Dense lesions in the lungs causes. Our forums about drug addiction

I.E. Tyurin

Focal formations in the lungs represent an independent radiological and clinical syndrome; in most cases they are asymptomatic and are detected during preventive X-ray examinations.

Single lesion in the lungs (SLP) defined as a local area of ​​compaction lung tissue round or close to it in shape with a diameter of up to 3 cm. This international definition differs from the traditional domestic idea of ​​​​pulmonary lesions, the source of which is TB practice(in the classification of pulmonary tuberculosis, the size of lesions does not exceed 1 cm, and compactions bigger size are defined as infiltrates, tuberculomas and other types of changes).

The maximum size of a single lesion, equal to 3 cm, corresponds to the currently accepted staging scheme for non-small cell disease. lung cancer, in which lesions of this size are classified as stage T1 tumor growth. Foci in the lung tissue can be single (from 2 to 6 inclusive) or multiple. The latter refer to radiological dissemination syndrome and are usually considered in the context differential diagnosis interstitial (diffuse parenchymal) lung diseases.

Single lesions occupy intermediate position, and their estimate is to a large extent determined by the specific clinical situation (for example, screening for lung cancer, a history of a malignant tumor of an extrathoracic location, etc.). The presence of a single lesion is one of the main criteria for AOL syndrome.

Proper characterization of OIL remains important clinical problem in thoracic radiology and respiratory medicine in general. It is known that 60-80% of resected AOLs are malignant tumor. Among all AOLs detected during X-ray examination, the frequency of tumors is much lower (usually it does not exceed 50%), however, even in this case, a correct assessment of changes in the lungs requires great importance for the patient.

The main task X-ray examination with AOL is a non-invasive differential diagnosis of malignant and benign processes, as well as identifying forms of pulmonary tuberculosis among them. In some cases this is possible based on characteristic features detected by radiography or routine computed tomography(CT).

However, the specificity of most of these symptoms is low, so additional methods and alternative technologies are necessary to correctly assess AML. These include assessment of the growth rate of a lesion in the lung, analysis of probabilistic factors of malignancy, dynamics of accumulation contrast agent with CT and 18-fluorodeoxyglucose (18-FDG) with positron emission tomography (PET), as well as a morphological study of the material obtained with transthoracic needle aspiration biopsy or videothoracoscopy.

It is obvious that in everyday life clinical practice It is unlikely that there can be a single algorithm for the differential diagnosis of AOL for all patients and for all clinical situations, and the task of any clinical recommendations is an accurate assessment of the opportunities provided by individual diagnostic methods and their combinations.

Detection of single lesions in the lungs. Until now, the method of primary detection of foci in the lung tissue remains the usual X-ray examination - radiography or fluorography. Single lesions are found in 0.2-1.0% of all X-ray studies chest. On plain radiographs or fluorograms, it is rarely possible to identify a single lesion the size of<1 см.

Even larger lesions may be missed due to interposition of anatomical structures (heart shadow, roots of the lungs, ribs, etc.) or the presence of so-called distracting factors, such as developmental anomalies or cardiac pathology. More than 90% of all AOLs visible on radiographs can be detected retrospectively on previous images 1 or even 2 years ago.

CT scan is becoming increasingly important in the diagnosis of pulmonary lesions, which can be performed both when the presence of acute pulmonary disease is suspected based on radiography, and for other indications (to exclude pneumonia, when examining patients with chronic obstructive pulmonary disease and emphysema, etc.). In general, CT can detect 2-4 times more lesions in the lung tissue than radiography, while the average size of detected lesions is 2 times smaller.

However, CT is also not an absolute diagnostic method. The results of lung cancer screening using low-dose CT show that the main reasons for missing pathology are small lesion sizes (the sensitivity of CT in detecting lesions the size<5 мм равна 72%), низкая плотность очагов по типу “матового стекла” (чувствительность 65%) и их локализация в центральных зонах легкого (чувствительность 61%). В среднем частота пропусков патологии при первичном КТ-скрининге может достигать 50%. В выявлении ООЛ размером >1 cm CT sensitivity is usually above 95%.

A number of special techniques contribute to increasing the accuracy of CT in identifying small lesions in lung tissue - programs for computer-aided diagnosis (CAD) and three-dimensional reformation programs, such as maximum intensity projections (MIP) and volume rendering (volume rendering technique (VRT).

Anatomical assessment of single lesions in the lungs X. Assessing the skialological features of the AOL according to radiography or CT is of great importance for differential diagnosis. The lesions can be divided by size, nature of the contours, structure, density, and condition of the surrounding lung tissue. Almost all signs have a probabilistic meaning, being more or less characteristic of a benign or malignant process.

Only in exceptional cases can a nosological diagnosis be assumed on the basis of radiation examination data. Thus, the presence of fatty inclusions is typical for hamartoma, ring-shaped or total calcification of the lesion is usually observed in tuberculomas, the presence of afferent and efferent vessels, along with typical contrast enhancement, distinguishes arteriovenous malformations.

The localization of the lesion in the lung tissue is not of fundamental importance, since exceptions and coincidences are observed here too often. More than 70% of lung cancer lesions are located in the upper lobes of the lungs, more often in the right lung than in the left. This localization is typical for most tuberculous infiltrates. Lower lobe localization is typical for lung cancer arising against the background of idiopathic pulmonary fibrosis. Tuberculous infiltrates located in the lower lobes are more often localized in their apical segments.

Lesions in the lung tissue can have different contours: smooth or uneven (wavy, bumpy), clear or unclear (radiant or blurred due to the “ground glass” zone along the periphery). In general, fuzzy and uneven contours are more characteristic of malignant neoplasms, although they can also be observed with inflammatory infiltrates. In one study, based on high-resolution CT (HRCT) data, all lesions with a low-density rim, 97% of lesions with pronounced radiant contours, 93% of lesions with uneven contours, and 82% with wavy contours were malignant.

With lesion sizes >1 cm, such contours serve as a strong argument in favor of a malignant process and, therefore, an indication for morphological verification. Clear, even contours can be observed when benign diseases, but are also constantly observed in single metastases, certain histological forms of lung cancer (squamous cell, small cell) and pulmonary carcinoids.

In one study, among lesions that had clear wavy contours, the incidence of malignant tumors reached 40%. That's why round shape and clear contours of the lesion in themselves are not signs of a benign process and cannot serve as a reason to complete the diagnostic process.

The density of single lesions in the lungs, determined by CT, allows us to divide all lesions into three groups:

• “frosted glass” type lesions;
• mixed or partially solid lesions;
• solid type lesions.

Foci of the “frosted glass” type are characterized by low density; against their background, the walls of the bronchi, the contours of blood vessels and elements of the altered pulmonary interstitium are visible. They are observed in non-destructive inflammatory processes, atypical adenomatous hyperplasia and well-differentiated adenocarcinomas.

The morphological basis of this phenomenon is the thickening of the interalveolar septa in a limited area while maintaining the airiness of the alveoli, which can occur due to inflammatory infiltration, fibrous changes, or partial filling of the alveoli with exudate. With the development of adenocarcinoma (including bronchioloalveolar) tumor cells located along the walls of the alveoli, long time without filling their gap. As a result, a tumor focus appears as a “ground glass” type, which in most cases is not visible on radiographs and linear tomograms.

Lesions of mixed or partially solid type are characterized by the presence of a denser area in the center and a low-density “ground glass” zone along the periphery. Such lesions usually arise around old scars in the lung tissue, including post-tuberculosis scars. In most cases, they represent the growth of a glandular tumor. Up to 34% of non-solid lesions are a malignant tumor, and among lesions of a partially solid type the size<1,5 см этот показатель достигает 50%.

Solid lesions have a typical structure of local compaction of a round shape, soft tissue density, with various contours. They can be observed in almost any pathological process in the lung tissue.

The structure of the pulmonary tract, detected by CT, can be different: homogeneous, with areas of low density caused by necrosis, with air, fat, liquid and high-density inclusions, with visible lumens of the bronchi. None of these symptoms are specific to any particular pathological process, with the exception of the already mentioned fatty inclusions in hamartomas.

With conventional radiography, it is possible to identify only part of the calcifications and air inclusions in the form of cavities, air cells (honeycombs, pores) or bronchial lumens. CT scans reveal calcifications in the primary area 2 times more often than conventional X-ray examinations. Calcifications can be focal (like “puffed corn”), layered (including in the form of calcification of the lesion capsule) and diffuse, occupying the entire volume of the lesion.

Such calcifications are typical for benign processes. The only exceptions are metastases of bone sarcomas, glandular cancer of the colon and ovaries after chemotherapy, and pulmonary carcinoids. In all other cases, the probability of a non-tumor process is extremely high. In malignant foci, including adenocarcinomas, dotted or amorphous, without clear contours, calcium inclusions are often detected.

In general, the incidence of calcification in peripheral cancer tumors according to CT data reaches 13%. Exceptions to this rule are ground-glass lesions seen on CT and lesions of any structure on x-ray that represent bronchioloalveolar carcinoma. Patients with these types of lesions require longer follow-up.

Another factor limiting the possibilities of dynamic or retrospective observation is the size of the TLC.<1 см. Удвоение объема опухолевого очага диаметром 5 мм приводит к увеличению его диаметра всего на 1,5 мм (до 6,5 мм). Оценка подобной динамики находится за пределами возможностей не только традиционной рентгенографии, но и в большинстве случаев КТ.

In this regard, today great importance is attached to computer assessment of the volume of lesions based on spiral CT data, when the computer builds three-dimensional models of identified lesions and compares their volumes. This technique, which is part of CAD systems, is designed for solid lesions and cannot be used with confidence for ground glass lesions and partially solid lesions.

Probabilistic Analysis. Clinical assessment of patients with identified AML is of great importance in differential diagnosis, although it is often underestimated by attending physicians and radiologists. Probabilistic analysis takes into account the quantitative significance of risk factors or the lack thereof to make assumptions about the nature of the AOL. Using such calculations, it is possible to determine the individual risk of a malignant tumor in a specific clinical situation. Both clinical factors and radiological symptoms are taken into account.

The most important factors in favor of a malignant process are:

• cavity wall thickness in the lesion >16 mm;
• uneven and unclear contours of the lesion on CT;
• hemoptysis;
• history of malignant tumors;
• age >70 years;
• lesion size 21-30 mm;
• doubling time of lesion volume<465 дней;
• low-intensity shadow on radiography.

The factor of long-term smoking and amorphous calcifications in the lesion, detected by CT, are also of great importance. Unfortunately, existing probabilistic analysis models do not include data from modern technologies such as dynamic CT and PET.

Characteristics of single lesions in the lungs with dynamic CT. Assessing the blood supply to the peripheral tract using dynamic spiral CT has shown its effectiveness in numerous studies. It is known that the density of the TLC during native examination varies widely and does not have any diagnostic value (except for inclusions of fat and calcium).

With dynamic CT, pathological formations that have their own vascular network actively accumulate intravenously administered contrast agent, and their density increases. A typical example of such lesions are malignant tumors. On the contrary, formations that are devoid of their own vessels or filled with avascular contents (pus, caseosis, exudate, etc.) do not change their density. Such lesions can be represented by tuberculomas, cysts, abscesses and other pathological processes.

The dynamic CT technique for AOL is of greatest importance in regions with a high incidence of tuberculosis, since it allows one to accurately distinguish between malignant tumors and tuberculomas. Dynamic CT is performed in the form of a series of tomographic slices through the pathological formation, which are performed initially, during the administration of a contrast agent and 1, 2, 3 and 4 minutes after it. The lesion density is measured in a zone of interest (ROI), which occupies at least 3/4 of the lesion cut area.

To distinguish between benign and malignant processes, it is necessary to select the so-called enhancement threshold - a numerical value of the attenuation coefficient, the excess of which suggests the presence of a malignant tumor. This threshold, determined empirically in a large multicenter study, is 15 HU. At this gain threshold, the sensitivity of dynamic CT in detecting malignant tumors reaches 98%, the specificity is 58%, and the overall accuracy is 77%.

Despite its high sensitivity for malignant tumors, the technique has a number of disadvantages. These include difficulties in assessing small (<1 см) очагов, низкую специфичность, технические ошибки, связанные с дыханием пациента и артефактами от костных структур и контрастного вещества. Эти недостатки частично компенсированы внедрением в клиническую практику многослойной КТ (МСКТ).

Most studies evaluate the accumulation, but not the clearance, of contrast from the lesions. Meanwhile, it has been shown that an increase in density by more than 25 HU and a rapid decrease in density by 5-30 HU when using MSCT is typical for malignant neoplasms. Benign lesions are characterized by an increase in density by less than 25 HU (in some cases, the density increases by more than 25 HU, but then there is a rapid decrease in density by more than 30 HU or no decrease in density at all). If we choose an enhancement threshold of 25 HU and a density reduction range of 5-30 HU, then the sensitivity, specificity and overall accuracy of the technique for malignant tumors will be 81-94, 90-93 and 85-92%, respectively.

Metabolic characteristics of single lesions in the lungs with PET. All anatomical imaging modalities, including X-ray, ultrasound, CT, and magnetic resonance imaging, focus on macroscopic features of pulmonary lesions, most of which are not specific enough. In recent years, studies of the metabolic characteristics of the lesion using 18-FDG PET have become increasingly widespread. Malignant tumors are characterized by higher metabolic activity, which is characterized by rapid and significant accumulation of 18-FDG in the lesion and its long-term persistence.

Numerous studies have shown that PET is characterized by high sensitivity (88-96%) and specificity (70-90%) for malignant lesions in the lungs. Even better results are obtained with the combined use of PET and CT scanners - PET/CT studies with subsequent combination of the metabolic and anatomical picture. False-positive PET results are observed in active inflammatory processes, including active pulmonary tuberculosis.

A negative PET result is considered extremely important for excluding the malignant nature of the tumor, however, false-negative conclusions can be observed in primary lung tumors of the “ground glass” type and lesions of<7 мм. Поэтому данные ПЭТ должны обязательно сопоставляться с результатами КТ для более точного понимания их клинического значения. В целом в настоящее время ПЭТ является наиболее точным методом для разграничения доброкачественных и злокачественных очагов в легочной ткани размером >1 cm.

Biopsy. For lesions that have anatomical or metabolic features of malignancy, morphological verification is necessary before any treatment is initiated. This rule is mandatory, since the tactics of examination and treatment for primary non-small cell, small cell and metastatic tumors in the lung can be completely different.

There are several methods for collecting material from a pulmonary lesion, including transthoracic needle aspiration and biopsy, transbronchial biopsy, video-assisted thoracoscopic resection of the lesion followed by biopsy, and open biopsy during minithoracotomy. Transthoracic biopsy is performed under the guidance of fluoroscopy, CT, and, in recent years, increasingly under CT fluoroscopy. Transbronchial biopsy is usually performed under fluoroscopic guidance. Puncture of lesions adjacent to the chest wall can be performed using ultrasound guidance.

Transthoracic fine-needle aspiration biopsy of pulmonary lesions, performed with CT and CT fluoroscopic guidance, has a sensitivity of 86% and a specificity of 98% for malignancy, but its sensitivity for lesions<7 мм в диаметре составляет лишь 50%. Все пункционные методы биопсии отличаются низкой чувствительностью при лимфомах с поражением легочной ткани (12%) и доброкачественных образованиях (до 40%).

In these cases, preference should be given to core needle biopsy, the sensitivity of which in these categories reaches 62 and 69%, respectively. Complications with transthoracic biopsy (mainly pneumothorax and intrapleural bleeding) occur in approximately 25% of patients. After a biopsy, no more than 7% of patients require drainage, so this procedure can be performed on an outpatient basis. Contraindications to a biopsy include severe respiratory and heart failure, severe pulmonary emphysema, and location of the lesion in close proximity to the diaphragm or pericardium.

Transbronchial biopsy can be performed when the lesion is localized in the hilar regions, especially in cases of so-called “centralization” of the malignant tumor. In this case, the endobronchial component can be detected during bronchological examination. Another verification option is a brush biopsy, in which material is taken from the inner surface of the bronchus located next to the lesion or inside it. To carry out such a procedure, a preliminary assessment of the lesion and the adjacent bronchi using HRCT is mandatory.

Diagnostic algorithms for single lesions in the lungs. Currently, there is no unified approach to determining the nature of OOL. Obviously, in patients with a high risk of malignant tumor, the optimal approach is the earliest possible morphological verification of the diagnosis with transthoracic biopsy. In patients with a low risk of malignancy, it is more rational to carry out dynamic observation.

In any case, the modern approach requires performing HRCT when AOL is detected by radiography, fluorography or conventional CT. Another mandatory step is to find and study any previous lung scans.

The result of these actions may be the identification of a group of patients with an apparently benign process, as evidenced by: the absence of lesion dynamics for > 2 years, the presence of “benign” calcifications, inclusions of fat (hamartoma) or fluid (cyst) in the lesion according to CT data For these patients only observation is necessary. This also includes cases of arteriovenous malformations and other vascular changes, as well as inflammatory processes in the lungs (round tuberculous infiltrate, tuberculoma, mycetoma, etc.), requiring specific treatment.

The second possible result is the detection of signs of a malignant process (a lesion >1 cm with radiant uneven contours, ground-glass lesions and mixed solid type lesions, which should be regarded as potentially malignant), for which morphological verification is necessary in a specialized medical institution.

All other cases are considered intermediate or indeterminate. The largest group among them consists of patients with newly diagnosed ACLs (in the absence of an X-ray archive) measuring >10 mm, soft tissue density, with relatively clear smooth or wavy contours, without any inclusions according to CT data. Clarification of the nature of AOL in such patients can be carried out using biopsy, dynamic CT, PET and PET/CT. Waiting tactics and dynamic observation are permissible here only in exceptional cases, justified by clinical expediency.

A separate group consists of patients with non-calcified lesions identified by CT scanning.<10 мм. Обычно их обнаруживают при КТ, проведенной для исключения пневмонии или уточнения характера эмфиземы, при трудностях интерпретации рентгеновских снимков и т.д. Такие очаги обычно не видны при обычном рентгенологическом исследовании, их верификация с помощью трансторакальной биопсии малоэффективна, а использование ПЭТ сопряжено с большим количеством ложноотрицательных результатов.

In addition, the likelihood of a malignant process with lesions with a diameter of<5 мм не превышает 2%. В связи с этим принята следующая тактика. Очаги размером <5 мм не требуют никакого динамического наблюдения, таким пациентам может быть рекомендовано обычное профилактическое обследование (флюорография или КТ) через 1 год. Очаги размером 5-10 мм требуют проведения контрольной КТ через 3, 6, 12 и 24 мес. При отсутствии динамики наблюдение прекращается, а любые изменения формы, размеров или количества очагов служат показанием для биопсии.

Thus, differential diagnosis when identifying a single lesion in the lungs is a complex clinical task, which in modern conditions is solved using various methods of radiation and instrumental diagnostics.

A single lesion in the lungs is a localized area of ​​increased density, which has a round or oval shape and reaches 30 millimeters in diameter. The reasons for the occurrence of such seals can be different, and to determine them, an examination by a doctor and an x-ray are not enough. In order to make an accurate, reliable diagnosis, a number of important studies will have to be carried out (biochemical analysis of blood, sputum, as well as puncture of lung tissue).

There is a widespread belief that the factor provoking the occurrence of lesions in the lungs is exclusively tuberculosis, but this is not true.

Most often, lesions in the lung tissue are a symptom of the following conditions:

• malignant neoplasms;
• impaired fluid exchange in the respiratory system;
• prolonged pneumonia.

That is why, when making a diagnosis, it is necessary to use the results of laboratory tests of blood and sputum. Even if the doctor is sure that the patient is suffering from focal pneumonia, the test results will help identify the causative agent of the disease and eliminate it using an individually selected treatment regimen.

Sometimes people are in no hurry to undergo diagnostic tests due to the distance of the laboratory from their place of residence. It is extremely undesirable to neglect laboratory tests, since without treatment the lesion in the lungs begins to be secondary.

Features of lesions from an anatomical point of view

Anatomically, single pulmonary lesions are altered areas of lung tissue or the pathological presence of fluid (blood or sputum) in it.

It should be noted that the criteria in the international and domestic classification of pulmonary lesions differ. Foreign medicine recognizes formations reaching 3 centimeters in size as single lesions in the lungs. In the Russian Federation, lesions in the lung tissue are diagnosed if they do not exceed 10 millimeters in diameter. Anything that is large in size refers to infiltrates or tuberculomas.

The problem of reliable diagnosis and classification of lesions in the lungs is one of the most important in medicine.

According to statistical data, from 60 to 70 percent of single lesions in the lung tissue that reappear after treatment are malignant. That is why great attention is paid to the development of new diagnostic methods in this area.

Today the following diagnostic procedures are widely used:

1. Computer examination, including tomography, which allows you to determine the size of lesions in the lungs with great accuracy.
2. Radiography.
3. Magnetic resonance imaging.
4. Laboratory examination of blood and sputum, as well as lung tissue.

Despite the reliability of the results of these studies, there is still no uniform algorithm for making a diagnosis when lesions are detected in the lung tissues. Each case of the disease is individual and must be considered separately from general practice.

Single lesions in the lungs: possibilities of radiodiagnosis

Correct diagnosis and making the correct diagnosis is very important when single lesions are detected in the lungs. Radiation diagnostics in these cases provides assistance that is difficult to overestimate.

The main tasks of radiological diagnosis of lesions in the lungs:

1. Using these methods, it is possible to identify the nature of the origin of lesions in the lungs and determine whether they are malignant or benign.
2. Radiation diagnostics allows you to reliably determine the form of tuberculosis when it is detected.

However, using radiography and fluorography, it is extremely difficult to see single formations whose diameter is less than 1 cm. In addition, due to the different structures that are anatomically located in the sternum, it is sometimes impossible to distinguish large-scale lesions in the lungs. Therefore, when diagnosing, greater preference is given to computed tomography. It makes it possible to examine the lung tissue from different angles and even in cross-section. This eliminates the possibility that single formations will be indistinguishable behind the heart muscle, ribs or root of the lung.

Computed tomography is a unique diagnostic method that can detect not only lesions, but also pneumonia, emphysema and other pathological conditions of the lungs. But it must be remembered that even this diagnostic method has its drawbacks. Thus, in approximately 50% of cases of primary examination, neoplasms with a diameter of less than 5 millimeters are not detected in the photo. This is explained by such difficulties as the location of lesions in the center of the lung, the small size of the formations or their too low density.

If the formation exceeds 1 centimeter in diameter, then the diagnostic accuracy of computed tomography reaches 95 percent.

Tuberculosis in figures and facts

Tuberculosis remains a very common disease, despite the fact that huge amounts of money are allocated annually to combat it and large-scale research is carried out.

The most interesting facts about tuberculosis:

1. The causative agent of the disease is Koch's bacillus or mycobacterium, which is quickly transmitted by coughing or sneezing, that is, by airborne droplets.
2. One patient with tuberculosis releases from 0 to 000 mycobacteria into the air with sputum. They spread within a radius of 1-7 meters.
3. Koch's bacillus can survive even at subzero temperatures (up to -269 degrees Celsius). When dried in the external environment, the mycobacterium remains viable for up to four months. In dairy products, the rod lives up to one year, and in books - six months.
4. Mycobacterium adapts very quickly to antibiotics. In almost every state, a type of tuberculin bacillus has been identified that is not sensitive to existing medications.
5. 1/3 of the world's population are carriers of the tuberculosis bacillus, but only 10 percent of them have suffered an active form of the disease.

It is important to remember that having had tuberculosis once, a person does not acquire lifelong immunity and can contract the disease again.

Are medical masks useful?

Scientists from Australia have conducted a number of scientific studies and have reliably established that medical masks practically do not protect against viruses and bacteria that are transmitted by airborne droplets. Moreover, they absolutely cannot be used in conditions where the risk of infection is high (constant work in the intensive care unit, tuberculosis).

In developed countries, hospital staff use special respirators that effectively trap air particles containing viruses and bacteria.

Single lesions in the lungs on CT: subpleural segments, OGK

Using computed tomography, lesions in the lungs are classified. It can also be used to identify whether a single or multiple lesion has affected the lung, and also to suggest the most adequate treatment. This diagnostic procedure is one of the most reliable today. Its principle is that the tissues of the human body are exposed to X-rays, and then a conclusion is given based on this study.

If there is a suspicion of any lung disease, the doctor will refer the patient to a CT scan of the chest organs. All segments of this part of the body are clearly visible on it.

Depending on their location, outbreaks are divided into two categories:

1. Subpleural lesions in the lungs, located under the pleura - the thin membrane that encloses the lungs. This localization is characteristic of the manifestation of tuberculosis or malignant tumors.
2. Pleural lesions.

Using computed tomography, the apical lesion in any segment of the lung is clearly visible. This type of lesion represents the proliferation of fibrous tissue and the replacement of healthy cells with it. The perivascular fibrous lesion is located near the blood vessels that provide its nutrition and growth.

Lesions in the lungs on CT: classification of formations

For an accurate diagnosis, it is very important to study lesions in the lungs using CT. Classification of formations allows us to understand how they should be treated.

Depending on the size of the formations in the lungs they are divided into:

• small (from 0.1 to 0.2 cm);
• medium size (0.3-0.5 cm);
• large lesions (up to 1 centimeter).

Based on density:

• not dense;
• medium-dense;
• dense.

By number:

• polymorphic lesions in the lungs - multiple formations having different densities and different sizes. Polymorphism of foci is characteristic of tuberculosis or pneumonia;
• single outbreaks.

If the lesions are located in the pleura, then they are called pleural; the subpleural lesion is located near it.

Thus, the answer to the question of focal lung damage and what it is has been received. It must be remembered that in order to exclude any diseases in the lungs, such a simple procedure as annual fluorography should not be neglected. It takes just a few minutes and is capable of identifying any pathologies in the lungs in the early stages.

Lesions in the lungs

A CT scan was done again - without contrast - on 04/10/2017.

The results - compared to the first - are without dynamics.

At the border of S2,3, in S4 of the right lung, in S3,4 of the left subprevulsion and in the lateral sections along the vessel, foci of the same size remain.

Subprevular in S8 lion. Lung - single focus up to 0.6 cm. For the rest of the length - not detected. Everything is the same as 1 result.

The conclusion given was signs of bronchitis. The lesions are probably inflammatory in nature.

According to the latest blood tests - excess alkaline phosphatase - 342UL, a-amylase - 282.2. creatinine and urea are normal. Well, ESR - over the last year - jumps from 17 to 27. Now - 17. They wanted to be hospitalized. To treat the pancreas and general condition. But because of these lesions, they are referred to a phthisiatrician. They scared me. Now even antidepressants don't help me. Maybe you can give me some advice and express your opinion about such hotbeds. Yes. no cough. I can’t even imagine how to give sputum - since there is none) Thank you in advance for your answer. With uv. Tatiana.

Also, don’t forget to thank your doctors.

pulmonologist3 22:56

pulmonologist3 23:01

Thank you again for your understanding and useful advice.

pulmonologist6 16:33

I have already been admitted to the hospital. You were right about depression - they sent me to go to the gastro, and the head of the reception wanted to immediately put me in the department of borderline conditions. In general, we’re still on the road. But I consulted a good psychiatrist. I also added one more medicine. In general, we treat both.

I will hope that I will make it through.

I wish you health too and thank you for your understanding and advice!

Why do lung lesions occur and why are they dangerous?

Focal formations in the lungs are tissue compaction caused by various diseases. They are usually detected by X-ray examination. Sometimes an examination by a specialist and diagnostic methods are not enough to make an accurate conclusion. For final confirmation, it is necessary to carry out special examination methods: blood tests, sputum tests, tissue puncture. This happens with malignant tumors, pneumonia and impaired fluid exchange in the respiratory system.

What are lung lesions?

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 more likely to determine 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.

Oncological factors

Up to 70% of single lesions in the lungs are 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.

Free legal advice:

The imperfection of the equipment does not allow a clear diagnosis of the disease using the hardware method. When taking an X-ray of the lungs, it is difficult to detect focal changes, the size of which does not reach 1 cm. 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.

Causes of focal formations in the lungs

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

• oncological diseases, the consequences of their development (metastases, neoplasms themselves, etc.);
• focal tuberculosis;
• pneumonia;
• swelling 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 a 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. This is a way to study the human body, allowing us to identify various changes and pathologies in the patient’s internal organs. It is one of the most modern and accurate diagnostic methods. The essence of the method is the influence of X-rays on the patient’s body, and then, after passing through it, computer analysis.

With its help you can install:

• in the shortest possible time and with particular accuracy, 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.

Disadvantages of tomography

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 its 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 the lesions on the lungs is not given decisive importance. Particular attention is paid to their contours. If they are uneven and unclear, 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 of benign neoplasms or tuberculosis.

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

Another nuance of computed tomography is the determination of the substance collecting in the lungs. Only fat deposits make it possible to determine pathological processes, and the rest cannot be classified as specific symptoms.

Types of focal formations

After obtaining CT images of the lungs, in which the compactions are visible, they are classified. Modern medicine distinguishes the following types of them, 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:

Classification by quantity:

Single seals. They may be a factor in a serious pathology (malignant tumor) or refer to normal age-related changes that do not pose a threat to the patient’s life.

Multiple seals. They are mainly characteristic of pneumonia and tuberculosis, but sometimes numerous and quite rarely diagnosed cancers are also caused by the development of a large number of compactions.

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

Modern medicine has several methods for diagnosing tuberculosis and other lung diseases. Computed tomography is widely used to identify 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 characteristic of 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.

Related video: Focal formations in the lungs

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What are lesions in the lungs

A lesion is usually called a radiologically identified small round, polygonal or irregularly shaped formation in the lung tissue up to 1-1.5 cm in size.

Limited dissemination is numerous foci scattered in the pulmonary field over a limited extent (no more than two intercostal spaces).

The dispersion of multiple foci throughout one or more often both lungs gives the syndrome of diffuse dissemination.

Diseases causing focal shadow syndrome

1. Concussion and contusion of the chest, inhalation of hot fumes and toxic gases, aspiration of food masses, water (drowning), blood (during pulmonary hemorrhages), exposure to ionizing radiation
2. Disturbances of blood circulation and fluid exchange in the lungs: heart attack, pulmonary embolism, pulmonary edema
3. Inflammation: acute focal pneumonia, focal tuberculosis
4. Allergic lesions: infiltration and swelling of an allergic nature
5. Tumor lesions: primary malignant tumor, metastases of malignant tumors, benign tumor, infiltration in diseases of the blood and lymphatic system (reticulosis, lymphogranulomatosis, etc.)
6. Diffuse connective tissue diseases

In practice, however, most lesions are caused by inflammatory changes (acute pneumonia, focal pulmonary tuberculosis), less often by peripheral cancer or small metastasis to the lungs of a malignant tumor, an abnormality of the blood vessels of the lung.

The most common and important disease that is accompanied by limited dissemination syndrome is tuberculosis.

Lesions in the lungs

Lesions in the lungs often attack the respiratory organs, since many of their diseases cause the appearance of cavities similar in appearance and purpose to the lesions. Such formation in the respiratory organs is dangerous to health, especially if the patient does not intend to treat the pathology. The causes of the formation of lesions are various ailments that greatly impair the functioning of organs. In most cases, when diagnosing a disease that causes lumps or cavities, it will not be enough for the doctor to examine the patient and take an x-ray. In this case, the patient will have to donate blood for analysis, sputum and puncture of the lung tissue in order to accurately make a diagnosis.

What diseases can cause a single or multiple dense lesion

Lesions in the lungs - what could it be? The opinion that a single or multiple lesion causes only pulmonary tuberculosis is considered erroneous. Many diseases of the respiratory organs can lead to the development of lesions, so you should pay special attention to them when making a diagnosis.

If the doctor notices a formation in the lung cavity (tomography can reveal this), he suspects the following diseases in the patient:

• violation of fluid metabolism in the respiratory organs;
• neoplasms in the lungs, which are not only benign, but also malignant;
• pneumonia;
• cancer in which large-scale organ damage occurs.

Therefore, in order to correctly diagnose a sick person, you need to examine him. Even if the doctor implies that the inflammation was caused by pneumonia, before prescribing a therapeutic course, he needs to conduct a sputum analysis in order to be absolutely sure of the correctness of the diagnosis.

Currently, indurated, calcified and centrilobular lesions in the lungs are often diagnosed in humans. However, their course is too complicated due to the fact that few patients agree to undergo a number of specific tests, on which their health and general condition of the body directly depend.

The genesis of pulmonary lesions is not always favorable for a person; this indicates serious disturbances in the functioning of the respiratory system. Based on the type (it can be dense or liquid), it becomes clear what kind of damage the disease will cause to human health.

How to identify and what these neoplasms are

Focal lung damage - what is it? This pathology is a serious disease, during the development of which compactions begin to appear in the lung tissue, resembling lesions in appearance.

Depending on their number, such neoplasms have different names:

1. If only one lesion was noticeable in a patient after tomography, it is called solitary.
2. If several neoplasms were identified in a patient after diagnostic procedures, they are called single. Most often, there are no more than 6 such seals in the cavity.
3. If a large number of formations of different shapes are found in the lungs, they are called multiple. Doctors call this condition of the body dissemination syndrome.

Today there is a slight difference in the concept of defining what pulmonary lesions that develop in the cavity of the respiratory organs are. This difference is formed in the opinions of scientists from our country and foreign researchers. Doctors abroad believe that a single or secondary lesion noticed in the respiratory organs is a small round lump. At the same time, the diameter of the neoplasm does not exceed 3 cm. In our country, lumps larger than 1 cm are no longer considered foci - they are tuberculomas or infiltration.

It is important to note that examining the affected lung on a computer, called tomography, helps to accurately identify the type, size and shape of tumors that have appeared in the lung tissue. However, we should not forget that this method often has failures.

A lesion in the lungs, what could it be? As mentioned earlier, various diseases can cause the appearance of a lesion. Why do they need to be treated immediately after detection? The fact is that diseases often repeatedly attack the human respiratory organs. In 70% of cases, the secondary disease is considered malignant, which means that incorrect treatment tactics cause the development of cancer.

Therefore, in order to avoid serious health problems, the patient will need to undergo some diagnostic procedures, namely:

It is especially important for the patient to undergo a CT scan, because it will be able to identify the danger of foci, which may be the formation of cancer or a complex form of tuberculosis. However, in order to accurately identify the type of disease that caused the appearance of lesions in the respiratory organs, you will need to undergo additional types of examinations, since hardware methods alone are often not enough. Nowadays, not a single clinic or hospital has a single algorithm of actions according to which diagnostics are carried out.

The classification of lesions in the lungs on CT allows one to understand their type and cause of occurrence, so this procedure must be undergone by the patient. But the rest of the methods are prescribed by the doctor after a complete examination of the patient and familiarization with his medical record.

Why do doctors not always manage to make the correct diagnosis of a patient? To identify the course of tuberculosis, pneumonia or another disease, the desire of doctors alone is not enough. Even if all the tests are carried out and correctly interpreted, imperfect equipment will not allow identifying some foci of the disease. For example, during a trip to x-ray or fluorography, it is impossible to identify lesions whose diameter is less than 1 cm. It is also not always possible to correctly examine large lesions, which aggravates the diagnosis of pathology.

Unlike the above procedures, tomography is able to correctly determine the location and type of lesions, as well as identify the disease that initiated the development of the disease. For example, this is pneumonia, emphysema, or simply an accumulation of fluid in a person’s lungs.

Features of the disease

In modern medicine, there is a specific gradation of lung lesions that differ in shape, density, and damage to nearby tissues.

It is important to note that an accurate diagnosis using a single computer procedure is unlikely, although such cases have been seen in the modern world. This often depends on the anatomical features of the body.

After going through all the diagnostic procedures prescribed by the doctor, in order to understand what a subpleural lesion of the lung is – what it is, you first need to figure out what the classification of pulmonary lesions is. After all, the accuracy of diagnostic measures depends on it.

For example, often with pulmonary tuberculosis, the seals are located in the upper parts; during the development of pneumonia, the disease uniformly affects the respiratory organs, and during the course of cancer, the foci are localized in the lower parts of the lobe. Also, the classification of pulmonary neoplasms depends on the size and shape of the compactions, which are different for each type of disease.

Having discovered one or another symptom of pulmonary diseases, you must consult a doctor who will prescribe a series of tests and then prescribe the correct treatment that can benefit the patient’s body.

Signs of development of compaction in the lungs include:

• difficulty breathing;
• accumulation of fluid in the lungs, which causes a wet cough or wheezing when speaking;
• frequent sputum discharge;
• the appearance of shortness of breath;
• coughing up blood;
• inability to breathe deeply;
• chest pain after physical labor.

WHAT IS A LOCALITY IN LUNG TISSUE?

A pulmonary focus is a limited area of ​​decreased transparency of the lung tissue (darkening, compaction) of small size, detected using X-ray or computed tomography (CT) of the lungs, not combined with pathology of the lymph nodes or collapse of part of the lung - atelectasis. According to Western terminology, the term "node" or "focus" about means a darkening of less than 3 cm in size; if the diameter of the area is more than 3 cm, the term “mass formation” is used. The Russian school of radiology traditionally calls a “focus” an area with a diameter of up to 10-12 mm.

If radiography or computed tomography (CT) reveals one similar area, we are talking about a single (or solitary) lesion; if several areas are detected, single foci are reported. With multiple foci that involve, to one degree or another, the entire lung tissue, we speak of dissemination of the foci.

This article will discuss single lesions, their radiological manifestations, and medical actions when they are detected. There are a number of diseases of a very different nature that can appear as a lesion on radiographs or computed tomograms.

Single or single lesions in the lungs are most often found in the following diseases:

1. such as lymphoma or
2. Benign tumors - hamartoma, chondroma
3. Pulmonary cysts
4. Tuberculosis, in particular the focus of Gon or
5. Fungal infections
6. Inflammatory non-infectious processes such as rheumatoid arthritis or Wegener's granulomatosis
7. Arteriovenous malformations
8. Intrapulmonary lymph nodes

Detection of a single nodule on a chest x-ray poses a difficult task that many doctors face: the differential diagnostic range for such changes can be long, but the main task is to determine whether the nature of the lesion is benign or malignant. Resolving this issue is key in determining further treatment and examination tactics. In controversial and unclear cases, to accurately determine the benignity or malignancy of a focal formation, a second opinion is recommended - a review of a CT scan or X-ray of the lungs in a specialized institution by an experienced specialist.

METHODS FOR DIAGNOSTICS OF FOCI IN THE LUNG

The primary method of examination is usually chest x-ray. With it, most solitary pulmonary lesions are discovered by chance. Some studies have examined the use of low-dose chest CT as a lung cancer screening tool; Thus, the use of CT leads to the detection of smaller nodes that need to be assessed. As availability increases, PET and SPECT will also play an important role in the diagnosis of solitary pulmonary lesions.

The criteria for the benignity of the identified lesion are the patient's age less than 35 years, the absence of other risk factors, the stability of the node for more than 2 years according to radiography, or external signs of benignity detected on radiographs. These patients are less likely to be malignant and require periodic chest x-rays or CT scans every 3 to 4 months during the first year, and every 4 to 6 months during the second year.

LIMITATIONS AND ERRORS OF DIAGNOSTIC METHODS

Chest radiography has better resolution than CT in determining the severity of calcification and its size. At the same time, visualization of some pulmonary nodules may be complicated due to the overlap of other organs and tissues.

The use of CT is limited by the high cost of this study and the need for intravenous contrast, and the risk of adverse reactions after its administration. CT is not as accessible a research method as radiography; In addition, a CT scanner, unlike X-ray machines, cannot be portable. PET and SPECT are much more expensive compared to CT and MRI, and the availability of these diagnostic methods varies.

RADIOGRAPHY

Often, solitary pulmonary nodules are first detected on chest radiographs and are an incidental finding. The first question that needs to be answered is whether the detected lesion is located in the lung or outside it. In order to clarify the localization of changes, radiography in the lateral projection, fluoroscopy, and CT are performed. Typically, the nodes become visible on radiographs when they reach a size of 8–10 mm. Sometimes nodes measuring 5 mm can be detected. On radiographs, you can determine the size of the lesion, its growth rate, the nature of the edges, the presence of calcifications - changes that can help assess the identified node as benign or malignant.

Peripheral formation of the right lung with the presence of a cavity (abscess). X-ray in direct projection.

Knot size

Nodules measuring greater than 3 cm are more likely to reflect malignant changes, while nodules smaller than 2 cm are more likely to be benign. However, node size alone is of limited importance. In some patients, small nodes may be malignant in nature, while large ones may reflect benign changes.

Node growth rate

Comparison with previously performed radiographs allows us to estimate the growth rate of the lesion. The growth rate is related to the time it takes for the tumor to double in size. On radiographs, the nodule is a two-dimensional image of a three-dimensional object. The volume of the sphere is calculated by the formula 4/3*πR 3, therefore, an increase in the diameter of the node by 26% corresponds to a doubling of its volume. For example, an increase in the size of a node from 1 to 1.3 cm is equivalent to one doubling of volume, while a change in size from 1 to 2 cm corresponds to an 8-fold increase in volume.

The volume doubling time for bronchogenic carcinomas is usually 20–400 days; the time required for doubling of volume, 20–30 days or less, is typical for infections, pulmonary infarction, lymphoma and rapidly growing metastases. If the volume doubling time is greater than 400 days, the changes are benign, with the exception of low-grade carcinoid tumors. The absence of changes in the size of the node for more than 2 years most likely indicates a benign process. However, it is impossible to determine the size of the lesion without error. It may be difficult to assess a 3 mm increase in nodule size on a chest x-ray; Taking measurements on radiographs after digital processing allows you to more accurately determine the size of the lesion.

Hearth contours

Benign nodes usually have clearly defined, even contours. Malignant nodes are characterized by typical irregular, multicentric, spicule-shaped (corona radiata) edges. In this case, the most significant sign suggesting the malignancy of the changes is the radiance of the edges; It is extremely rare that malignant tumors have smooth edges.

Calcined

Deposits of calcium salts and calcifications are more typical of benign focal formations, but on CT they are also found in approximately 10% of malignant nodes. In benign processes, five typical types of calcification are usually found: diffuse, central, laminar, concentric, and popcorn. Popcorn-shaped calcifications are characteristic of hamartomas, and punctate or eccentrically located calcifications are observed predominantly in malignant nodes. Calcifications can be more accurately detected and assessed using CT.

Benign tumors in the lungs are relatively rare, but in typical cases, CT can clearly distinguish them from a malignant tumor. A space-occupying lesion in the left lung is a hamartoma. Popcorn-shaped calcification.

FOCI IN THE LUNG ON CT - WHAT IS IT?

Focal formations in the lungs are detected better on CT than on plain radiography. On CT, focal changes measuring 3–4 mm in size can be distinguished, and specific morphological signs (characteristic, for example, of rounded atelectasis or arteriovenous malformation) are also better visualized. In addition, CT allows a better assessment of those areas that are usually poorly distinguished on radiographs: the apexes of the lungs, the hilar zones, and the costophrenic sinuses. Also, CT can reveal the multiple nature of focal lesions; CT can be used for tumor staging; In addition, needle biopsy is performed under CT guidance.

Peripheral formation of the left lung. Typical CT signs of peripheral cancer: round shape, uneven radiant contours.

Subpleural lesions in the lungs - what are they? Computed tomography demonstrates a nodular mass adjacent to the interlobar pleura. Signs of such lesions are not specific and require additional examination. A biopsy confirmed a fungal infection.

X-ray density of the lesion on CT

With the help of computed tomography, a certain indicator can be measured - the attenuation coefficient, or X-ray density of the lesion. The measurement results (CT densitometry) are displayed in Hounsfield scale units (X units, or HU). Below are some examples of attenuation factors:

Air: -1000 EX

Fat: -50 to -100 EX

Water: 0 EX

Blood: 40 to 60 EX

Non-calcified node: from 60 to 160 EX

Calcified node: more than 200 EX

Bone: 1000 EX

When using CT densitometry, it becomes possible to detect hidden calcifications that may not be visible visually even on thin high-resolution CT sections. In addition, density measurement helps to detect fatty tissue inside the node, which is a sign of its benignity, especially in cases of hamartoma.

Contrast-enhanced CT

Malignant nodes are usually more vascular than benign ones. The assessment of contrast enhancement of a node is made by measuring its density before and after the administration of contrast with an interval of 5 minutes. Increase in density by less than 15 Units. X suggests the benign nature of the node, while contrast enhancement of 20 Units. X or more is typical for malignant lesions (sensitivity 98%, specificity 73%).

Feeding vessel symptom

The feeding vessel symptom is characteristic of intrapulmonary nodes of vascular etiology, for example, hematogenous pulmonary metastases or septic emboli.

Cavity wall thickness

The cavity can be found in both malignant and benign nodes. The presence of a cavity with a thin wall (1 mm or less) is a sign indicating the benign nature of the changes, while the presence of a thick wall does not allow a conclusion to be made about the benign or malignant nature of the formation.

MAGNETIC RESONANCE IMAGRAPHY (MRI) OF THE LUNG

When staging lung cancer, MRI allows for better visualization of lesions of the pleura, diaphragm and chest wall compared to CT. At the same time, MRI is less useful in assessing the pulmonary parenchyma (especially for identifying and characterizing pulmonary focal changes) due to its lower spatial resolution. Since MRI is a more expensive and less accessible diagnostic method, this diagnostic method is used as a backup method for evaluating tumors that are difficult to evaluate by CT (for example, Pancoast tumor).

Ultrasound of the lungs

Ultrasound is not often used in the evaluation of solitary pulmonary lesions; this method has limited value and is used for control when performing percutaneous biopsy of larger nodes located in the peripheral regions.

RADIONUCLIDE DIAGNOSTICS OF FOCAL CHANGES IN THE LUNG

The use of nuclear medicine techniques (scintigraphy, SPECT, PET) in the evaluation of solitary intrapulmonary nodules has been studied through research studies. Thus, the use of PET and SPECT has been approved in the USA for the evaluation of intrapulmonary nodules.

PET-CT

Malignant tumor cells are characterized by greater metabolic activity compared to non-tumor cells, as a result of which the level of glucose accumulation in them is higher. PET of the chest organs uses a combination of radioactive fluorine nuclide with mass number 18 and a glucose analogue (F 18-fluorodeoxyglucose, FDG). Increased FDG accumulation is found in most malignant tumors, and this point is fundamental in the differential diagnosis of benign and malignant pulmonary nodules.

FDG uptake can be quantified using a standardized uptake factor, which is used to harmonize factors based on patient weight and the amount of radioisotope administered, allowing comparison of radiotracer uptake across different lesions in different patients. A standardized accumulation factor value greater than 2.5 is used as a “marker” of malignancy. Another advantage of FDG PET is better detection of metastases in the mediastinum, which allows for more optimal staging of lung cancer.

SPECT

The advantage of single photon emission tomography (SPECT) compared to PET is its greater availability. The scan uses deptreotide, a somatostatin analog labeled with technetium-99m, which binds to somatostatin receptors that are expressed in non-small cell cancer. However, the use of SPECT has not been studied in large samples. Overall, both PET and SPECT are promising noninvasive modalities that can differentiate between malignant and benign lesions and assist in the evaluation of indeterminate lesions.

Degree of reliability of PET and SPECT of the lungs

Using a meta-analysis, the average sensitivity and specificity for detecting malignant changes in focal pulmonary lesions of any size were 96% and 73.5%, respectively. For pulmonary nodules, sensitivity and specificity were 93.9% and 85.8%, respectively.

Errors in PET-CT of the lungs

With FDG PET, false-positive results may be due to metabolically active nodes of a different nature, for example, infectious granulomas or inflammatory foci. In addition, tumors characterized by low metabolic activity, such as carcinoid tumor and bronchioloalveolar carcinoma, may not be detected. At high serum concentrations of glucose, it competes with FDG in cells, resulting in reduced accumulation of the radioisotope.

Vasily Vishnyakov, radiologist

Pavel asks:

Hello, I am 22 years old, I have never smoked, I lead a healthy lifestyle. FG showed 2 rounded shadows in both lungs, as a result of CT the conclusion was given: “additional focal formations in the lung parenchyma, more evidence for focal tuberculosis.” More specifically: The pulmonary fields are of the correct shape, normal density, the pulmonary pattern is not deformed. In the lower lobes on both sides there are additional focal formations of medium intensity with fuzzy even contours. On the left is S8 5mm, on the right in S10 is 5.5mm, also in S1 of the right lung is 2mm in diameter. The lobar and segmental bronchi are clearly visible. No volumetric pathological formations were detected in the anterior, middle and posterior mediastinum, the lymph nodes of the mediastinum were not enlarged, and fluid in the pleural cavities was not detected. The heart, blood vessels, and chest are normal. I feel satisfactory, but I have had a rare dry cough for several months now. Please tell me your opinion about the CT scan conclusion, how dangerous such a diagnosis is, and whether a full recovery is possible. Thank you in advance!

The data obtained speak in favor of the tuberculosis process. You need to consult a TB doctor and undergo a timely course of anti-tuberculosis therapy. With timely treatment, the recovery rate is very high, but you must follow all the doctor’s instructions, because The treatment is quite long and combined.

Pavel asks:

Hello! Thanks for your answer! I continue to be examined by a phthisiatrician, and my additional tests (blood, urine, Mantoux) showed that I am healthy. And most importantly, the X-ray did not show a single lesion in the lungs. How is it that the CT scan showed three lesions, the FG showed two shadows, and the X-ray was clear? Naturally, I don’t want to have tuberculosis, but I’ve had a cough for almost a year, what if I miss timely treatment? What else can be done to clarify the diagnosis?

You need to test sputum for CD and you can do a diagnostic bronchoscopy.

Katya asks:

Hello. My friend is 21 years old. He has been smoking since he was 18. He no longer has bad habits. The FG image SHOWED ONE BLACKOUT. The phthisiologist looked at the picture and said that he had a closed form of tuberculosis at an early stage. I'm wondering if tuberculosis will appear again?

Based on the data you provided, the patient already has tuberculosis - as evidenced by the diagnosis. This disease will progress if treatment is not started immediately.

Ekaterina asks:

Can a person who has cured closed tuberculosis at an early stage get sick with it again? And can he die?

Persons infected with tuberculosis are constantly at risk for this disease. In tuberculosis, death is possible from complications of this disease (bleeding, respiratory failure, multiple organ failure). In order to effectively combat this dangerous disease, it is necessary to follow all the prescriptions of the attending TB doctor, and in the future it is necessary to be under regular supervision of this specialist doctor.

Katerina asks:

Can a person suffering from the closed form of tuberculosis infect another person through close contact (kissing, sex)?
And if a person suffering from a closed form of tuberculosis began timely treatment and was cured, can tuberculosis return? And why?
Thank you!

The closed form of tuberculosis is called closed because a person suffering from this form of tuberculosis does not release Mycobacterium tuberculosis into the environment, i.e. non-infectious to others. Treatment of tuberculosis can be long-term, it should continue until complete recovery; most often, a patient with an uncomplicated form of tuberculosis is cured completely and without relapses. But, in case of incomplete treatment, if medical recommendations are not followed, with poor diet, smoking, drinking large quantities of alcohol or drugs, this disease may return, since such people have a sharply reduced level of the immune system, and they become extremely sensitive to any infection.

Elena asks:

Hello! After FLG, X-ray and X-ray, my husband (39 years old) was diagnosed with tuberculosis, but the final diagnosis has not yet been established; they have some doubts. Preliminary Dz: Focal tuberculosis S1-2 of the right lung in the decay phase? At the dispensary we were offered to undergo a Spiral CT scan on our own. That's what we did.
Results:
1. In the upper lobes, centrilobular bullae from 7 to 111 mm with thin walls are determined. Against this background, soft tissue foci of 3-6 mm with clear contours and a homogeneous structure are visualized in S2 of the right lung.
2. The broncho pattern is not changed.
3. The mediastinum is structural and not displaced. Trachea without features.
4.Bronchi of the 1st-3rd order are passable, not deformed.
5. The diaphragm is located normally, its contours are smooth and clear.
6. Pleural cavities - without features.
7. Intrathoracic nodes are not enlarged.
CONCLUSION: Lesions in the intralobe of the right lung. Bullous emphysema of both lungs in the intralobes.
QUESTIONS:
1. Is bullous emphysema related to tuberculosis or is it a separate disease?
2. What does centrilobular bullae mean? Do they contain air or liquid?
3. Does this study confirm decay in the lungs?
4. What is your prognosis - is this form completely curable?

Thank you for existing. I'll be looking forward to your answer, I'm really scared.

Bullous enphysema can be a consequence of an infectious process in the body, as well as as a result of obstruction of the bronchi by tuberculous foci in the decay phase. With centrilobular emphysema, the air spaces in the center of the lobule are affected; they are located in the upper lobe; they can also occur in smokers. There is air inside the bullae, but an accumulation of mucus may form at the bottom. The presence of soft tissue lesions 3-6 mm with clear contours and a homogeneous structure may indicate the presence of lesions without decay. With timely, controlled treatment, the prognosis is favorable.

Svetlana asks:

Can a person suffering from the closed form of tuberculosis infect another person through close contact (kissing, sex?)

Svetlana comments:

HELLO, WE'RE JUST PLANNING A CHILD NOW, AT FIRST WE WERE TOLD TO HUSBAND THAT I HAD PNEUMONIA, THEN IT FOUND OUT THAT IT WAS CLOSED FORM TUBERCULOSIS, I WANTED TO ASK IS IT POSSIBLE TO GET PREGNANT OR NOT YET? WERE YOU TREATED FOR PNEUMONIA. NOW AS SHOULD BE MONITORED AND TREATED BY A PHTHISIATICIAN.

It is not recommended to plan pregnancy during tuberculosis treatment, because such specific treatment negatively affects spermatogenesis and the ability to fertilize. Only after completing the course of treatment and after 2-3 months is it recommended to plan a pregnancy. This time is necessary for the restoration of the spermatogenic epithelium.

Alexey asks:

focal formations on both sides on the tops of the heads. what is it, and is it contagious? I’m 29 years old and I wouldn’t want to infect my family!

To clarify the diagnosis, a personal examination by a dermatologist is necessary, only after examination and examination: scraping from the affected surface of the skin, an accurate diagnosis will be made and adequate treatment will be prescribed. It is necessary to exclude trichophytosis and lichen. In this case, it may be a contagious disease; it is recommended to limit contact with family members and not use other people’s pillows or comb. Read more about this disease in a series of articles by clicking on the link: Ringworm.

Julia asks:

Hello! My mother (age 57 years old) has had wheezing in her lungs for 8 months, and for the last 3 months she has had a dry cough and for two weeks the temperature has risen to 37.2, when she takes a deep breath she stops breathing, she took x-rays twice, the doctors said it was bronchitis or there was pneumonia. They did a CT scan, the conclusion: in the area of ​​the middle lobe and S6 of the right lung, uneven large areas of fibrosis (most likely of a post-inflammatory nature) are determined. Focal shadows are determined in the lung parenchyma on both sides (S6 and S9 on the right to
10.5 mm in diameter, as well as 4 pieces in the left lung up to 7 mm in diameter - S6 and S3). In the pleural cavity on the right, an accumulation of fluid is determined, with a layer thickness of up to 9 mm. Single paratracheal and bifurcation lymph nodes of the mediastinum are visualized. There are no bone destructive changes at the examined level identified. Tell me, what are these symptoms of? It could be cancer.

Svetlana asks:

Hello! My husband is suspected of tuberculosis, but Koch's bacilli were not found in the sputum, they did an X-ray CT scan. The mediastinum is not displaced. The pulmonary fields are of the correct shape, their airiness is increased. The pulmonary pattern is moderately deformed due to the mixed component. On both sides, multiple areas of centrilobular and panlobular are identified and paraseptal emphysema with the formation of bullae measuring from 1.0x1.5 to 2.0x2.7 cm (the largest in the upper lobe on the right). In the upper lobe of the left lung, large thick-walled cavities of destruction ranging in size from 1.0x2.4 cm to 4.1x4.4x3.2 cm are visualized associated with dilated bronchi. The cavities are separated from each other by fibrous partitions 0.3-0.6 cm thick, adjacent to thickened apical and costal pleura. In the surrounding lung tissue there are small calcified foci. The segmental and subsegmental lumens are unevenly expanded, their walls are compacted, with calcifications. In S4 on the left there are multiple foci of compaction of the lung tissue ranging in size from 0.3 cm to 0.5x0.6 cm without calcifications. Scattered foci of compaction against the background of fibrotic changes are visualized in the basal segments of the lower lobe on the right. Large bronchi are clearly visible, regular in shape, the walls are compacted. The heart and large vessels are of normal size, usually located. Subaortic, lower paratracheal, bifurcation, lymph nodes up to 0 in size are differentiated .7 cm. No additional formations were found in the mediastinum. In the pleural cavities and in the pericardial cavity without pathological contents. Conclusion: CT picture of fibrous-cavernous TVS of the lungs. Emphysema
The tests are all normal, a dry, sparse cough without sputum. In 1995, he suffered a pneumothorax; in 2010, a CT scan showed a cyst on the left lung and emphysema. Could this be open tuberculosis?

Dima asks:

Hello. Calcifications were found on my linear tomogram. Then they took an x-ray and here is the conclusion: in the upper lobe of the left lung there are apical layers and isolated foci of medium intensity, adhesions of the pleura and diaphragm in the lower part. I was in therapy for this with bronchitis and asthma, no drips, injections didn’t help much and they were discharged . I have had a low-grade fever for about two and a half years (37-37.3.4) and have coughed up blood in my sputum twice. And the cough has been very strange since December, as if it’s coming from one lung - the left one.

Vagif asks:

I would like to argue with any doctor that tuberculosis can be treated even in the most advanced forms. I myself was sick and they told me that you’ll last half a year. This was 1982. It’s time to admit that doctors cannot fully treat.

Curing tuberculosis is possible, but the success of treatment is largely determined by the form and stage of the disease, compliance with medical prescriptions, the availability of appropriate living conditions, etc. You can obtain more detailed information on the issue you are interested in in the appropriate section of our website by clicking on the following link: . Treatment control, as well as the dynamic picture of the disease, can be assessed using laboratory and instrumental diagnostic methods that are used in modern medical institutions.

Vagif comments:

Tell me, I can advertise and treat tuberculosis with my elixir in three months.

You do not have the right to engage in medical practice without a higher medical education. In the event that your elixir is a personal paramedical invention, you can contact the appropriate authorities to conduct tests, research, and obtain reliable results of effectiveness. You can find out more detailed information on this issue in the corresponding section of our website by clicking on the following link: Therapist

Olga asks:

Hello. I had a medical examination at work and a spot was found on the “flush”. I went to the phthisiatrician and had a CT scan of the lungs done. This is what showed: with a spiral CT scan of the chest organs in the apical parts of the upper lobes of both sides in S6 of the lower lobe of the right lung, numerous polymorphic foci with relatively clear contours, with a diameter of 5 to 15 mm, with cords to the pleura. In some of the foci (in S1, at the border of S2\S3 of the right lung, in S1-2 of the left lung) small decay cavities are visualized, without fluid levels, and in S1- 2 the draining bronchus approaches the decay cavity. In S6 of the lower lobe the area is light. the lesions contain inclusions of amorphous calcium. In S8, lung area, subplevaral, there is an area of ​​local pneumofibrosis, measuring 2.8*1 cm. Please tell me, is this very scary and what is it? I don't experience any symptoms. Thank you

In this case, it is possible that you have previously suffered from bronchitis and pneumonia several times. It is also necessary to exclude pulmonary tuberculosis, so I recommend that you personally visit a phthisiatrician to prescribe adequate treatment. You can get more detailed information on the issue you are interested in in the corresponding section of our website by clicking on the following link: Tuberculosis

Olga asks:

Hello. On January 9, I was admitted to the hospital because of my lung scans, they checked for the presence of tuberculosis. I gave sputum 4 times and had a mantoux test. Everything is normal. Today they did a dioxin test, if it’s fine, is there any point in staying there? Doctors refer to the area of ​​decay, they say if there is decay, then there should be a wand, we’ll look for it. They’ll send me for bronchoscopy, but I’m a little scared.))

The Diaskin test is a more informative study, so I recommend that you wait for the results. However, if the X-ray picture corresponds to the stage of decay, treatment is indicated for you in any case. I recommend that you continue monitoring with a TB doctor. You can get more detailed information on the issue you are interested in in the corresponding section of our website by clicking on the following link: Diagnosis of tuberculosis

Adilet asks:

I have closed multi tuberculosis. who has been treating for 2 years. I was told that I should be treated in the hospital for 8 months. There are patients here with open tubes. I'm still afraid of getting infected. Can I be treated at home?

In this situation, you have nothing to worry about, since re-infection cannot occur. You can get more detailed information on the issue you are interested in in the corresponding section of our website by clicking on the following link: Treatment and prevention of tuberculosis

NATALIA asks:

HELLO! AFTER 2 STROKES, OUR GRANDFATHER WAS TREATED AND DISCHARGED WITH A RECOMMENDATION TO A PHTISIAN WITH A DIAGNOSIS OF TUBERCULOSIS. THEY TOOK THE MICTURES, AN EXTRACT AND WENT TO THE APPOINTMENT WITHOUT HIM, BECAUSE HE IS BEDBED, IF HE HAS TUBERCULOSIS MAY BE REGISTERED, MAYBE WHAT PILLS WILL BE PRESCRIBED AND IS THERE A RISK OF INfection, THE DOCTOR LOOKED AT THE IMAGE AND SAID HE HAS NOTHING T. THE EXTRACT SAYS TOMOGRAPHY OF THE LUNG - FOCAL TVS S1 OF THE LEFT LUNG, COMPRESSION PHASE. WE LIVE TOGETHER, WE CARE. IS THERE STILL A DANGER FOR US?

To make a diagnosis of tuberculosis, a comprehensive assessment of the results of all studies performed, as well as an examination of the patient, is required. It is also necessary to take a sputum test, which will determine the form of tuberculosis - open or closed. In the absence of bacilli excretion, there is no risk to others. Consider having your grandfather examined by a TB specialist at home. You can get more detailed information on the issue you are interested in in the thematic section of our website by clicking on the following link: Tuberculosis

saule asks:

Hello, my mother is 55 years old. She was diagnosed with tuberculosis during an X-ray; they said it started in 2011; now the characteristic symptoms are cough, chest pain, sputum, and fever. please tell me what are the chances of recovery? the doctor said it was possible, but she lives in the province and they are negligent in their duties, if they didn’t detect it back in 2011, tell me what to do?

In this situation, you should take the issue of treatment seriously - contact a TB doctor personally, who will study the research protocols, establish the stage of the disease and its form, and then prescribe adequate treatment. If treatment for tuberculosis is to be carried out for the first time in life, it should be carried out in a specialized medical institution. You can get more detailed information on the issue you are interested in in the corresponding section of our website by clicking on the following link: Treatment and prevention of tuberculosis

Veronica asks:

Hello, I'm 29 years old. I was diagnosed with tuberculoma of the upper lobe of the left lung. rounded shadow with a clear contour up to 1.7 cm in diameter. No rods were found in the sputum. Treatment was prescribed: chemotherapy regimen 1 and additional follow-up: PBS with brush biopsy and cons. oncologist, endocrinologist (I have hypothyroidism) Subsequent surgical treatment Everything is fine. For 2 months she took medications and was examined, the diagnosis of VK was effective, there was a significant positive dynamics of partial resorption of the infection in the upper lobe of the left lung. Surgical treatment is not indicated, small forms. The culture came back and the result was negative; treatment was left with 2 drugs, rifampicin and isoniazid. And now the paradise phthisiatrician says that I must undergo either sanatorium-resort or inpatient treatment. Sanatorium treatment is voluntary, but do I need hospital treatment with such a course of the disease and positive dynamics?

As a rule, with such a diagnosis as tuberculosis, sanatorium-resort treatment is mandatory, and the need for inpatient treatment is determined individually by the attending physician, and with pronounced positive dynamics in the course of the disease, treatment in a hospital is not a categorical requirement. I recommend that you personally consult with your TB doctor to determine further treatment tactics and observation. You can get more detailed information on the issue you are interested in in the corresponding section of our website by clicking on the following link: Tuberculosis.

Evgeniya asks:

Hello, my husband and I are in the dispensary, I have CD (-), my husband has CD (+), we both take pills, can I get infected from kissing? Thank you.

The risk of re-infection is possible, but it is minimal. We recommend that you consult in detail with your TB doctor. You can find out more detailed information on this issue in the thematic section of our website by clicking on the following link: Treatment and prevention of tuberculosis

Natalya asks:

I’ve had a bad FG for 7 years now, I feel fine, I haven’t had a long-term cough, I haven’t been sick with anything except colds during this time, I’ve given birth to two children. What could this be besides tuberculosis?

Unfortunately, it is not possible to assess the situation without studying the images, so we recommend that you take an additional spirogram, take a sputum test, a general blood test and personally visit a pulmonologist. Changes in the fluorogram can occur with a wide variety of diseases: chronic bronchitis, bronchial asthma, tuberculosis, amyloidosis, etc. Read more on this issue in the thematic series of articles on our website by following the link: Bronchitis and pneumonia. You can also get additional information in the following section of our website: X-ray

Inna asks:

Hello My husband fell ill with closed form tuberculosis and is now undergoing treatment
Currently undergoing treatment, taking antibiotics Linamide 500 mg pyrazinamide
Rifampicin
Amikacin, has already completed the course of injections, is going for physical treatment! I donated sputum, blood tests show good results! I checked with my doctor, had tests, fluorography, in general, all the tests and they are good, I’m healthy! What should we do, we want a baby! Is it possible to get pregnant if this is the situation? Will this affect the pregnancy, it will not affect the baby!

In this situation, unfortunately, pregnancy will have to be postponed until your spouse achieves stable remission for at least 6 months, which will allow you to conceive and give birth to a healthy child. Considering the use of antibiotics, it is now not recommended to plan a pregnancy, since this group of medications has a negative effect on conception.

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Focal pulmonary tuberculosis is characterized by the presence of various origins and duration of small (up to 10 mm in diameter, predominantly productive), foci within 1-2 segments in one or both lungs and an asymptomatic course.

Among people newly diagnosed with tuberculosis, focal forms are diagnosed in 15-20% of cases. Its main signs are limited lesions and localization in the apex or upper lobe of the lung. There are soft-focal and fibrous-focal pulmonary tuberculosis. According to the modern classification of tuberculosis, soft-focal- this is focal tuberculosis in the infiltration phase, i.e. a fresh form of the disease that needs to be treated.

Fibrous-focal- This is focal tuberculosis in the phase of compaction and calcification. This form of tuberculosis develops as a result of incomplete resorption and compaction of soft-focal, infiltrative, acute disseminated tuberculosis of the respiratory organs. By size, all lesions are divided into small - up to 3 mm in diameter, medium - from 4 to 6 mm and large - from 7 to 10 mm.

Pathogenesis of focal tuberculosis

Very rarely, focal tuberculosis can occur as primary tuberculosis. As a rule, this form of tuberculosis is of secondary origin and occurs due to:

a) exogenous superinfection;

b) endogenous reactivation of old (calcified) tuberculous foci, scars or inductive fields formed after a previous

Reactivation of post-tuberculosis changes occurs as a result of the transformation of L-forms of the pathogen capable of multiplying. Reversion of Mycobacterium tuberculosis is promoted by various reasons that reduce acquired immunity. These include acute and chronic diseases (influenza, NLD, diabetes mellitus, gastric and duodenal ulcers, pneumoconiosis, drug addiction, alcoholism, AIDS, mental disorders). Reactivation can also be facilitated by exogenous superinfection.

Pathomorphology

With exogenous superinfection, first of all, changes occur in the wall of the apical lobular bronchi, and caseous panbronchitis develops. Subsequently, the inflammatory process moves to the alveoli, where areas of exudative or productive inflammation are formed. These foci were described by A.I. Abrikosov in 1904.

When the process worsens due to endogenous reactivation, leukocytes penetrate into the lesion and, due to proteolytic enzymes, melt caseous necrosis. The fibrous capsule around the lesion is infiltrated by lymphocytes and loosened; A zone of perifocal nonspecific inflammation develops around such a focus. Subsequently, damage to the bronchi occurs. This occurs due to the spread of mycobacteria (lymphatic vessels) and caseous masses to the peribronchial tissue and the development of panbronchitis. If caseous masses break into the lumen of the bronchus, fistulas occur.
As a result of treatment, the lesions may resolve completely or scars may form in their place. A fibrous capsule develops around other foci and fibrous-focal tuberculosis is formed.

Symptoms of focal tuberculosis

Most patients with focal tuberculosis do not report any symptoms of the disease. However, with focal tuberculosis, symptoms of intoxication and symptoms of respiratory damage may be observed. Intoxication syndrome is manifested by prolonged low-grade fever, decreased appetite and performance, sweating, and malaise. Patients may complain of coughing with slight sputum production. Symptoms of intoxication are characteristic of fresh (soft-focal) forms of focal tuberculosis, i.e. focal tuberculosis in the infiltration phase, and damage to the respiratory organs - for chronic ones (in the compaction phase).

With focal tuberculosis in the infiltration phase, there are no percussion changes. Auscultation can detect focal wheezing in the presence of decay. Treatment consists of a course of antimycobacterial therapy.

With focal tuberculosis in the phase of compaction and calcification (fibrous-focal form), bronchiectasis often forms, which causes sputum production and, in some cases, hemoptysis.

The apices of the lungs are wrinkled, and therefore the supraclavicular and subclavian fossae are clearly visible. The upper edge of the trapezius muscle is flaccid and atrophic. Percussion over the apexes reveals dullness, and on auscultation there may be weakened or harsh breathing, as well as moist rales. The cause of wheezing is severe fibrosis and the formation of bronchiectasis. Finally, with focal forms of tuberculosis, limited perifocal tuberculosis may develop.

Patients with focal forms in the infiltration phase and in the compaction phase during exacerbations are subject to treatment. In such cases, antibiotic therapy is prescribed for 2-3 months. If there are no signs of process activity, persons with focal forms of tuberculosis in the consolidation phase are considered cured and only need periodic general improvement.

Forecast

Favorable - complete resorption of pathological changes (occurs with lesions with a diameter of up to 5 mm). Relatively favorable - the formation of petrification, segmental pneumosclerosis. Unfavorable - progression of the process. Focal tuberculosis develops in the decay phase, which can develop into fibrous-cavernous tuberculosis.

Differential diagnosis

Of the two variants of focal pulmonary tuberculosis (focal tuberculosis in the infiltration phase and focal tuberculosis in the calcification phase), differential diagnosis with other diseases is usually carried out for tuberculosis in the infiltration phase. The diseases with which this form of tuberculosis must be differentiated are peripheral lung cancer, metastatic lung cancer.

Bronchopneumonia is a nonspecific inflammatory process localized within a segment, lobule or acini. In typical cases, patients indicate hypothermia, an acute onset with symptoms of pharyngitis, high body temperature, significant cough, and chest pain. Often, moist or dry changing rales can be heard over the site of the lesion against the background of hard breathing, while with focal tuberculosis, pathological noises are practically not heard.

Leukocytosis, shift of the formula to the left, high ESR are more characteristic of pneumonia. On an x-ray with pneumonia, the lesions are of low intensity, monomorphic, with blurred contours, most often located in the lower parts of the lungs, sometimes in the upper part, but not at the apex. In focal tuberculosis, MBT is rarely detected in sputum, but in unclear cases this study must be carried out repeatedly.

The Mantoux test can also be positive in tuberculosis-infected individuals with pneumonia, but a hyperergic reaction indicates tuberculosis. It should be borne in mind that atypical focal pneumonias with asymptomatic or low-symptomatic progression occur, and if they are localized in areas of the lungs typical for tuberculosis, doubts arise regarding the diagnosis. Therefore, there is no need to rush to establish a diagnosis of tuberculosis, but prescribe test therapy with broad-spectrum antibiotics. Resorption of lesions after 2-3 weeks confirms the diagnosis of bronchopneumonia.

Diagnosticcriteria for bronchopneumonia:

• often occurs against or after an acute respiratory illness or hypothermia;
• has an acute (sudden) onset with pronounced clinical manifestations (febrile temperature, chills, severe weakness, poor appetite, cough with sputum, chest pain, sometimes shortness of breath at rest);
• Hard breathing, wet and dry rales are heard above the lungs;
• in the blood test - significant leukocytosis, a shift of the formula to the left, a significant increase in ESR:
• X-ray - characterized by the presence of bilateral focal shadows with a diameter of 1.0-1.5 cm of low intensity with blurred contours, which are often localized in the lower lobes;
• the pulmonary pattern is enhanced throughout the pulmonary fields due to hyperemia. The shadow of the roots of the lungs is expanded;
• Treatment with broad-spectrum antibiotics gives positive dynamics after 7-10 days (resorption of lesions).

In cases where the diagnosis cannot be accurately established, pneumonia is first treated with broad-spectrum antibiotics; they are not used in the treatment of tuberculosis.

Smallperipheral lung cancer- characterized by a latent course and the absence of clinical symptoms at the beginning of development (as with tuberculosis). If we also take into account that on the x-ray at this stage the shadow of the cancerous tumor is small, has an irregular polygonal shape with unclear contours, then it is very similar to a tuberculosis lesion. The lung tissue around such a tumor is not changed. A cancerous tumor acquires typical radiological signs only when it reaches a size of more than 2 cm. Then it is necessary to differentiate it from.

It should be taken into account that there is always one cancerous node, and with focal tuberculosis, as a rule, a group of polymorphic foci is visible. Therefore, the detection of one isolated lesion in a person (usually a man) over 40 years of age should always be considered from the point of view of a possible malignant tumor. Unlike focal tuberculosis, which is located predominantly in the 1st segment, the predominant localization of cancer is the lower part, the 3rd (anterior) segment. In the 2nd segment, both pathological processes are possible with equal probability.

Symptoms appear only in the later stages of cancer development, when it reaches neighboring anatomical structures. The most constant symptom is pain not associated with the act of breathing; unmotivated shortness of breath and sometimes hemoptysis are less common, and in case of focal tuberculosis, intoxication syndrome predominates. The hemogram of patients sometimes reveals anemia and increased ESR, which rarely happens with focal tuberculosis. If the reaction to the Mantoux test is negative, the diagnosis of focal tuberculosis is unlikely.

Bronchoscopy should be supplemented by bronchial catheterization with collection of material for cytological and bacteriological examination. Radioisotope and radioimmunological research methods can provide some assistance in establishing a diagnosis.

Diagnosticcriteria for peripheral lung cancer:

• Cancer occurs more often in men over 40 who smoke a lot;
• the onset is asymptomatic, broncho-pulmonary-pleural symptoms predominate (cough, hemoptysis);
• X-ray: one lesion, with unclear contours, against an unchanged background; frequent localization of the tumor - III, IV, V segments and the lower part;
• in most cases, small peripheral cancer has an irregular spherical shape, fuzzy hilly, sometimes radiant shadow contours, represented by short strands - “rays” extending into the adjacent lung tissue. They form a picture of a “malignant crown”; the contour of the peripheral cancer shadow has the Rigler notch;
• the tumor shadow is of medium intensity, inhomogeneous (as if it consists of several small formations, merging), calcified inclusions are observed;
• the Mantoux test with 2 TU PPD-L may be negative, which is not observed in focal tuberculosis;
• When treated with anti-tuberculosis drugs, the malignancy progresses.

Metastaticcancer- there are several similar roundish (coin-like) lesions with clear contours, which are found in different parts of the lungs.