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4. Lung cavity syndrome

REASONS: The formation of a cavity in the lung is usually preceded by compaction of the lung tissue. Most often, this is inflammatory infiltration (abscesses, lung gangrene, staphylococcal destruction of the lungs, pneumonia, tuberculosis), tumor decay, pulmonary infarction. SYMPTOMS:

  1. Shortness of breath, often a productive cough, possibly hemoptysis;

  2. Lag in the act of breathing of the affected half of the chest;

  3. Strengthening of voice trembling and bronchophony;

  1. Percussion: a blunt-tympanic sound is determined. With a large cavity located on the periphery, tympanic sound is observed;

  1. Auscultatory: bronchial, and sometimes amphoric breathing, sonorous medium and large bubble rales are revealed.

It should be emphasized that all these signs are determined in the presence of a smooth-walled cavity of at least 4 cm in diameter, located close enough to the surface of the chest containing air, connecting to the bronchus and surrounded by a densified lung tissue. In the absence of these conditions, the cavity in the lung remains "dumb" and is detected only during x-ray examination.

  1. X-ray (linear tomography, CT) signs of a cavity syndrome in the lung are limited enlightenment of a round or oval shape, usually against a background of blackout. A horizontal level of fluid in the cavity is characteristic if it communicates with the bronchus and contains exudate and air.

Pic 2.2 Linear tomography

5. The syndrome of fluid accumulation in the pleural cavity

REASONS: As a rule, a complication of another disease.

The causes of transudate are heart failure, kidney disease - nephrotic syndrome, hypo- and dysproteinemia.

The causes of exudate are inflammation of the pleura (pleurisy) of various etiologies (infectious exudate in pneumonia, abscess, tuberculosis; non-infectious exudate in malignant tumors, autoimmune diseases, uremia), wounds, trauma (hemothorax), chylous exudate (x). SYMPTOMS:

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  1. respiratory dyspnea;

  1. On examination - protrusion and limitation of mobility of the corresponding side, smoothing of intercostal spaces;

  1. Palpation - increased resistance of intercostal spaces, weakening or absence of voice trembling;

  1. Percussion - dullness or absolute dullness over a liquid; directly above its level - a blunt-tympanic sound; the appearance of a dull sound on the healthy side due to displacement of the mediastinal organs (with large effusions); downward hepatic dullness. (Damuaso Line, Rauchfus-Grocco and Garland Triangles).

  1. Auscultatory - the presence of fluid suggests the absence or weakening of breathing and bronchophony, and above the fluid level in the Garland triangle - a bronchial shade of breathing (on the effusion side).

  1. X-ray homogeneous dimming is determined in the lower part of the pulmonary field with a characteristic oblique upper border for exudate and a more horizontal upper border for transudate. In the latter case, the process is often two-way. There is a shift in the mediastinal organs to a healthy side.

Pic 2.4 The line of Damoiso-Ellis-Sokolov (1); The Garland Triangle (2)

and the Rauchfus-Grocco Triangle (3) with exudative pleurisy.

Pic 2.5 Left-

sided exudative pleuritis

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Table 2.1 Differential diagnostic signs of exudates and transudates.

Type of effusion

Transudate

Exudate

Relative density

Usually

below

1.015;

rarely

Not

lower

than

1.015;

(with

compression of

large

usually 1.018

vessels by a tumor) - above

1.013-1.025

Coagulation

-

+

Color

and

Almost

transparent;

lemon

Serous

exudates

in

transparency

yellow or light yellow

appearance

do not

differ

from

transudates;

other

types

of

exudates

are

cloudy;цвет различен

Rivalt's reaction

-

+

Содержание белка

<30 g / l, usually 5-25 g / l

> 30 g / l, usually 30-50 g / l,

in purulent - up to 80 g / l

Cytological

There are few cellular elements;

There

are

more cellular

study

common

elements

than

in

mesothelial cells, red blood cells,

transudates. The number of

sometimes

lymphocytes

cellular elements,

their

predominate;

types and condition depend

after

repeated

punctures

on the etiology and phase

sometimes - eosinophils

of

the

inflammatory,

oncological processes