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

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

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

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

Gon's focus and calcified foci in the lungs - what is it

Gon's focus is a formation on the apex or upper segments of the lungs, caused by damage to the lung tissue by mycobacteria. Morphological examination of the material reveals a large number of granulation cells, macrophages. The body is constantly fighting the causative agent of pulmonary tuberculosis, so the dynamics is growing slowly. Only when viewing a series of images of the chest organs for 3-6 months, it is possible to identify some changes.

With prolonged preservation of tuberculous lesions, the formation of a calcified focus is possible. Calcium salts are deposited in the places of caseous destruction. This is how the mummification of the pathogen occurs, which prevents re-infection of the lung tissue.

Calcified foci in the lungs are not only manifestations of tuberculosis infection. They occur in chronic pneumonia, helminthic invasions, fibrosing alveolitis (Hammen-Richie).

Digital radiograph: miliary tuberculosis, lesions on both sides

Gon's focus is a rare form of infection in the present period of time. Due to the uncontrolled use of antibiotics, microorganisms have become resistant to antibiotics. In the treatment of other diseases with these drugs, a certain activity of the chemical compound on Mycobacterium tuberculosis is ensured. Bacteria are not completely killed. If microorganisms do not have multi-resistance, under the influence of antibiotic therapy for pneumonia, bronchitis, and other diseases, a person stops the active progression of tuberculosis, without suspecting it.

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

Dense foci in the lungs in focal opacification syndrome

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

If the area goes beyond 2 intercostal spaces, they speak of a disseminated process. Focal darkening is differentiated into primary, secondary. In diseases with damage to the lung tissue, the pathogenesis of the syndrome is accompanied by the following pathogenetic mechanisms:

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

Gon's focus syndrome, polymorphic, fibrous, intense, calcified, can be traced with tumors, inflammation of the lung tissue, and vascular anomalies.

The definition of a focal shadow in the picture does not always allow to verify the morphology, the etiological factor.

With different diseases, the syndrome of focal blackout has a radiographic similarity. The specific gravity of the tumor, fibrous, necrotic, inflammatory focus differs slightly. To differentiate the gradations, computed tomography is used, which makes it possible to study the density of the shadow. The study allows you to clearly verify calcified, calcified, intense and weak blackouts.

Ghosn's focus in the lungs on an X-ray in a classic state is clearly visualized. The remaining nosological forms are not accompanied by concomitant signs that allow verification of the nosology.

Dense foci in the lungs - what is it

Dense foci on an x-ray of the lungs indicate either a chronic infection or a cured inflammatory, traumatic process. At the site of prolonged inflammation, scar tissue accumulates, pneumosclerosis is formed, carnification occurs with pneumonia. On the roentgenogram with all these nosologies, dense (intense) blackouts are traced.

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

Tumor;
Aneurysm;
retention cyst;
primary cancer;
Focal tuberculosis.

Only with dissemination there are signs of severe intoxication:

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

During the inflammatory process, laboratory changes are traced: leukocytosis, acceleration of the erythrocyte sedimentation rate. Focal tuberculosis is characterized by specific clinical symptoms:

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

With tuberculosis infection, a blood test is not accompanied by inflammatory changes. Diagnosis of the disease requires the determination of Mycobacterium tuberculosis in the washings of the bronchial tract. With small peripheral cancer, solitary metastases, changes in blood tests are traced.

With a lung infarction, a syndrome of focal blackout is traced, which occurs with thrombophlebitis of the lower extremities. Clinic - hemoptysis, complaints of pain in the side.

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

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

Fibrous foci in the lungs - what is it

With inflammatory changes, the focal shadow has an average intensity, uneven, blurred boundaries. With chronic inflammation, fibrous tuberculosis, darkening is intense with jagged, sharp edges.

Fibrous deposits disrupt the ventilation of the bronchial tract. The degree of respiratory failure is determined by the volume of the lesion.

If fibrosis is provoked by a tumor, a “belt” can be traced around the rounded shadow, an accumulation of small foci due to an enhanced pulmonary pattern.

With tuberculosis, a vascular "path" extends from the fibrous focus, directed to the root of the lung. Several tortuous thin strips of vessels directed towards the root, often found in chronic tuberculosis.

An increase in lymph nodes, a path, a round shadow in the lung parenchyma are most often radiographic signs of cancer.

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

In conclusion, I would like to recall that polymorphic foci in the lungs are not always a manifestation of pulmonary pathology. If the syndrome is detected on a direct radiograph, there is a possibility of damage to the pleura. Pleurisy can be not only exudative, but also dry. After healing, calcifications, fibrous foci remain.

Focal opacification syndrome in the lungs is an X-ray manifestation of many nosological forms. For differential diagnosis, several methods are used.

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

The focus is called a small spot, which is detected by x-ray, round or irregular in shape, located in the tissue of the lungs. 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, they include seals in the lungs about 3 cm in size. Domestic medicine puts limits up to 1 cm, and refers to other formations as infiltrates.

Computed tomography is more likely to establish the size and shape of 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 accumulation of fluid in the form of sputum or blood. Many experts consider their establishment to be one of the important tasks.

Cancer factors

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

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

The imperfection of the equipment does not allow a clear diagnosis of the disease by the hardware method. It is difficult to detect focal changes, the size of which does not reach 1 cm, during the passage of x-ray of the lungs. The interposition of the anatomical structures makes even larger formations invisible.

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

Computed tomography for diagnosing the location of the focus

Causes of focal formations in the lungs

The main factors of pathology include the occurrence of seals on the lungs. Such symptoms are inherent in dangerous conditions that, if not properly treated, can cause death. Diseases that provoked this condition include:

• oncological diseases, the consequences of their development (metastases, directly neoplasms, etc.);
• focal tuberculosis;
• pneumonia;
• caused by circulatory disorders or as a result of an allergic reaction;
• myocardial infarction;
• bleeding;
• severe bruising of the chest;

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

In a third of patients, minor signs of respiratory damage are observed. A feature of pulmonary tuberculosis is the absence of symptoms or their minimal manifestation. Basically, it is detected during preventive examinations. The main picture of tuberculosis is given by radiography of the lungs, 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 passing an examination in the form of fluorography, it is impossible to detect a seal less than 1 cm in size. It will not work to analyze the whole picture completely and without errors.

Many doctors advise their patients to undergo computed tomography. This is a method of studying the human body, which allows you to identify various changes and pathologies in the internal organs of the patient. It belongs to the most modern and accurate diagnostic methods. The essence of the method consists in the influence of X-rays on the patient's body, and in the future, after passing through it, computer analysis.

With it, 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 the density of tissues, diagnose the condition of the alveoli and measure the respiratory volume);
• analyze the state of the pulmonary vessels of the lungs, heart, pulmonary artery, aorta, trachea, bronchi and lymph nodes located in the chest area.

This method also has weaknesses. Even with a CT scan, focal changes are missed. This is due to the low sensitivity of the device with lesions up to 0.5 cm and low tissue density.

Experts have found that during the primary screening of CT, 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 corresponds to 1 cm, then the sensitivity of the device in this case is 95%.

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

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

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

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

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

Focal formations in the lungs are usually classified by density:

• dense;
• medium density;
• loose.

Quantity classification:

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

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

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

• pleural foci;
• subpleural foci.

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

Conclusion

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

I.E. Tyurin

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

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

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

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

The foci in the lung tissue are distinguished by a wide variety of sizes, density (intensity of the shadow on radiography), structure and nature of the contours. In the domestic literature, it is customary to divide foci by size into small and miliary (up to 2 mm), medium-sized (3-5 mm) and large (6-10 mm). On radiography, lesions often have an average shadow intensity, which on computed tomography (CT) corresponds to soft tissue density. However, in a number of pathological processes, foci are displayed on axial sections as areas of low density compaction - foci of the “ground glass” type. As a rule, they are not visible on conventional X-ray examination and are detected only on thin-layer CT. Such changes in the lungs are observed, for example, in respiratory bronchiolitis or hypersensitivity pneumonitis.

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

Despite the well-known regularities in the location of foci in the lungs and the nature of focal shadows, the possibilities of conventional X-ray examination in the differential diagnosis of such changes are small. As a rule, they are limited to the typical manifestations of the most common diseases in the presence of reliable clinical data. The advent of high-resolution CT (HRCT) in the 1980s led to the emergence of a new group of symptoms that greatly simplified the differential diagnosis of focal changes in the lung tissue and significantly increased its effectiveness. Thin-layer CT has great potential in
differentiation of the nature of focal disseminations in the lungs and determination of the method of their verification.

All of the above symptoms of focal dissemination are applicable to both traditional x-ray and CT. However, if during radiography the most important characteristics are the localization of foci in the lungs and the features of the foci themselves (their size, shape, contours and structure), then with HRCT, the ratio of foci in the lung tissue to the anatomical elements of the secondary lung lobule (SLD) becomes a more important characteristic of the pathological process. and to the visceral pleura.

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

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

In the interlobular septum there are lymphatic vessels and veins. Normally, HRCT reveals only the largest septa - they are located in the anterior and outer parts of the upper, middle and lower lobes, as well as paramediastinally in the lower lobes of the lungs. With thickening of the septa due to any pathological process, they become clearly visible on HRCT.

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

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

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

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

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

Symptom "tree in the kidneys" is a tomographic display of dilated and pathologically filled intralobular bronchioles in longitudinal section. Centrilobular changes of this type are observed with endobronchial spread of pulmonary infections, including tuberculosis, as well as with various forms of non-infectious bronchiolitis, occupational diseases (silicosis, anthracosis), etc.

The second variant of centrilobular foci is represented by small, poorly defined, low-density lung tissue seals of the “frosted glass” type. Such foci most often result from cellular infiltration of the peribronchiolar lung tissue and are observed in hypersensitivity pneumonitis and some forms of bronchiolitis. A significant number of such foci, with their close location and partial merging, can create the illusion of diffuse infiltrative changes of the “frosted glass” type.

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

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

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

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

The first shoulder is the analysis of dissemination in the presence of foci along the visceral pleura. Such foci, as a rule, are formed during the hematogenous or lymphogenous spread of the pathological process. With hematogenous spread of the process, the foci are located in the lung tissue without connection with the anatomical elements of VLD. Changes in the pulmonary interstitium (thickening of the interlobular septa, walls of the bronchi and blood vessels) are mild or absent. In the costal and interlobar pleura, single foci can be found, while the pleura sheets themselves, as a rule, are not changed. This type of foci is defined as chaotic.

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

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

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

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

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

The second arm of the algorithm is the analysis of dissemination in the absence of foci along the visceral pleura. In this case, two different types of changes can also be distinguished. The key element here is the presence or absence of bronchiolectasis - dilated and pathologically filled intralobular bronchioles that form typical Y-shaped or V-shaped figures (symptom "tree in the kidneys").

In the first variant, there are no such changes, and only focal changes can be detected on axial sections. The foci are located deep in the lung tissue, and in the cortical regions they can be seen at a distance of 3-5 mm from the visceral pleura. They are usually peribronchial and peribronchiolar infiltrates or granulomas. Such foci may have a soft tissue density and clear contours, such as in histiocytosis, which is typically accompanied by the formation of numerous cysts, mainly in the upper lobes of the lungs, which, in combination with the centrilobular location of the foci, creates a very characteristic picture.

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

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

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

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general description

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

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

Acid-resistant bacteria of the genus Mycobacterium are considered responsible for the development of the tuberculosis process. There are 74 species of such bacteria and they are found everywhere in the human environment. But not all of them become the cause of tuberculosis in humans, but the so-called human and bovine species of mycobacteria. Mycobacteria are extremely pathogenic and are characterized by high resistance in the external environment. Although pathogenicity can vary significantly under the influence of environmental factors and the state of the defenses of the human body that has been infected. The bovine type of the pathogen is isolated during illness in rural residents, where infection occurs through the alimentary route. Avian tuberculosis affects persons with immunodeficiency states. The overwhelming majority of primary infections of a person with tuberculosis occurs by aerogenic route. Alternative ways of introducing infection into the body are also known: alimentary, contact and transplacental, but they are very rare.

Symptoms of pulmonary tuberculosis (infiltrative and focal)

• Subfebrile body temperature.
• Torrential sweats.
• Cough with gray sputum.
• Coughing may cause blood to come out or blood to come out of the lungs.
• Pain in the chest is possible.
• The frequency of respiratory movements is more than 20 per minute.
• Feeling of weakness, fatigue, emotional lability.
• Bad appetite.

Diagnostics

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

Treatment of pulmonary tuberculosis (infiltrative and focal)

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

Essential drugs

There are contraindications. Specialist consultation is required.

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

What to do if you suspect a disease

• 1. Blood test for tumor markers or PCR diagnostics of infections
• 4. CEA test or Complete blood count

• Blood test for tumor markers

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

• PCR diagnostics of infections

  A positive result of PCR diagnostics for the presence of the causative agent of tuberculosis with a high degree of accuracy indicates the presence of this infection.

• Blood chemistry

  In tuberculosis, an increase in the level of C-reactive protein can be observed.

• Biochemical study of urine

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

• CEA analysis

  In tuberculosis, the level of CEA (cancer-embryonic antigen) is increased (70%).

• General blood analysis

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

• Fluorography

  The location of focal shadows (foci) in the image (shadows up to 1 cm in size) in the upper parts of the lungs, the presence of calcifications (rounded shadows, comparable in density to bone tissue) is typical for tuberculosis. If there are many calcifications, then it is likely that the person had a fairly close contact with a patient with tuberculosis, but the disease did not develop. Signs of fibrosis, pleuroapical layers in the picture may indicate past tuberculosis.

• General sputum analysis

  With a tuberculous process in the lung, accompanied by tissue breakdown, especially in the presence of a cavity communicating with the bronchus, a lot of sputum can be secreted. Bloody sputum, consisting almost of pure blood, is most often observed in pulmonary tuberculosis. In pulmonary tuberculosis with cheesy decay, sputum is rusty or brown in color. Fibrinous convolutions consisting of mucus and fibrin can be found in sputum; rice bodies (lentils, Koch lenses); eosinophils; elastic fibers; Kurschmann spirals. An increase in the content of lymphocytes in sputum is possible with pulmonary tuberculosis. The determination of protein in sputum can be helpful in the differential diagnosis between chronic bronchitis and tuberculosis: in chronic bronchitis, traces of protein are determined in sputum, while in pulmonary tuberculosis, the protein content in sputum is higher and it can be quantified (up to 100-120 g /l).

• Rheumatoid factor test

  The indicator of rheumatoid factor is above the norm.

Publication date: 11-11-2012

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

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

According to clinical manifestations, acute, acute, subacute and chronic forms of disseminated pulmonary tuberculosis are distinguished.

The most acute form of disseminated pulmonary tuberculosis - such as Landuzi's typhobacillosis - is observed in children and adolescents during the period of primary tuberculosis. It proceeds with the phenomena of pronounced intoxication: adynamia, general weakness, loss of appetite, severe headaches, temperature up to 39-40 °, often hectic in nature, chills, night sweats, cyanosis, dry cough, shortness of breath (the number of breaths reaches 30-40 per minute) ; tachycardia, pulse up to 100-120 beats per minute. In the study of changes in the lungs and heart are not observed. The abdomen is soft, usually painless on palpation. The liver and spleen are enlarged (hepato-lienal syndrome). On the part of the blood, leukopenia with a shift to the left, eosinopenia, lymphopenia, monocytosis. Albumin-globulin ratio is reduced to 0.7-0.8. ESR increased to 40 mm per hour. Mycobacteria are usually not found in sputum. Urine in most patients without pathology.

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

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