Transparency change of the lung field

Brightening on a lung’s sciagram is diffuse or local. The diffuse increase of lungs transparency is observed at emphysema (hyperinflation of pulmonary tissue) and at pneumothorax (a presence of air in the pleura cavity). Local increase of transparency arises up at valvular (bullouz) emphysema, partial pneumothorax and presence of large cavities which contain air (e.g. air cyst, tubercular cavity).

The diminishing of lung’s transparency over are brought by diminishing of air maintenance in it, exudation of liquid in teethridges, infiltration of pulmonary parenchym by an inflammatory process, excrescence of connecting tissue, tumour.

Diffuse, or the total darkening is the result of corkingof the main bronchus and of the proper lungs, diffuse excrescence of connecting tissue (by a cirrhosis) of the lungs, total exudative pleurisy, pneumonia, delete lungs. For differential diagnostics of these pathological states it necessary to pay attention to homogeneity of shade and presence of mediastinal organs displacement.

Local or limited shades are described after an amount, localization, form, sizes, contours, intensity, and structure.

The shades are distinguished after an amount - single (2-3 shades), plural (more than 3 shades).

Location of the shade is determined by the sciagrams in 2 projections. Shades in the apex and superior pulmonary fields often have tuberkular ethiology, shades in the middle and inferior fields are the reflection of inflammatory or tumour process.

The shades distinguished after a form: oval, ring-shaped, three-cornered, linear and indefinite form of shade. The rounded and oval shades give a peripherial cancer, tubercular infiltrate, tuberkuloma, and echynococcus, bening tumours.

The size of pathological shades measure in millimetres and centimetres. Shades to 2 sm are named focal, greater - infiltrative. If the shades occupy the whole segment or lobe, they are described as segmentare and partial. Focal shades are divided into shallow (acinar, miliar) a size to 2-3mm, middle (nodose) a size to 1 sm, large (segmentar) a size 1-2 sm; they are observed at tuberculosis, metastases of malignant tumours, acute pneumonias. Infiltrative shades appear at inflammatory processes of lungs and malignant diseases. Segmentar and partial shades can be seeing at croupous pneumonia in the stage of hepatisation, local pneumosclerosis. Volume education by a size to 2 sm, which appears on tomograms, called a solid node, anymore than 2 sm - by mass.

Contours of the shade can be clear or unclear, even or unequal (jagged). Of innocent and chronic pathological processes have a clear and even contour, unclear and unequal - malignant and cancer.

Intensity of the shade can be small, middle and large. On the shade background of small intensity a lung pattern is traced, middle intensity - not traced, but visible shade of rib. Intensive shades recover the image of vascular pattern and ribs.

The structure of shades is homogeneous or heterogeneous (non-homogeneous). Homogeneous shades give atelectasis; cyst filled with the liquid, exudative pleurisies, croupous pneumonias in the stages of hepatisation, of bening tumours. Heterogeneous shades are typical for malignant tumours, bronchopneumonia, complicatrd by an abscess and chronic interstitial pneumonias.

Changes of lung’s roots and lung’s pattern

Expansion of lung’s roots and strengthening of lung’s pattern specifies on either side, as a rule, on stagnation in the small circle of blood circulation, predefined the mitral deformity of heart which is accompanied the change of the heart configuration. Expansion of lung’s roots with the loss of his structure specifies on the increase of bronchopulmonare lymphatic nodes, for children usually as a result of tubercular lymphadenitis, for people of old years - as a result of tumours of lymphatic nodes, pneumosclerosis and others. At pneumosclerosis there is also strengthening and deformation of lung pattern, sclerosis of aortal arc. Expansion, deformation and displacement of root, is lungs upwards observed through fibrous changes in roots at fibrous-cavernous and cirrhotic tuberculosis.

Strengthening (enriching) of the lung pattern shows up in the increase of amount and size of linear shades of pulmonary vessels and distribution of him to periphery. The diffuse bilateral strengthening of the lung pattern is observed at mitral and some born hearts defects which are accompanied by increasing of pressure in the vessels of blood circulation in the small circle. Strengthening of lung pattern within the limits of one segment, lobes or lungs is at croupous pneumonia in the stage of hyperemia and at incomplete atelectasis. A lung pattern increases and deformes at excrescence of connecting tissue in lungs at pneumosclerosis, cirrhosis, as a result of the protracted tubercular process, chronic bronchitis, and chronic pneumonia.

The impoverishing of lung pattern is met at emphysema, large air cysts, born heart defects of from increasing of pressure in the vessels of blood circulation in the small circle, stenosis of opening of the pulmonary barrel.

Changes of diaphragmal shade and mediastinal organs position

Reason of pride of place of diaphragm cupula can be diaphragm relaxation as a result of paresis of diaphragm nerve, atelectasis or cirrhosis of lobe lungs, increases of liver, subdiaphragmal abscess, and ascites. A diaphragm occupies low position at emphysema, exudative pleurisy, and pneumothorax. Deformed diaphragm contour is through diaphragm hernia, pleura accretions, uneven reduction of parts of diaphragm muscle.

Displacements of the shade of mediastinal organs in a healthy side cause an exudative pleurisy, emphysema, partial pneumonia, mediastinal tumours, and in a side patology - cirrhosis, aplasy of the one lung.

Roentgeno-functional signs of thoracal organs state. The state of thoracal organs is studied in the process of respiratory, reductions of the heart, change of the body position and others like that. A respiratory function is estimated after the excursion of diaphragm, which can be normal (4-6 sm), megascopic, diminished, absent, paradoxical. Shade of pathological education in lungs, related to the thorasic wall, moves upwards during inhalation and downward during exhalation, and intrapulmonal - vice versa, down at inhalation and up at exhalation. Shades of not dense educations (e.g. cysts, limited exudative pleurisy) some narrow in the moment of inhalation, and to exhalation -broaden.

1) Goltsnecht-Yakobson’s symptome is push-like displacement of mediastinum organs toward hypoventilasion or atelectasis during the forced inhalation;

2) Prozorov’s symptom is a displacement of mediastinal organs in a healthy side during the forced exhalation or couhg shove; 3) respirator emphysema`s symptome is saving of high transparency of lobe or segment after inhalation in the case of valvular mechanism of violation ventilation.

At sufficient pulmonary ventilation there is a substantial difference of the lungs transparency in the moment of maximal inhalation and exhalation (Falconi`s test). At emphysema this difference will be little expressed.

At presence of free liquid in a pleura cavity there is its moving during examination sick in different positions: on the back, on the anterior , on a side.

An independent pulsation is incident to physiology (heart, aorta) and pathological educations (aneurysm of aorta, pulmonary artery, arteriovenous aneurysm). Pulsational transmission displacements look after physiology (to the esophagus) and pathological (cysts) educations which adjoin to the heart or aorta.

Theme № 15 Radio diagnostics of the breathing organs inflammatory diseases.

Radio diagnostics of the breathing organs acute and chronic inflammatory diseases: bronchitis; pneumonias and their complications (abscess, destruction, pleurisy); pneumo-, hydro, hydro-pneumothorax |.