Radio diagnostics of the breathing organs inflammatory diseases.

Bronchitis

Bronchitis (see fig 16.1) is inflammation of bronches, which is clinically shown up by a cough with plenty of sputum, increase of the body temperature, stuffiness, and intoxication.

At an acute bronchitis a roentgenological pattern is inexpressive. Only in the case of heavy motion, strengthening of lung pattern is marked, sometimes visible dual strips of the thickened walls of bronches of the 3-4th orders and them U-like forks.

A chronic bronchitis is characterized by strengthening and deformation of lung pattern. The walls of bronches are thickened roentgenological determined as dual linear shades (symptom of "rails") and ring-shades in the case of axial location of bronches in anterior alion of x-ray irradiation. On bronchograma the inequality to the contour of bronches is noticeable, openings of mucus glands are extended, the amount of bronchial branches is diminished. Almost half of the patients with a chronic bronchitis have a normal roentgenological pattern, and pathological changes can appear through complication - pneumonia or emphysema.

Fig.16.1. Bronkhoectasis is on a sciagram and CT

Pneumonia

Modern classification of pneumonias: 1) unhospital (domestic); 2) hospital (arises up through 48 hours after patient`s hospitalization); 3) aspirational; 4) for persons with an immunodeficiency.

Pneumonia is an inflammation of lungs with involvement in the inflammatory process of all of component parts of pulmonary tissue: bronches, bronchiols, alveoles, connecting tissue and other. Pneumonias classify on ethiology (bacterial, viral, mycotic), clinical motion (acute, chronic, atypicial), clinico-morphological description (lobar, segmentar, interstitial).

Acute pneumonia begins suddenly and shows up the increase of temperature of the body to 38-39°, by headache and pain in the thorax, which increase during a cough. A cough at first is dry, then moist. Wheezes and crepitation appear. In bloodwe can be seen hypergranulocytosis, increase of ESR, eosinophylia, and thrombocytopenia. Pathanatomichaly in the area of inflammatory infiltration, alveolus are filled with exudate.

Lobar (crupous) pneumonia in our time rarely will strike all of lobe and limited by 1-2 segments, that is why it is often named segmentary pneumonia. Roentgenological distinguish 3 stages of lobar pneumonia: wave, hepatisation and permitios.

Fig.16.2 Crupous pneumonia is in the stage of hepatisation and permitios

In the stage of wave, that lasts about 1-2 days, there is a wave of blood in pulmonary vessels. There is strengthening of lung pattern in the area of defeat, root lungs is extended, without a clear structure, and the bulge of adjoining pleura appears in the case of subpleural location of pathological process. Stage of hepatisation, that lasts 3-9 days, characterizes the expressed inflammation with exudation of blood plasma rich on a fibrin to the alveoles, the thrombosis of small vessels and necrosis of pulmonary parenchym is possible. Roentgenological - homogeneous shade of the middle intensity appears with protuberant scopes. From the side of interlobar fissure shade has an even clear contour, because inflammation does not spread on surrounding lobes. At localization of pneumonia in the superior or middle lobe a low bound can be protuberant from the increase of volume and weight of lobe and its "sagging", or through the development of concomitant interlobar pleurisy. The image of air strips of forks bronches (symptom of "air bronchography") is saved, that facilitates differential diagnostics with and cancer of lungs. In the stage of permitios, that lasts usually 7-10 days, takes place dilution and proteolise of fibrin. Intensity of the homogeneous darkening diminishes roentgenological, beginning from superior and middle departments of the lobe. A lung pattern, extended and a root is unstructured lungs, is enriched, thickened an interlobar pleura can be observed yet during a month after convalescence.

Bronchopneumonia (see fig 16.3) is inflammation of separate pulmonary lobes and their groups, rarer acinus. More frequent all pneumonic hearths are disposed in inferior lobes, possibly in both lungs. Roentgenological observed calculation of focal shade of middle intensity with unclear contours, small or large sizes (micro- or macro-focal pneumonia) which quite often meet between it self, forming the whole areas of infiltration of considerable departments of segment or lobe (pneumonia with confluent foci). At the level focal shades a lung pattern is washed out, root lungs infiltrated. Typical for focal pneumonias is a rapid changeability of roentgenological pattern: during 4-6 days symptoms grow, and in 10-12 days of hearth resolve fully. The bronchopneumonia, as a rule, is develops from bronchitis, when an inflammatory process from bronches spread to pulmonary parenchyma and focal shades disposes after bronchial motion.

Interstitial pneumonia is caused by various viruses. Endothelial of capillaries and interstitial tissue, which surrounds vessels, bronches, acinuses is struck. Clinically shows up intoxication (headache, cold, cough, and feverish state), stuffiness, and cyanosis. Physical changes are not expressed: percution of changes are not discovered, auscultation - hearkened unset, fine moist and dry rales. Roentgenological in lungs from one or both sides there are focal shades of different size with different contours, strengthening and deformation of lung pattern, the structure of root diminishes. As a result of joining of bacterial infection in parenchym there are infiltrative changes on the type of micro-focal pneumonia. Such mixed interstitial parenchymatous pneumonia has the protracted motion - to 2 months.

Fig.16.3 Bronchpneumonia

Fig.16.4. interstitial pneumonia

It is possible to define localization and prevalence of process more precisely by computer tomography before the changes of pulmonary tissue appear at acute pneumonia.

The pneumonia complicated by an abscess (see fig 16.5)- festering inflammation of pulmonary tissue and its disintegration with formation of cavity which arises up usually in 2-3 weeks from the beginning of acute pneumonia. In motion of acute abscess distinguish 3 stages: 1) festering infiltration and forming of festering cavity, when intensity of shade of acute pneumonia grows roentgenological, and its contours are round; 2) emptying (drainage)of the festering cavity through a bronchus, when roentgenological ring-shade of abscess appears with a thick wall and horizontal level of liquid; 3) absorbtion and scarring, when the thickness of wall of abscess diminishes, the cavity of abscess acquires extended, later fissural forms and in 2-3 months is substituted by a scar.

Fig.16.5. Pneumonia complicated by an abscess