Dense foci in the lungs cause. Our addiction forums

I.E. Tyurin

Focal formations in the lungs are an independent radiological and clinical syndrome; in most cases, they are asymptomatic and are detected during preventive x-ray studies.

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

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

Single foci occupy intermediate position, and their estimate in to a large extent determined by the specific clinical situation (for example, lung cancer screening, history of extrathoracic malignancy, etc.). The presence of a single focus is one of the main criteria for the AOL syndrome.

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

Main task radiological examination in AOL is a non-invasive differential diagnosis of a malignant and benign process, as well as the identification of forms of pulmonary tuberculosis among them. In some cases, this is possible due to characteristic features detected on radiography or routine computed tomography(CT).

However, the specificity of most of these symptoms is low, therefore, for the correct assessment of TRL, it is necessary to involve additional methods and alternative technologies. These include an assessment of the growth rate of the focus in the lung, an analysis of the probabilistic factors of malignancy, the dynamics of accumulation contrast medium 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.

Obviously, in everyday 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 guidelines is an accurate assessment of the opportunities provided by individual diagnostic methods and their combinations.

Identification of single foci 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 survey radiographs or fluorograms, it is rarely possible to identify a single focus with a size<1 см.

Even larger lesions may be missed due to interposition of anatomical structures (cardiac shadow, lung roots, ribs, etc.) or the presence of so-called distractions, such as malformations or cardiac pathologies. More than 90% of all AOLs seen on x-rays can be retrospectively detected on previous x-rays 1 or even 2 years old.

CT is gaining more and more importance in the diagnosis of pulmonary lesions, which can be performed both in case of suspicion of the presence of AOL according to radiography, and for other indications (to exclude pneumonia, when examining patients with chronic obstructive pulmonary disease and emphysema, etc.). In general, CT allows to detect 2-4 times more foci in the lung tissue than radiography, while the average size of detected foci 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 the small size of the foci (CT sensitivity in detecting foci of 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 typically above 95%.

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

Anatomical assessment of single lesions in the lungs X. Evaluation of the skiological features of the OOL according to X-ray or CT data is of great importance for differential diagnosis. The foci can be divided by size, nature of the contours, structure, density, condition of the surrounding lung tissue. Almost all signs have a probabilistic value, being more or less characteristic of a benign or malignant process.

Only in exceptional cases, on the basis of radiological data, a nosological diagnosis can be assumed. So, the presence of fatty inclusions is typical for hamartoma, ring-shaped or total calcification of the focus is usually observed in tuberculomas, the presence of an adductor and efferent vessel, along with a typical enhancement during contrast, distinguishes arteriovenous malformations.

The localization of the focus in the lung tissue is not of fundamental importance, since exceptions and coincidences are observed here too often. More than 70% of lung cancer foci 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 characteristic of lung cancer that occurs against the background of idiopathic pulmonary fibrosis. Tuberculous infiltrates located in the lower lobes are more often localized in their apical segments.

The foci in the lung tissue can have different contours: even or uneven (wavy, bumpy), clear or indistinct (radiant or blurred due to the “frosted 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 radiance of contours, 93% of lesions with uneven and 82% with wavy contours were malignant.

With a focus >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 with benign diseases, but are also constantly observed in solitary metastases, individual histological forms of lung cancer (squamous, small cell) and lung 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 focus in themselves are not signs of a benign process and cannot serve as a reason to complete the diagnostic process.

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

• foci of the type of "frosted glass";
• mixed or partially solid lesions;
• foci of a solid type.

Foci of the "frosted glass" type are characterized by low density, against their background, the walls of the bronchi, the contours of the 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, fibrotic 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, there is a tumor focus of the “ground glass” type, which in most cases is not visible on radiographs and linear tomograms.

Foci 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 foci usually occur around old scars in the lung tissue, including post-tuberculous ones. In most cases, they represent the growth of a glandular tumor. Up to 34% of non-solid lesions are a malignant tumor, and among the lesions of a partially solid type, the size<1,5 см этот показатель достигает 50%.

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

The structure of the AOL, detected by CT, can be different: homogeneous, with areas of low density due to necrosis, with air, fatty, liquid and high-density inclusions, with visible bronchial lumen. None of these symptoms is specific to any particular pathological process, with the exception of the already mentioned fatty inclusions in hamartomas.

With conventional radiography, it is possible to reveal only a part of calcifications and air inclusions in the form of cavities, air cells (honeycombs, pores) or bronchial lumens. With CT, calcifications in the OOL are detected 2 times more often than with conventional X-ray examination. Calcifications can be focal (like “popcorn”), layered (including in the form of calcification of the focus capsule) and diffuse, occupying the entire volume of the focus.

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 exceptionally high. In malignant foci, including adenocarcinomas, punctate or amorphous, without clear contours, calcium inclusions are often detected.

In general, the frequency of calcifications in peripheral cancerous tumors according to CT data reaches 13%. Exceptions to this rule are ground-glass lesions on CT scans and lesions of any structure on x-rays that represent bronchioloalveolar carcinoma. Patients with such lesions require longer follow-up.

Another factor limiting the possibilities of dynamic or retrospective follow-up is the size of the ROL.<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, great importance is now attached to the computer assessment of the volume of foci according to spiral CT data, when the computer builds three-dimensional models of the identified foci and compares their volumes. This technique, which is an integral part of CAD systems, is designed for solid lesions and cannot be used with confidence for ground-glass and partially solid lesions.

Probabilistic analysis. Clinical assessment of patients with identified AOL is of great importance in the differential diagnosis, although it is often underestimated by the attending physicians and radiologists. Probabilistic analysis takes into account the quantitative value of risk factors or their absence to suggest the nature of the AOL. Using such calculations, it is possible to determine the individual risk of a malignant tumor in a particular clinical situation. This takes into account both clinical factors and radiological symptoms.

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

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

The factor of prolonged smoking and amorphous calcifications in the focus, 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 on dynamic CT. Evaluation of the blood supply of the LL with dynamic helical CT has shown its effectiveness in numerous studies. It is known that the density of the OOL in a native study varies widely and does not have any diagnostic value (except for the inclusions of fat and calcium).

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

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

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

Despite the high sensitivity to malignant tumors, the technique has a number of disadvantages. These include the difficulty of estimating 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 lesions. Meanwhile, it has been shown that an increase in density by more than 25 HU and a rapid decrease by 5-30 HU using MSCT is typical for malignant neoplasms. Benign lesions are characterized by an increase in density of less than 25 HU (in some cases, the density increases by more than 25 HU, but then there is a rapid decrease in more than 30 HU or no decrease in density at all). If we choose an increase threshold of 25 HU and a density reduction range of 5-30 HU, then the sensitivity, specificity, and overall accuracy of the technique in relation to malignant tumors will be 81-94, 90-93, and 85-92%, respectively.

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

Numerous studies have shown that PET has 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 examination, followed by a 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 essential to rule out a malignant AOL, but false-negative findings can be seen in primary ground-glass lung tumors and lesions sized<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 evidence of malignancy, morphological verification is required prior to any treatment. 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 of taking material from the pulmonary lesion, including transthoracic needle aspiration and biopsy, transbronchial biopsy, videothoracoscopic resection of the lesion followed by biopsy, and open biopsy with minithoracotomy. Transthoracic biopsy is performed under the control of fluoroscopy, CT, and in recent years - more and more often with CT fluoroscopy. Transbronchial biopsy is usually performed under fluoroscopy guidance. Puncture of lesions adjacent to the chest wall can be performed using ultrasound guidance.

Transthoracic fine-needle aspiration biopsy of lung lesions using CT and CT-fluoroscopic guidance for malignancy has a sensitivity of 86% and a specificity of 98%, 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 biopsy, the sensitivity of which in these categories reaches 62 and 69%, respectively. Complications of transthoracic biopsy (predominantly pneumothorax and intrapleural bleeding) occur in approximately 25% of patients. After a biopsy, no more than 7% of patients need to install a drain, so this procedure can be performed on an outpatient basis. Contraindications for biopsy are severe respiratory and heart failure, severe emphysema, the location of the focus in close proximity to the diaphragm or pericardium.

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

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

In any case, the modern approach requires HRCT when an AOL is detected on radiography, fluorography, or conventional CT. Finding and studying any previous lung scans is another mandatory step.

The result of these actions may be the selection of a group of patients with an obviously benign process, as evidenced by: the absence of the dynamics of the focus for >2 years, the presence of “benign” calcifications, inclusions of fat (hamartoma) or fluid (cyst) in the focus according to CT For these patients only observation is needed. 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 (lesion > 1 cm with radiant uneven contours, ground-glass and mixed solid lesions, which should be regarded as potentially malignant), which require morphological verification in a specialized medical institution.

All other cases are regarded as intermediate or indeterminate. The most numerous group among them are patients with newly diagnosed AOL (in the absence of an X-ray archive) >10 mm in size, soft tissue density, with relatively clear even 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. Expectant management and dynamic observation are allowed here only in exceptional cases, justified by clinical expediency.

A separate group consists of patients with non-calcified foci of size<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 probability of a malignant process in foci 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 in the detection of 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 focus in the lungs is a localized area of ​​increased compaction, which has a round or oval shape and reaches 30 millimeters in diameter. The causes of such seals can be different and to establish them, an examination by a doctor and an x-ray is 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 tissues).

There is a widespread belief that the factor provoking the occurrence of foci 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 organs of 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 with the help of an individually tailored treatment regimen.

Sometimes people are in no hurry to take diagnostic tests due to the remoteness of the laboratory from their place of residence. It is highly undesirable to neglect laboratory tests, since without treatment, the focus in the lungs begins to be secondary.

Features of the foci in terms of anatomy

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

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

If you believe the statistics, then from 60 to 70 percent of single foci in the lung tissue that recur after treatment are malignant tumors. That is why much attention is paid to the development of new diagnostic methods in this area.

To date, the following diagnostic procedures are widely used:

1. Computer examination, including tomography, which allows you to determine the size of the foci 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 foci are found in the lung tissues. Each case of illness is individual and should be considered separately from general practice.

Solitary foci in the lungs: possibilities of radiodiagnosis

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

The main tasks of radiation diagnostics of foci in the lungs:

1. Using these methods, it is possible to identify the nature of the origin of foci 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, with the help of radiography and fluorography, it is extremely difficult to see single formations with a diameter of less than 1 cm. In addition, due to the various structures that are anatomically located in the sternum, it is sometimes impossible to distinguish large-scale foci in the lungs. Therefore, in the diagnosis, more preference is given to computed tomography. It makes it possible to examine the lung tissue from different angles and even in section. This eliminates the possibility that single formations will be indistinguishable behind the heart muscle, ribs or lung root.

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. So, in about 50% of cases of primary research, neoplasms with a diameter of less than 5 millimeters are not detected in the photo. This is due to such difficulties as finding foci 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 accuracy of diagnosis with computed tomography reaches 95 percent.

Tuberculosis facts and figures

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

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. With sputum into the air, one patient with tuberculosis secretes from 0 to 000 mycobacteria. They spread within a radius of 1-7 meters.
3. Koch's wand is able to survive even at negative 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 stick lives up to one year, and in books - six months.
4. Mycobacterium very quickly adapts to antibiotics. In almost every state, a type of tuberculin bacillus has been identified that is not sensitive to existing drugs.
5. 1/3 of the world's population are carriers of the tuberculosis bacillus, but only 10 percent of them have had an active form of the disease.

It is important to remember that, having been ill with tuberculosis once, a person does not acquire lifelong immunity and can suffer the disease again.

Are medical masks useful?

Scientists from Australia conducted a series of scientific studies and 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 (permanent work in the intensive care unit, tuberculosis).

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

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

With the help of computed tomography, the classification of foci in the lungs is carried out. It can also be used to identify whether a single or multiple focus has affected the lung, and also to suggest the most adequate treatment. This diagnostic procedure is one of the most reliable to date. Its principle is that X-rays act on the tissues of the human body, and then a conclusion is made based on this study.

If any lung disease is suspected, the doctor refers the patient to a CT scan of the chest. All segments of this part of the body are perfectly visible on it.

Depending on the location, the foci are divided into two categories:

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

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

Lung lesions on CT: classification of formations

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

Depending on the size of the formation in the lungs are divided into:

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

Based on density:

• not dense;
• medium-dense;
• dense.

By number:

• polymorphic foci in the lungs - multiple formations with different density and different sizes. Foci polymorphism is characteristic of tuberculosis or pneumonia;
• single foci.

If the foci 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, what it is, has been received. It must be remembered that in order to exclude any diseases in the lungs, one cannot neglect such a simple procedure as annual fluorography. It takes a few minutes and is able to identify any pathologies in the lungs at an early stage.

Lung lesions

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

Results - in comparison with the first - without dynamics.

At the border of S2.3, in S4 of the right lung, in S3.4 of the left subprevious and in the lateral sections along the course of the vessel, foci of the same size are preserved.

Subprevally in S8 lev. Lung - a single focus up to 0.6 cm. The rest of the length was not found. All - as well as 1 result.

The conclusion was given - signs of bronchitis. Foci, probably of an inflammatory nature.

According to the latest blood tests - an excess of alkaline phosphatase - 342UL, a-amylase - 282.2. creatinine and urea are normal. Well, ESR - over the past year - jumps from 17 to 27. Now - 17. wanted to be hospitalized. To treat the pancreas and general condition. But because of these foci, they are sent to a phthisiatrician. Scared me. Now antidepressants don't help me anymore. Maybe you will find something to suggest to me and express my opinion about such foci. Yes. no cough. I can’t even imagine how to pass sputum - since it doesn’t exist) Thank you in advance for your answer. With uv. Tatiana.

Also do not forget to thank the doctors.

pulmonologist3 22:56

pulmonologist3 23:01

Thanks again for your understanding and helpful 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 waiting room wanted to put me right away in the department of borderline conditions. In general - while in the gastro. But I had a consultation with a good psychiatrist. I added one more medicine. In general, we treat both.

I hope I get through.

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

Why do foci in the lungs occur and why are they dangerous?

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, it is necessary to conduct special examination methods: blood tests, sputum, tissue puncture. This happens with malignant tumors, pneumonia and impaired fluid exchange in the respiratory system.

What are foci in the lungs?

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.

Free legal advice:

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.

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;
• swelling 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.

Disadvantages of tomography

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.

Varieties of focal formations

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:

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:

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.

Related video: Focal formations in the lungs

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What are foci in the lungs

It is customary to call a focus a small, round, polygonal, or irregularly shaped formation in the lung tissue, up to 1-1.5 cm in size, identified radiographically.

Limited dissemination - these are numerous foci scattered in the lung field over a limited extent (no more than two intercostal spaces).

Scattering of multiple foci throughout one or more often both lungs gives a syndrome of diffuse dissemination.

Diseases giving focal shadow syndrome

1. Concussion and bruising of the chest, inhalation of hot vapors and poisonous gases, aspiration of food masses, water (during drowning), blood (during pulmonary hemorrhage), exposure to ionizing radiation
2. Circulatory and fluid exchange disorders in the lungs: heart attack, pulmonary embolism, pulmonary edema
3. Inflammation: acute focal pneumonia, focal tuberculosis
4. Allergic lesions: infiltration and edema 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 foci are caused by inflammatory changes (acute pneumonia, focal pulmonary tuberculosis), less often by peripheral cancer or a 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.

Foci in the lungs

Lesions in the lungs often attack the respiratory organs, since many of their diseases cause cavities that are similar in appearance and purpose to foci. Such education in the respiratory organs is dangerous to health, especially if the patient is not going to treat the pathology. The causes of the formation of foci are various ailments that greatly impair the functioning of organs. In most cases, when diagnosing a disease that causes seals or cavities, it will not be enough for a 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 make an accurate diagnosis.

What diseases can cause a single or multiple dense focus

Foci in the lungs - what can it be? The opinion that a single or multiple focus causes only pulmonary tuberculosis is considered erroneous. Many diseases of the respiratory organs can lead to the development of foci, so they should be paid special attention when making a diagnosis.

If the doctor noticed 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 system;
• neoplasms in the lungs, which are not only benign, but also malignant;
• pneumonia;
• cancer, in which there is a large-scale damage to the organ.

Therefore, in order to correctly diagnose the diseased, it is necessary to examine it. Even if the doctor implies that pneumonia caused inflammation, before prescribing a therapeutic course, he needs to conduct a sputum analysis in order to be sure of the correctness of the diagnosis.

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

The genesis of pulmonary foci is not always favorable for a person, this indicates serious violations in the work 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 lesion of the lungs - what is it? This pathology is a serious disease, during the development of which seals begin to appear in the lung tissue, resembling foci in appearance.

Depending on their number, such neoplasms have a different name:

1. If the patient after the tomography showed only one focus, it is called single.
2. If a patient has several neoplasms 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 various shapes are found in the lungs, they are called multiple. Doctors call this condition the syndrome of dissemination.

Today there is a slight difference in the concept of definition, what are pulmonary foci that develop in the cavity of the respiratory system. This difference is formed in the opinions of scientists from our country and foreign researchers. Abroad, doctors believe that a single or secondary focus, seen in the respiratory system, is a small compaction of a round shape. At the same time, the diameter of the neoplasm does not exceed 3 cm. In our country, seals larger than 1 cm are no longer considered foci - these are tuberculomas or infiltrate.

It is important to note that the examination of the affected lung on a computer, which is called tomography, helps to accurately identify the type, size and shape of neoplasms that have appeared in the tissues of the lungs. However, do not forget that this method often has failures.

A focus in the lungs, what could it be? As mentioned earlier, various diseases can cause the appearance of a focus. Why do they need to be treated immediately after detection? The fact is that often diseases re-attack the respiratory organs of a person. In 70% of cases, a secondary disease is considered malignant, which means that the wrong tactics of its treatment 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 consist in 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 foci in the respiratory organs, it will be necessary 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 would be carried out.

Lesions in the lungs on CT, the classification of formations allows us to understand their type and cause of occurrence, so this procedure must be completed 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 doctors are not always able to make a correct diagnosis of the patient? To detect the course of tuberculosis, pneumonia or other diseases, the desire of doctors alone is not enough. Even if all analyzes are carried out and correctly deciphered, imperfect equipment will not allow to identify some foci of the disease. For example, during a trip to x-ray or fluorography, it is impossible to identify foci with a diameter of less than 1 cm. Also, it is not always possible to correctly examine large foci, which aggravates the diagnosis of pathology.

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

Features of the disease

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

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

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

For example, often with tuberculosis of the lungs, seals are located in the upper parts; during the development of pneumonia, the disease evenly 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 seals, which are different for each type of disease.

Having found one or another symptom of pulmonary diseases, it is necessary to consult a doctor who will prescribe a series of studies, and then prescribe the correct treatment that can benefit the patient's body.

Signs of the development of compaction in the lungs include:

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

WHAT IS A FOCUS IN THE LUNG TISSUE?

A pulmonary focus is a limited area of ​​reduced transparency of the lung tissue (darkening, compaction) of small size, detected by 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. In Western terminology, the term "node" or "center" about a blackout less than 3 cm in size is indicated; if the diameter of the area is greater than 3 cm, the term "mass formation" is used. The Russian school of radiology traditionally calls an area with a diameter of up to 10-12 mm a "center".

If radiography or computed tomography (CT) reveals one such area, we are talking about a single (or solitary) focus; when several areas are found - about single foci. With multiple foci, capturing to one degree or another the entire lung tissue, they speak of, or dissemination of foci.

This article will focus on single foci, their radiological manifestations, and medical actions when they are detected. There are a number of diseases of a very different nature, which can manifest as a focus on x-rays or computed tomograms.

Solitary or single foci in the lungs are most common 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

The detection of a single nodule on a chest x-ray poses a challenge faced by many clinicians: the differential diagnostic series for such changes can be long, but the main challenge is to determine whether the nature of the lesion is benign or malignant. The solution of this issue is key in determining the further tactics of treatment and examination. In controversial and unclear cases, in order to accurately determine the benignity or malignancy of a focal lesion, a Second Opinion is recommended - a review of CT or X-ray of the lungs in a specialized institution by an experienced specialist.

METHODS FOR DIAGNOSTICS OF LUNGS IN THE LUNGS

The primary method of research is usually a chest x-ray. With it, most of the solitary pulmonary foci are found by chance. Some studies have examined the use of low-dose chest CT as a screening tool for lung cancer; 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 lung lesions.

The criteria for benignness of the identified focus 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 found on radiographs. These patients are not likely to be malignant and require periodic chest x-rays or CT scans every 3 to 4 months for the first year and every 4 to 6 months for the second year.

LIMITATIONS AND ERRORS OF DIAGNOSIS METHODS

Chest X-ray is characterized by better resolution than CT in determining the severity of calcification and its size. At the same time, visualization of some pulmonary nodules can be complicated due to overlaps of other organs and tissues.

The use of CT is limited by the high cost of this study and the need for intravenous contrast, 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 than CT and MRI, and the availability of these diagnostic methods may vary.

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 is located outside it. In order to clarify the localization of changes, radiography is performed in the lateral projection, fluoroscopy, CT. Nodules usually become visible on radiographs when they are 8–10 mm in size. Occasionally, nodules as small as 5 mm can be found. On radiographs, you can determine the size of the focus, its growth rate, the nature of the edges, the presence of calcifications - changes that can help evaluate the identified node as benign or malignant.

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

Node size

Nodules larger than 3 cm are more likely to reflect malignant changes, while those smaller than 2 cm are more likely to be benign. However, the size of the node itself is of limited value. In some patients, small nodules may be malignant, while large nodules may reflect benign changes.

Node Growth Rate

Comparison with previously performed radiographs allows us to estimate the growth rate of the focus. The growth rate is related to the time it takes for the tumor to double in size. On radiographs, the node is a two-dimensional image of a three-dimensional object. The volume of a sphere is calculated using the formula 4/3*πR 3 , therefore, an increase in the diameter of a 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 increase in volume of 8 times.

The doubling time for bronchogenic cancer is usually 20–400 days; the time interval required to double the volume, which is 20–30 days or less, is characteristic of infections, pulmonary infarction, lymphoma, and rapidly growing metastases. If the volume doubling time is greater than 400 days, this indicates benign changes, with the exception of a low-grade carcinoid tumor. The absence of changes in the size of the node for more than 2 years with a high degree of probability indicates a benign process. However, it is impossible to determine the size of the focus without error. On a chest x-ray, estimating a 3 mm increase in nodule size can be difficult; measurements on radiographs after digital processing allows you to more accurately determine the size of the focus.

The contours of the hearth

Nodules of a benign nature usually have well-defined, even contours. Malignant nodules are characterized by typical irregular, multicentric, spiky (crown radiant) margins. At the same time, the most significant sign that allows us to assume the malignancy of the changes is the radiance of the edges; extremely rarely, malignant tumors have smooth edges.

Calcined

Deposits of calcium salts, calcifications are more typical for benign focal formations, however, they are also found on CT in approximately 10% of malignant nodes. In benign processes, five typical types of calcification are commonly found: diffuse, central, laminar, concentric, and popcorn. Calcifications in the form of "popcorn" are characteristic of hamartomas, dotted or eccentrically located calcifications are observed mainly 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. Volumetric formation of the left lung - hamartoma. Calcification in the form of "popcorn".

LUNGS ON CT - WHAT IS IT?

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

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

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

X-ray density of the focus on CT

With the help of computed tomography, a certain indicator can be measured - the attenuation coefficient, or the x-ray density of the focus. Measurement results (CT densitometry) are displayed in units of the Hounsfield scale (Unit X, 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: 60 to 160 EX

Calcified Node: Over 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, the measurement of density helps to detect fatty tissue inside the node, which is a sign of its goodness, especially in cases of hamartoma.

CT with contrast enhancement

Malignant nodes are usually richer in blood vessels than benign ones. The assessment of the contrast enhancement of the node is performed by measuring its density before and after the introduction of contrast with an interval of 5 minutes. Less than 15 density increase X suggests a benign nature of the node, while a contrast enhancement of 20 units. X or more is characteristic of malignant lesions (sensitivity 98%, specificity 73%).

Symptom of the feeding vessel

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

The wall thickness of the cavity formation

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 us to conclude that the formation is benign or malignant.

MAGNETIC RESONANCE IMAGING (MRI) OF THE LUNGS

When staging lung cancer, MRI provides better visualization of lesions in the pleura, diaphragm, and chest wall compared to CT. At the same time, MRI is less applicable in assessing the lung parenchyma (especially for detecting and characterizing focal pulmonary changes) due to lower spatial resolution. Because MRI is more expensive and less readily available, it is used as a back-up for tumors that are difficult to assess with CT (eg, Pancoast's tumor).

Ultrasound of the lungs

Ultrasonography is infrequently used in the evaluation of solitary lung lesions; this method is of limited value and is used to guide percutaneous biopsy of larger nodes located in the peripheral regions.

RADIONUCLIDE DIAGNOSTICS OF FOCAL LUNG CHANGES

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 United States for the evaluation of intrapulmonary nodules.

PET-CT

Malignant neoplasm 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. Chest PET uses a compound of a radioactive fluorine nuclide with a mass number of 18 and a glucose analog (F 18-fluorodeoxyglucose, FDG). An increase in 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 unify values ​​based on patient weight and amount of radioisotope administered, allowing comparison of radiopharmaceutical uptake at different lesions in different patients. A standardized accumulation factor value greater than 2.5 is used as a "marker" for malignancy. Another advantage of FDG PET is better detection of mediastinal metastases, which allows for more optimal staging of lung cancer.

SPECT

The advantage of single photon emission tomography (SPECT) over PET is greater availability. Scanning 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 non-invasive techniques to differentiate between malignant and benign lesions and to assist in the evaluation of lesions of uncertain nature.

Confidence level of PET and lung SPECT

Using the meta-analysis, the mean sensitivity and specificity for detecting malignancy in focal lung lesions of any size was 96% and 73.5%, respectively. In the case of pulmonary nodules, the sensitivity and specificity were 93.9% and 85.8%, respectively.

Errors in PET-CT of the lungs

In FDG PET, false-positive results may be due to metabolically active nodules of a different nature, such as infectious granulomas or inflammatory foci. In addition, tumors with low metabolic activity, such as carcinoid tumor and bronchioloalveolar carcinoma, may not show up at all. At high serum glucose concentrations, it competes with FDG in cells, resulting in a decrease in the accumulation of the radioisotope.

Vasily Vishnyakov, radiologist

Paul asks:

Hello, I am 22 years old, 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 lesions in the lung parenchyma, more data for focal tuberculosis." More specifically: Lung fields of regular shape, normal density, lung pattern is not deformed. In the lower lobes on both sides - additional focal formations of medium intensity with fuzzy even contours. On the left S8 5mm, on the right in S10 5.5mm, also in S1 of the right lung 2mm in diameter. Lobar and segmental bronchi are well traced. Volumetric pathological formations in the anterior, middle and posterior mediastinum were not detected, the lymph nodes of the mediastinum were not enlarged, the fluid in the pleural cavities was not detected. Heart, blood vessels, chest are normal. I feel satisfactory, but there is a rare dry cough for several months now. Please tell me your opinion about the CT scan, how dangerous such a diagnosis is, whether a full recovery is possible. Thank you in advance!

The data obtained speak in favor of the tuberculous process. You need to consult a phthisiatrician and take a course of anti-tuberculosis therapy in a timely manner. With timely therapy, the percentage of recovery is very high, but it is necessary to follow all the doctor's instructions, because. treatment is quite long and combined.

Paul asks:

Hello! Thanks for your answer! I continue the examination already at the phthisiatrician, and my additional tests (blood, urine, Mantoux) showed that I am healthy. And most importantly, X-ray did not show a single focus in the lungs. How is it that CT showed three foci, FG showed two shadows, and the x-ray is clean? Naturally, I do not want to have tuberculosis, but I have been coughing for almost a year, what if I miss timely treatment? What else can be done to clarify the diagnosis?

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

Katya asks:

Hello. My friend is 21 years old. He has been smoking since he was 18. There are no more bad habits. The FG snapshot SHOWED ONE BLACKOUT. The phthisiatrician looked at the picture and said that he had a closed form of tuberculosis at an early stage. Whether me interests the tuberculosis can 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.

Catherine asks:

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

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

Catherine asks:

Can a person suffering from a closed form of tuberculosis infect a person through close contact (kissing, sex)?
And if a person suffering from a closed form of tuberculosis began timely treatment and recovered, can tuberculosis return? And for what?
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. harmless to others. Treatment of tuberculosis can be long, it must continue until complete recovery, most often, a patient with an uncomplicated form of tuberculosis is cured completely and without relapse. But, in case of incomplete treatment, non-compliance with medical recommendations, malnutrition, smoking, drinking large amounts of alcohol or drugs, this disease can 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 CT, my husband (39 years old) was diagnosed with tuberculosis, but the final diagnosis has not yet been established, they have some doubts. Preliminary D-z: 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. Which is what we did.
Results:
1. In the upper lobes, centrilobular bullae are defined from 7 to 111 mm with thin walls. Against this background, in S2 of the right lung, soft tissue foci of 3-6 mm with clear contours and a homogeneous structure are visualized.
2. Broncho pattern is not changed.
3. The mediastinum is structural, not displaced. Trachea without features.
4. Bronchi of 1-3 orders are passable, not deformed.
5. The diaphragm is usually located, its contours are even, clear.
6. Pleural cavities - without features.
7. Intrathoracic nodes are not enlarged.
CONCLUSION: Foci in/lobe of the right lung. Bullous emphysema of both lungs in/lobes.
QUESTIONS:
1. Is bullous emphysema related to tuberculosis or is it a separate disease?
2. What does centrilobular bullae mean? What is air or liquid in them?
3. Does this test confirm lung decay?
4. What is your prognosis - is this form curable to the end?

Thank you for being you. I'm looking forward to the answer, I'm really scared.

Bullous enphysema can be as a result 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, and can also occur in smokers. There is air inside the bullae, but accumulation of mucus may form at the bottom. The presence of soft tissue foci 3-6 mm with clear contours, homogeneous structure, may indicate the presence of foci without decay. With timely treatment under control, the prognosis is favorable.

svetlana asks:

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

svetlana says:

HELLO, WE ARE JUST NOW PLANNING A CHILD, FIRST THEY TOLD MY HUMAN THAT PNEUMONIA, THEN IT WAS FOUND THAT TUBERCULOSIS IS CLOSED FORM, I WANTED TO ASK IS IT POSSIBLE TO PREGNANT OR NOT YET? OBSERVED AND TREATED BY A PHTHISIATOR.

It is not recommended to plan a pregnancy during the treatment of tuberculosis, because. such specific treatment negatively affects spermatogenesis and the ability to fertilize. Only after the end of 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. what is it, and is it contagious? I am 29 years old, I would not like 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 skin surface, an accurate diagnosis will be made and adequate treatment will be prescribed. It is necessary to exclude trichophytosis, lichen. In this case, it can be a contagious disease, it is recommended to limit contact with family members, do not use other people's pillows, a comb. Read more about this disease in a series of articles by clicking on the link: Deprive.

Julia asks:

Hello! My mother (age 57) has been wheezing in her lungs for 8 months, and for the last 3 months she has had a dry cough and for two weeks her temperature rises to 37.2, she catches her breath when she takes a deep breath, she took x-rays twice, the doctors said it was bronchitis or there was pneumonia. A CT scan was done, the conclusion: in the area of ​​\u200b\u200bthe middle lobe and S6 of the right lung, uneven extensive areas of fibrosis are determined (probably of a post-inflammatory nature).
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, fluid accumulation is determined, with a layer thickness of up to 9 mm. Single paratracheal and bifurcation lymph nodes of the mediastinum are visualized. Bone destructive changes at the studied level are not revealed. Tell me, are these symptoms of what disease? Could it be an oncological disease.

Svetlana asks:

Hello! My husband is suspected of having tuberculosis, but Koch's bacilli were not found in the sputum, they did CT. The mediastinum is not displaced. The pulmonary fields are of the correct shape, their airiness is increased. and paraseptal emphysema with the formation of bullae ranging in size 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 associated with dilated bronchi were visualized. The cavities are separated from each other by fibrous septa 0.3-0.6 cm thick, adjacent to thickened apical and costal pleura. There are small calcified foci in the surrounding lung tissue. The segmental and subsegmental lumens are unevenly expanded, their walls are compacted, with calcifications. In S4 on the left, there are multiple foci of lung tissue compaction 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 can be traced well, of regular shape, the walls are compacted. The heart and large vessels are of normal size, usually located. Differentiate subaortic, lower paratracheal, bifurcation, lymph nodes up to 0 ,7 cm. Additional formations in the mediastinum were not found. In the pleural cavities and in the pericardial cavity without pathological contents.
Analyzes are all normal, dry, rare cough without sputum. In 1995, pneumothorax was transferred, in 2010, CT scan showed a cyst on the left lung and emphysema. Could this be tuberculosis in an open form?

Dima asks:

Hello. Calcifications were found on my linear tomogram. Then they made an x-ray and here is the conclusion: in the upper lobe of the left lung, apical stratifications and single foci of medium intensity, adhesions of the pleura and diaphragm in the n / d remain. . There is a subfebrile temperature for about two and a half years (37-37.3.4) twice noticed blood coughing up in the sputum. Yes, and a very strange cough since December, as if coming from one lung - from the left.

Vagif asks:

I would like to argue with any doctor. That tuberculosis can be treated, even the most neglected forms. I myself was sick and they told me well, you can last half a year. It was 1982. It's time to admit that doctors cannot fully treat.

It is possible to cure tuberculosis, but the success of treatment is largely determined by the form and stage of the disease, the fulfillment of medical prescriptions, the availability of appropriate living conditions, etc. You can get more detailed information on the issue you are interested in in the relevant section of our website by clicking on the following link:. The control of treatment, as well as the picture of the disease in dynamics, can be assessed using the methods of laboratory and instrumental diagnostics, which are used in modern medical institutions.

Vagif comments:

tell me I can advertise. and cure tuberculosis with my elixir in three months.

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

Olga asks:

hello. contours, with a diameter of 5 to 15 mm., with cords to the pleura. 2, a draining bronchus approaches the decay cavity. In S6, the lower lobe is easy. the centers contain inclusions of amorphous calcium. In S8, pr. is easy, subpleural, there is an area of ​​local pneumofibrosis, 2.8 * 1 cm in size. Please tell me, this is very scary and what is it? I don't experience any symptoms. Thank you

In this case, it is possible that you have repeatedly endured bronchitis, pneumonia. 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 question you are interested in in the relevant 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 check for the presence of tubes. Everything is normal. Today they did a dioxin test, if it is in order, does it make sense to lie further? Doctors refer to the area of ​​decay, they say, if there is decay, then there should be a wand, we will look for it. They will send me for bronchoscopy, but I'm 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 in any case. I recommend that you continue monitoring with a phthisiatrician. You can get more detailed information on the question you are interested in in the relevant section of our website by clicking on the following link: Diagnosis of tuberculosis

adile asks:

I have closed tuberculosis multi. who has been in treatment for 2 years. I was told in the hospital I should be treated for 8 months. There are patients here with open tubes. I'm afraid it will get 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 question you are interested in in the relevant section of our website by clicking on the following link: Treatment and prevention of tuberculosis

NATALIA asks:

HELLO! WE HAVE GRANDPA AFTER 2 ISHEMS OF STROKE, TREATED, WRITTEN OUT WITH A RECOMMENDATION TO A TB PHYSICIAN WITH THE DIAGNOSIS OF TUBERCULOSIS. WE TAKE IMAGES, EXTRACT AND GO TO THE RECEPTION WITHOUT IT, BECAUSE HE IS LYING, MAYBE, IF HE HAS TUBERCULOSIS, MAKE A REGISTER, MAYBE WHAT PILLS WILL BE PRESCRIBED AND IS THERE A RISK OF INFECTING, THE DOCTOR LOOKED THE IMAGE, SAID HE HAS NOTHING T. IN THE EXTRACT IS WRITTEN THE TOMOGRAPHY OF THE LUNGS-FOCAL TVS S1 OF THE LEFT LUNG, THE PHASE OF SEAL. WE LIVE TOGETHER, WE CARE. IS THERE A DANGER FOR US?

To make a diagnosis of tuberculosis, a comprehensive assessment of the results of all studies, as well as an examination of the patient, is required. It is also necessary to pass a sputum test, which will determine the form of tuberculosis - open or closed. In the absence of bacillus shedding, there is no risk to others. Consider seeing grandpa at home with a TB specialist. 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 that it began in 2011, now the characteristic signs are cough, chest pain, sputum, temperature. please tell me what are the chances to recover? the doctor said that it is possible, but she lives in the provinces and they are negligent in their duties, if they did not reveal it back in 2011, tell me what to do?

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

veronica asks:

Hello, I am 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 sticks were found in the sputum. Treatment was prescribed 1 regimen of chemotherapy and additional treatment: FBS with brush biopsy and cons. oncologist, endocrinologist (I have hypothyroidism) Subsequent surgical treatment Everything is fine. Within 2 months she took drugs and was examined, the diagnosis was VC efficiency, significant positive dynamics of partial resorption of inf-that of the upper lobe of the left lung. Surgical treatment is not indicated, small forms. came sowing, the result is negative, the treatment was left with 2 drugs rifampicin and isoniazid. And now the paradise phthisiatrician says that I need to go through either a sanatorium or inpatient treatment without fail. Sanatorium treatment is voluntary, but do I need treatment in a hospital with such a course of the disease and positive dynamics?

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

Evgeniya asks:

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

The risk of re-infection is possible, but it is minimal. We recommend that you consult with your phthisiatrician in detail. 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

Natalia asks:

I have had a bad FG for 7 years now, I feel fine, there was no long-term cough, except for colds, during this time I didn’t get sick with anything, I gave birth to two children. What could it be besides tuberculosis?

Unfortunately, it is not possible to assess the situation without examining the images, so we recommend that you do an additional spirogram, take a sputum test, complete blood count and personally visit a pulmonologist. Changes in the fluorogram can be in 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 clicking on 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 currently undergoing treatment.
Currently undergoing treatment, taking antibiotics Linamide 500mg pyrazinamide
Rifampicin
Amikacin, the course of injections has already passed, he goes to physical therapy! I gave sputum, blood tests show good! I checked with my doctor, took tests, fluorography, in general, all the tests and they are good, I'm healthy! How can we be, we want a baby! Is it possible to get pregnant if such a situation has developed! Will it affect the pregnancy, will not affect the baby!

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

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Focal pulmonary tuberculosis is characterized by the presence of various genesis 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 those who first fell ill with tuberculosis, focal forms are diagnosed in 15-20% of cases. Its main features are limited lesions and localization in the region of the apex or upper lobe of the lung. There are soft-focal and fibro-focal pulmonary tuberculosis. According to the modern classification of tuberculosis, soft-focal- this is focal tuberculosis in the phase of infiltration, i.e. a fresh form of the disease that needs to be treated.

Fibrofocal- 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 system. In size, all foci 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. As a rule, this form of tuberculosis of secondary origin occurs due to:

a) exogenous superinfection;

b) endogenous reactivation of old (calcified) tuberculous foci, scars or indurative fields formed after suffering in the past

Reactivation of post-tuberculous changes occurs as a result of the transformation of the L-forms of the pathogen that can multiply. The reversion of Mycobacterium tuberculosis is facilitated by various causes that reduce the acquired immunity. These include acute and chronic diseases (influenza, NLD, diabetes mellitus, peptic ulcer of the stomach and duodenum, pneumoconiosis, drug addiction, alcoholism, AIDS, mental disorders). Reactivation can also be promoted by exogenous superinfection.

Pathomorphology

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

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

Symptoms of focal tuberculosis

Most patients with focal tuberculosis do not report any symptoms of the disease. At the same time, with focal tuberculosis, symptoms of intoxication and symptoms of damage to the respiratory system can be observed. Intoxication syndrome is manifested by prolonged low-grade fever, decreased appetite and performance, sweating, and malaise. Patients may complain of coughing with little sputum. Symptoms of intoxication are typical for fresh (mild-focal) forms of focal tuberculosis, i.e. focal tuberculosis in the phase of infiltration, and lesions of the respiratory organs - for chronic (in the phase of compaction).

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

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

The tops 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 tops is determined by dullness, and during auscultation, breathing may be weakened or hard, 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 can develop.

Patients with focal forms in the phase of infiltration and in the phase of compaction 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 compaction phase are considered cured and need only periodic general rehabilitation.

Forecast

Favorable - complete resorption of pathological changes (occurs with foci with a diameter of up to 5 mm). Relatively favorable - the formation of petrificates, segmental pneumosclerosis. Unfavorable - the progression of the process. Focal tuberculosis develops in the decay phase, which can turn 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 with 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 acinus. In typical cases, patients indicate hypothermia, acute onset with symptoms of pharyngitis, high body temperature, significant cough, chest pain. Often, wet 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 the radiograph with pneumonia, the foci of low intensity, monomorphic, with blurry contours, are more 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 found in sputum, but in unexplained cases, this study should be carried out repeatedly.

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

Diagnosticcriteria for bronchopneumonia:

• often occurs against the background or after an acute respiratory disease, hypothermia;
• has an acute (sudden) onset with severe clinical manifestations (febrile temperature, chills, severe weakness, poor appetite, cough with sputum, chest pain, sometimes there is shortness of breath at rest);
• hard breathing, wet and dry rales are heard over the lungs;
• in the blood test - a 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 more often localized in the lower lobes;
• the pulmonary pattern is enhanced throughout the lung fields due to hyperemia. The shadow of the roots of the lungs is expanded;
• treatment with broad-spectrum antibiotics gives a positive trend after 7-10 days (resorption of foci).

In cases where it is impossible to accurately establish the diagnosis, pneumonia is first treated with broad-spectrum antibiotics, 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 in tuberculosis). If we also take into account that on the radiograph at this stage the shadow of the cancerous tumor is small, has an irregular polygonal shape with fuzzy contours, then it is very similar to a tuberculous focus. 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 you have to differentiate it from.

It should be taken into account that the cancer node is always one, and with focal tuberculosis, as a rule, a group of polymorphic foci is visible. Therefore, the identification of one isolated focus> a person (usually a man), older than 40 years, should always be considered from the point of view of a possible malignant tumor. Unlike focal tuberculosis, which is located mainly in the 1st segment, the predominant localization of cancer is the lower part, the 3rd (anterior) segment. In segment 2, both pathological processes are equally likely.

Symptoms appear only in the later stages of the development of a cancerous tumor, when it reaches neighboring anatomical structures. The most constant symptom is pain, not associated with the act of breathing, unmotivated shortness of breath is less often noted, sometimes hemoptysis, and with focal tuberculosis, intoxication syndrome prevails. In the hemogram of patients, anemia, increased ESR is sometimes detected, 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 with catheterization of the bronchus with the taking of material for cytological and bacteriological examination. Some help in establishing the diagnosis can be provided by radioisotope and radioimmunological methods of research.

Diagnosticcriteria for peripheral lung cancer:

• cancer is more common in men over 40 who smoke a lot;
• the onset is asymptomatic, broncho-pulmonary-pleural symptoms (cough, hemoptysis) predominate;
• X-ray: one focus, with fuzzy contours, on 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 contours of the shadow, represented by short strands - "rays" extending into the adjacent lung tissue. They form a picture of a "malignant crown"; the contour of the shadow of peripheral cancer has a Rigler notch;
• the shadow of a tumor of medium intensity, inhomogeneous (as if it consists of several small formations, merge), calcified inclusions are observed;
• Mantoux test with 2 TU PPD-L may be negative, which is not observed in focal tuberculosis;
• in the treatment of anti-tuberculosis drugs, the progression of malignant formation occurs.

metastaticcancer- there are several similar roundish (coin-like) lesions with clear contours that occur in different parts of the lungs.