they are close together and partially merge, can create the illusion of diffuse infiltrative changes of the “ground glass” type.

The location of foci in the lung tissue in relation to the anatomical elements of the VLD has great importance to characterize dissemination, but this is not enough to determine the nature of the pathological process, even taking into account the usual X-ray features foci. In some cases, anatomical landmarks of the VLD, which help determine the type of lesions, may not be visible at all (for example, with a chaotic or centrilobular location of the lesions). No less important is the distribution of foci in the whole lung, the ratio of foci to the leaves of the visceral pleura, especially the costal and interlobar pleura, the walls relative to large bronchi and vessels.

The combination of two groups of signs - the type of foci and their distribution in the lung - allows you to analyze focal disseminations using a relatively simple algorithm, which is aimed at identifying from all possible options two or three most likely pathological processes.

Diagnostic algorithm. Step one is to identify focal dissemination (or mixed changes in the lung tissue with a predominance of foci). For this purpose, it is necessary to use thin-slice CT - in the form of step-by-step scanning with HRCT or spiral scanning with multi-slice CT. In difficult cases (for example, with difficult to distinguish miliary dissemination), the use of two-dimensional and three-dimensional transformation methods, multiplanar reformations with different layer thicknesses and maximum intensity projections is of great help. Such transformations can only be performed with multilayer CT and helical scanning protocol.

Step two is to determine the predominant type of lesions. To do this, it is necessary to analyze the state of the sheets of the visceral pleura, primarily the interlobar, as well as the costal and mediastinal. If the foci are visible not only in the lung tissue, but along the surface of the pleura, they can be classified as either chaotic or perilymphatic type (the first arm of the algorithm). If the layers of the pleura are not changed, there are no visible foci in them and that’s all focal formations are located deep in the lung tissue, then such changes can be attributed to the centrilobular type (the second arm of the algorithm).

The first arm is the analysis of disseminations in the presence of foci along the visceral pleura. These types of lesions, as a rule, are formed during hematogenous or lymphogenous spread of the pathological process. With hematogenous spread of the process, the foci are located in the lung tissue without connection with the anatomical elements of the VLD. Changes in the pulmonary interstitium (thickening of the interlobular septa, bronchial walls and blood vessels) are weakly expressed or absent altogether. In the costal and interlobar pleura one can find isolated outbreaks, while the layers of the pleura themselves, as a rule, are not changed. This type of outbreak is defined as chaotic.

The most important representatives of this kind of dissemination are hematogenous metastases of malignant tumors and hematogenously disseminated tuberculosis. Metastases are characterized by the presence of single or multiple foci in the lung tissue, often polymorphic - having different sizes and even densities. The lesions can have a very diverse structure (soft tissue density, with calcium inclusions, “frosted glass” type, with decay cavities), as well as clear or fuzzy outlines due to infiltration or hemorrhage into the adjacent lung tissue.

A distinctive feature of most metastatic hematogenous disseminations is the “feeding vessel” symptom, clearly visible on CT. This sign can also be observed with multiple septic embolisms, but it practically does not occur in hematogenous forms of tuberculosis. However, in many cases, the distinction between hematogenous metastases and hematogenously disseminated tuberculosis, especially in its acute and subacute course, is possible only according to clinical and laboratory data.

With the lymphogenous spread of the process, the foci have a clear tendency to be located along the altered structures of the pulmonary interstitium. Foci are detected in the walls of the bronchi and blood vessels, creating a kind of “jaggedness” of their contours, as well as in thickened interlobular septa. Even in cases where the septal lines themselves are not clearly visible, the ring-shaped arrangement of individual groups of lesions follows the shape of the septa. A large number of the foci are concentrated in the layers of the interlobar pleura, and usually the layers of the pleura are unevenly thickened and also have a distinct appearance. This picture is formed in the presence of perilymphatic type of lesions.

Such changes are most typical for respiratory sarcoidosis of stage II and sometimes stage III. In a typical picture of sarcoidosis, perilymphatic foci are located predominantly in the central part of the lung, especially along the oblique interlobar pleura. Reticular and infiltrative changes are expressed in varying degrees, sometimes significantly, but thickening of the septal septa is not typical for this disease. Distinctive features are the location of lesions in the walls of blood vessels and bronchi with their simultaneous thickening (peribronchial and perivascular couplings), in the interlobar pleura with thickening of its leaves, as well as frequent increase peritracheobronchial lymph nodes.

The differential diagnostic range for perilymphatic lesions includes pneumoconiosis, primarily silicosis and anthracosis, which may be indistinguishable from sarcoidosis on CT. Correct diagnosis Anamnestic data contributes. Lymphogenic carcinomatosis is also characterized by a perilymphatic location of metastatic foci, but pronounced reticular changes in the form of uniform or distinct thickening of the interlobular septa usually suggest the correct diagnosis. An additional sign of metastatic lesions, in addition to malignant tumor history, often indicates the presence of fluid in the pleural cavity.

The second arm of the algorithm is the analysis of disseminations in the absence of foci along the visceral pleura. In this case, we can also distinguish two various types changes. The key element here is the presence or absence of bronchiolectasis - dilated and filled with pathological contents of intralobular bronchioles, which form typical Y-shaped or V-shaped figures (symptom of “tree in the buds”).

In the first version, such changes are absent, and only focal changes can be detected on axial sections. The lesions are located deep in the lung tissue, and in the cortical sections they can be seen at a distance of 3-5 mm from the visceral pleura. They usually present as peribronchial and peribronchiolar infiltrates or granulomas. Such foci may have soft tissue density and clear contours, for example, with histiocytosis, which in typical cases is accompanied by the formation of numerous cysts mainly in the upper lobes of the lungs, which, in combination with the centrilobular location of the foci, creates a very characteristic picture.

Another option is low density lesions, when they appear on axial sections as small areas of ground glass compaction - for example, in subacute hypersensitivity pneumonitis (exogenous allergic alveolitis) or in respiratory bronchiolitis. This type of change is often difficult to distinguish from the chaotic type of foci during hematogenous dissemination. The key point differential diagnosis between them becomes the presence or absence of foci along the visceral (primarily interlobar) pleura.

The second type of changes in this arm of the diagnostic algorithm is a combination of focal dissemination with changes in small bronchi and bronchioles in the form of a “tree in the buds” symptom. Dilated and filled with pathological contents, the bronchioles are located both deep in the lung tissue and along the visceral pleura, at a distance of 3-5 mm from it. As a rule, this symptom reflects the bronchogenic spread of the pathological process: with bronchopneumonia, pneumomycosis, lung abscess and tuberculosis. The cause of widespread changes of this kind is most often disseminated tuberculosis with bronchogenic spread of infection (from a tuberculous cavity or bronchoglandular fistula).

Thus, among the whole variety of focal disseminations, the given diagnostic algorithm allows us to distinguish four main types of changes: chaotic foci, perilymphatic foci, centrilobular foci without bronchiolectasis and centrilobular.

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general description

Infiltrative tuberculosis is usually considered as the next stage in the progression of miliary pulmonary tuberculosis, where the leading symptom is already infiltration, represented by an exudative-pneumonic focus with caseous decay in the center and intense inflammatory reaction on the periphery.

Women are less susceptible to tuberculosis infection: they get sick three times less often than men. In addition, the trend towards a higher increase in incidence among men continues. Tuberculosis occurs more often in men aged 20-39 years.

Acid-fast bacteria of the genus Mycobacterium are considered responsible for the development of tuberculosis. There are 74 species of such bacteria and they are found everywhere in the human environment. But the cause of tuberculosis in humans is not all of them, but the so-called human and bovine species of mycobacteria. Mycobacteria are extremely pathogenic and are characterized by high resistance during external environment. Although pathogenicity can vary significantly under the influence of environmental factors and condition protective forces the human body that has been infected. The bovine type of pathogen is isolated during the disease in rural residents, where infection occurs through the nutritional route. People with avian tuberculosis are susceptible to immunodeficiency states. The overwhelming majority of primary human infections with tuberculosis occur through the airborne route. Alternative ways of introducing infection into the body are also known: nutritional, contact and transplacental, but they are very rare.

Symptoms of pulmonary tuberculosis (infiltrative and focal)

• Low-grade body temperature.
• Heavy sweats.
• Cough with gray sputum.
• When coughing, blood may be released or blood may appear from the lungs.
• Pain in the chest is possible.
• Frequency breathing movements- more than 20 per minute.
• Feeling of weakness, fatigue, emotional lability.
• Poor appetite.

Diagnostics

• General analysis blood: slight leukocytosis with a neutrophilic shift to the left, a slight increase in the erythrocyte sedimentation rate.
• Analysis of sputum and bronchial lavage: in 70% of cases, Mycobacterium tuberculosis is detected.
• X-ray of the lungs: infiltrates are most often localized in 1, 2 and 6 lung segments. From them to the root of the lung there is a so-called path, which is a consequence of peribronchial and perivascular inflammatory changes.
• Computed tomography of the lungs: allows you to obtain the most reliable information about the structure of the infiltrate or cavity.

Treatment of pulmonary tuberculosis (infiltrative and focal)

Tuberculosis must be treated in a specialized medical institution. Treatment is carried out with special first-line tuberculostatic drugs. Therapy ends only after complete regression of infiltrative changes in the lungs; this usually requires at least nine months, or even several years. Further anti-relapse treatment with appropriate drugs can be carried out already in conditions dispensary observation. With absence long lasting effect, preservation destructive changes, the formation of foci in the lungs is sometimes possible with collapse therapy (artificial pneumothorax) or surgery.

Essential drugs

There are contraindications. Specialist consultation is required.

• (Tubazid) - anti-tuberculosis, antibacterial, bactericidal agent. Dosage regimen: the average daily dose for an adult is 0.6-0.9 g, it is the main anti-tuberculosis drug. The drug is produced in the form of tablets, powder for the preparation of sterile solutions and a ready-made 10% solution in ampoules. Isoniazid is used throughout the entire period of treatment. If the drug is intolerant, ftivazid is prescribed, a chemotherapy drug from the same group.
• (semi-synthetic antibiotic wide range actions). Dosage regimen: taken orally, on an empty stomach, 30 minutes before meals. The daily dose for an adult is 600 mg. For the treatment of tuberculosis, it is combined with one anti-tuberculosis drug (isoniazid, pyrazinamide, ethambutol, streptomycin).
• (broad-spectrum antibiotic used in the treatment of tuberculosis). Dosage regimen: the drug is used in a daily dose of 1 ml at the beginning of treatment for 2-3 months. and more daily or 2 times a week intramuscularly or in the form of aerosols. In the treatment of tuberculosis, the daily dose is administered in 1 dose, with poor tolerance- in 2 doses, duration of treatment - 3 months. and more. Intratracheally, adults - 0.5-1 g 2-3 times a week.
• (antituberculous bacteriostatic antibiotic). Dosage regimen: taken orally, 1 time per day (after breakfast). It is prescribed in a daily dose of 25 mg per 1 kg of body weight. It is used orally daily or 2 times a week in the second stage of treatment.
• Ethionamide (synthetic anti-tuberculosis drug). Dosage regimen: prescribed orally 30 minutes after meals, 0.25 g 3 times a day, if the drug is well tolerated and body weight is more than 60 kg - 0.25 g 4 times a day. The drug is used daily.

What to do if you suspect a disease

• 1. Blood test for tumor markers or PCR diagnosis of infections
• 4. Analysis for CEA or General blood test

• Blood test for tumor markers

  In tuberculosis, the concentration of CEA is within 10 ng/ml.

• PCR diagnostics of infections

  Positive result of PCR diagnostics for the presence of the causative agent of tuberculosis with to a large extent accurately indicates the presence of this infection.

• Blood chemistry

  In tuberculosis, increased levels of C-reactive protein may occur.

• Biochemical examination of urine

  Tuberculosis is characterized by a decrease in the concentration of phosphorus in the urine.

• CEA analysis

  In tuberculosis, the level of CEA (carcinoembryonic antigen) is increased (70%).

• General blood analysis

  In tuberculosis, the number of platelets (Plt) is increased (thrombocytosis), relative lymphocytosis (Lymph) (more than 35%), monocytosis (Mono) is more than 0.8 × 109 /l.

• Fluorography

  Location of focal shadows (foci) in the image (shadows up to 1 cm in size) in upper divisions lungs, the presence of calcifications (shadows round shape, comparable in density to bone tissue) is typical for tuberculosis. 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. Signs of fibrosis and pleuroapical layers in the image may indicate previous tuberculosis.

• General sputum analysis

  At tuberculosis process in the lung, accompanied by tissue disintegration, especially in the presence of a cavity communicating with the bronchus, a lot of sputum can be released. Bloody sputum, consisting of almost pure blood, is most often observed with pulmonary tuberculosis. In case of pulmonary tuberculosis with cheesy disintegration, sputum is rusty or Brown. Fibrinous clots consisting of mucus and fibrin may be detected in the sputum; rice-shaped bodies (lentils, Koch lenses); eosinophils; elastic fibers; Kurschmann spirals. An increase in the content of lymphocytes in sputum is possible with pulmonary tuberculosis. Determination of protein in sputum can be helpful in the differential diagnosis between chronic bronchitis and tuberculosis: when chronic bronchitis traces of protein are detected in the sputum, while with pulmonary tuberculosis the protein content in the sputum is higher, and it can be quantified (up to 100-120 g/l).

• Rheumatoid factor test

  The rheumatoid factor level is higher than normal.

Publication date: 11-11-2012

At subacute form disseminated tuberculosis in the lungs there are predominantly tubercles in which the exudative phase of inflammation prevails. In these tubercles one can find lymphoid, epithelioid and Pirogov-Langhans giant cells. The tubercles can merge with each other, forming large acinar-dose foci, in which necrosis often occurs with the formation of stamped cavities.

In the chronic form, the proliferative-productive phase of inflammation predominates. The lesions are polymorphic: they have different sizes, their number varies and they are located asymmetrically; There are exudative, productive, alterative-necrotic foci, foci of encysted caseosis (such as small tuberculomas), dense foci and scars.

By clinical manifestations differentiate between acute, acute, subacute and chronic form disseminated pulmonary tuberculosis.

The most acute form of disseminated pulmonary tuberculosis - Landusi's typhobacillosis type - is observed in children and adolescents during the period of primary tuberculosis. Occurs with symptoms of pronounced intoxication: adynamia, general weakness, loss of appetite, severe headaches, temperature up to 39-40°, often hectic in nature, chills, night sweats, cyanosis, dry cough, shortness of breath (the number of respirations reaches 30-40 per minute); tachycardia, pulse up to 100-120 beats per minute. When examining changes in the lungs and heart, no changes were noted. The abdomen is soft, usually painless on palpation. The liver and spleen are enlarged (hepato-lien syndrome). From the blood side, leukopenia with a shift to the left, eosinopenia, lymphopenia, monocytosis. The albumin-globulin ratio was reduced to 0.7-0.8. ESR increased to 40 mm per hour. Mycobacteria are usually not found in sputum. Urine in most patients is without pathology.

If you feel heart ailments, and we are not talking about metaphors and sublime feelings, then we advise you to take your own health seriously. We recommend that you immediately consult a doctor who, after your detailed conversation, will send you for an ultrasound scan. You can find out the cost of heart ultrasound in St. Petersburg by following the link provided. Take care of your health!

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