The most characteristic radiological sign of pulmonary emphysema. What is pulmonary emphysema and how is it treated? Causes and mechanism of development of pulmonary emphysema

On an X-ray of the chest organs (CH) in frontal and lateral projections, with an increase in the airiness of the lungs, the following radiological syndromes are observed:

• enlightenment;
• expansion of intercostal spaces;
• barrel chest;
• deformation of the pulmonary pattern;
• decreased structure of the roots of the lungs;
• smoothness of the contours of the diaphragm domes;
• drip heart.

Attention! The barrel-shaped chest with emphysema is clearly visible in the lateral projection image, which visualizes an increase in the anteroposterior size (the distance between the sternum and the spine).

X-ray of the lungs in a lateral projection: an increase in the anteroposterior size with emphysema is clearly visualized

X-ray morphological symptoms are secondary. They appear due to the expansion of the chest due to an increase in lung capacity.

Other radiomorphological symptoms of excess air in the lung tissue:

• forward deviation of the sternum;
• horizontal arrangement of ribs;
• expansion of the anterior mediastinum;
• symmetrical protrusion of the chest anteriorly.

Radiological symptoms of emphysema are also observed in the lungs:

1. Increase in the area of ​​the lung fields.
2. Diffuse transparency enhancement.
3. Local areas of clearing in places of accumulation of emphysematous bullae.
4. Redundancy of the pulmonary pattern.

During the disease, the dome of the diaphragm deviates downwards due to the pressure on it from the increased size of the lungs. With severe disease, the dome of the diaphragm becomes like a “tent” - a pointed roof, with which the shadow of the heart merges.

Functional X-ray diagnostic syndromes

Functional X-ray diagnostic syndromes arise due to increased ventilation in the lung tissue. As the elasticity of the alveoli decreases, their volume increases. As a result, the internal cavity of the alveolar acini is filled with air. X-rays, passing through such anatomical formations, are not delayed, so a clearing is formed in the image.

The difference in X-ray contrast is clearly visible in the lower (basal) parts of the lungs, where active ventilation occurs.

To correctly read a picture of emphysema, radiologists perform the following tests:

1. When exposing the patient's chest, the right dome of the diaphragm is covered with a screen so that its upper edge is in the lower part of the rectangle. With emphysema, there is a restriction in the mobility of the diaphragm in a rectangle measuring 5x5 cm.
2. Sokolov's method: a series of photographs are taken on a small film (13x18 cm) in different phases of breathing (inhalation, exhalation and while holding the breath). In a healthy person, there is a difference in contrast between these images. With emphysematous lesions of the lung tissue, the difference is not noticeable.
3. The method of targeted images involves taking a series of targeted radiographs in areas of pronounced airiness during maximum inhalation, exhalation and respiratory pause.

Sight image of the right half of the chest with emphysema. It shows a total increase in transparency (clarification)

What does an x-ray tell you about increased transparency?

X-rays provide the clinician with a lot of information about the state of the lung fields. Classic plain radiography of the lungs makes it possible to establish a diagnosis, but it does not always correctly reflect the nature of the pathological process that formed the airiness of the pulmonary fields. In such a situation, a non-standard OGK x-ray is used, and computed tomography is used. It is more informative, but is characterized by increased radiation exposure, so it is used only in cases of extreme necessity.

Maximum benefit from computed tomography in cases of suspected bullous emphysema (with the formation of large air cavities). To identify the characteristics of the course of other forms of pathology, it is better to use magnetic resonance imaging.

X-rays can also be used to differentiate between the following types of emphysema:

The primary form is not associated with narrowing of the bronchi. Detecting it early can prevent complications, so radiologists must be very careful when reading images of the lungs.

In the secondary form of the disease, x-rays are less informative, since during the study it is impossible to view the internal structure of the bronchi, where chronic inflammatory changes accumulate.

The localized type of the disease is even more difficult to diagnose. Local small foci of increased airiness are very difficult to identify on images, since the affected areas are small, and X-rays are not reflected from the airy tissue.

No matter how informative an x-ray is when diagnosing emphysema, you cannot rely only on its signs, since the layer-by-layer image is quite deceptive.

CT and X-ray diagnostics of pulmonary emphysema

Signs of emphysema on x-rays

When interpreting radiographs, it is often necessary to differentiate pulmonary emphysema from clearing caused by other reasons. Thus, a dark (in negative photographs) image may indicate not emphysema, but an overexposure. Thus, an incorrect choice of voltage (kV) and current (mA*s) can lead to the fact that the pulmonary fields will be too dark, and the pulmonary pattern will not be visualized (especially in the periphery). In some cases, on the images one lung field appears darker than the other - this situation may be associated with the incorrect position of the screening grid; changes on the radiographs should not be regarded as emphysema.

A “dark” image resulting from overexposure should not be confused with emphysema!

On the left, the difference in the transparency of the lung fields is due to the incorrect position of the screening grid, while on the right, in the lower parts of the lung field, the increased transparency of the lungs on the x-ray is due to emphysema

When performing chest x-rays in patients with a history of mastectomy (on one side), a similar picture can be found - one lung field is darker than the other. In this case, the situation is associated with an uneven decrease in the volume of tissue through which X-ray radiation passes. If the patient is positioned incorrectly (during rotation) or with scoliosis, an asymmetry in the transparency of the pulmonary fields can also be detected, which is again associated with different volumes of tissue on the right and left sides.

Signs of pulmonary emphysema on radiographs include: “rarefaction” of the pulmonary (vascular and reticular) pattern; sign of “break” of pulmonary vessels (dilated branches of the pulmonary arteries abruptly “break” at the periphery of the pulmonary fields); flattening of the domes of the diaphragm, as well as obliteration of the anterior costophrenic sinus (can be detected on a radiograph in a lateral projection).

Changes in radiographs with pulmonary emphysema can be conditionally divided into 4 types, none of which, however, is pathognomonic, but all of them, together with clinical data, quite accurately make it possible to establish the diagnosis of emphysema. These include: - Changes in the chest. Often with pulmonary emphysema, x-rays can reveal an expansion of the chest, an increase in its anteroposterior and bilateral dimensions. The chest is barrel-shaped, the intercostal spaces are expanded, and the posterior segments of the ribs have a horizontal course.

Changes in the lung tissue. The main sign of emphysema on radiographs is an increase in the transparency of the lung fields, which, however, must be critically assessed (the conditions listed above must be taken into account). The pulmonary pattern can be “strengthened” (due to pneumosclerosis) or “sparse” (if there are no signs of pneumosclerosis yet). The root of the lung looks expanded (due to the pulmonary arteries) and has a “comma” shape. When bronchography with pulmonary emphysema, the picture resembles a “tree without leaves” due to the lack of filling of small-caliber bronchi with contrast. Functional radiography reveals no difference in the size of the retrosternal and retrocardial space.

Changes from the diaphragm. With emphysema, the right and left domes of the diaphragm are flattened and deformed (changes in the contour of the shadow of the diaphragm in the form of “folds” and all kinds of bulges can be detected). More often, the anteromedial portion of the dome of the diaphragm on the right side bulges, which creates a “double contour” effect on x-rays.

Changes in the heart and blood vessels (aorta, pulmonary artery). With pulmonary emphysema, one can observe the development of the so-called. “pulmonary” heart, with expansion of the shadow of the right ventricle (shift of the shadow of the heart on radiographs to the right). The arch of the pulmonary artery may also bulge.

Signs of emphysema on computed tomography

Emphysema is usually called dilatation of the airways located peripherally - distal to the terminal bronchioles, with destruction of the walls of the alveoli. There are three main types of emphysema (which can be detected on CT): panlobular (all alveoli of the pulmonary lobe are dilated), centrilobular (only the respiratory bronchioles are dilated), and paraseptal (characterized by distribution along the pleura).

Thus, the main signs of emphysema on computed tomography are: zones of increased pneumatization of lung tissue, which alternate with areas of normal structure and density, having clear contours. The density of these areas during exhalation increases minimally or does not increase at all (compared to normal lung tissue). The diameter of the pulmonary vessels near areas of emphysema is reduced.

The centrilobular type of emphysema is characterized by damage to the respiratory bronchioles, while the peripheral parts of the pulmonary lobule remain unaffected. Thus, with centrilobular pulmonary emphysema, CT scan can detect small zones of increased airiness localized inside normal lung tissue, as well as a decrease in the diameter of the pulmonary vessels. This type of emphysema is often found in smokers.

Centrilobular and panlobular emphysema. On the left, number 1 indicates the dilated terminal bronchiole, number 2 indicates normal alveoli; on the right, the number 3 marks the dilated alveoli

With panlobular pulmonary emphysema, computed tomography reveals dilated alveoli and alveolar ducts. Damage to lung tissue is usually diffuse: areas of swelling merge with each other, normal lung tissue is represented by separate “islands,” and there is a significant decrease in the vascularization of lung tissue. The lower lobes of the lungs are predominantly affected. In the final stage, it becomes impossible to distinguish between centrilobular and panlobular emphysema.

Paraseptal emphysema is characterized by expansion of the alveoli, which are directly adjacent to the pleura, as well as to the vascular-bronchial bundles. Clinically, this type of emphysema is the most favorable, since the volume of damage to lung tissue is small, and lung function is extremely slightly impaired. Most often, the paraseptal type of pulmonary emphysema can be detected by CT scan in the area of ​​the apexes of the lungs, in the area of ​​the costophrenic sinuses, as well as along the course of large vessels and bronchi.

1 – bullous elements are adjacent to the pleura, 2 – located along the bronchi and vessels

Congenital lobar emphysema appears on CT scan of the lungs as a zone with increased pneumatization of the lung tissue and reduced vascularization. Mediastinal shift may also be detected. The cause of lobar emphysema is stenosis of one of the lobar bronchi (most often the left upper lobe, less often the right middle lobe and right lower lobe bronchus). Swire-James syndrome manifests itself on computed tomography as follows: one lung has increased pneumatization and is depleted of blood vessels compared to the opposite side. Swire-James syndrome is the result of lung damage in the first years of life as a result of long-term obliterating bronchiolitis.

Schematic representation of areas of increased airiness during computed tomography of the lungs: 1 - pneumatocele - a cavity in the lung (most often of a traumatic nature), which has very thin walls, 2 - a cyst in the lung, has walls of uneven thickness (from 1 to 3 mm on average), 3 – bullae (cavities in the lung with thin walls, resulting from the destruction of the walls of the alveoli), 4, 5 – cavities in the lungs with abscesses, tumors with decay, tuberculosis cavities (have walls of uneven thickness, often irregular shape), 6 – changes in type “honeycomb lung” (areas of bullous and cystic transformation of lung tissue alternate with areas of pneumosclerosis)

Signs of pulmonary emphysema on computed tomography – in the area of ​​the apex of the right lung, areas with increased airiness are visualized, with walls of uneven thickness (pulmonary cysts)

CT signs of emphysema of the apices of both lungs

The patient has signs of pulmonary emphysema. CT. On the right, in the basal sections, multiple areas of increased airiness of the lung tissue are visualized (multiple bullae merging with each other), on the left - multiple bronchiectasis (marked with blue arrows)

Severe pulmonary emphysema. CT. Note multiple bullous elements in the lung parenchyma on both sides, as well as a giant bulla in the left lung

Bullous transformation of the lungs in a patient with emphysema. CT.

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Emphysema

X-ray diagnostics. The X-ray semiotics of pulmonary emphysema is very diverse and reflects certain pathomorphological and pathophysiological changes at various stages of this disease. Currently, most authors divide all radiological symptoms of pulmonary emphysema into morphological and functional.

X-ray morphological symptoms, reflecting changes in the shape and size of the difficult cell, are secondary and, as a rule, indicate advanced phases of the course of pulmonary emphysema. The most characteristic sign of severe pulmonary emphysema is the so-called barrel-shaped deformation of the chest (Fig. 3), especially clearly identified when examined in the lateral projection due to the predominant increase in the anteroposterior size, i.e., the distance between the sternum and the spine. Three factors contribute to this: a more horizontal position of the ribs than normal, kyphosis of the thoracic spine and anterior protrusion of the sternum. Protrusion of the sternum - a frequent and important symptom of pulmonary emphysema - is usually combined with another significant symptom - expansion of the anterior mediastinum and its increased transparency (“gaping” of the anterior mediastinum). At the same time, in the lateral projection, a noticeable increase in the distance between the sternum, on the one hand, and the shadow of the heart and great vessels, on the other, is noted. This occurs as a result of the heart and great vessels being pushed posteriorly by the expanded anterior sections of the lungs.

In the anterior projection, a noticeable symmetrical protrusion of the lower parts of the chest can be observed, over which, in severe cases of pulmonary emphysema, a kind of “waist” is formed, as a result of which the chest takes the shape of a bell or an hourglass (Fig. 4).

X-ray morphological symptoms are also observed in the lungs. Along with a general increase in the area of ​​the lung fields (mainly due to expansion of the vertical dimensions) and a diffuse increase in their transparency, local areas of increased transparency may be detected due to the formation of multiple large emphysematous bullae, local emphysema or acute swelling of individual areas of the lung (lobe, segment). These local areas of clearing, observed more often in the basal parts of the pulmonary fields, are of great diagnostic importance.

Most authors consider changes in the pulmonary pattern to be characteristic of pulmonary emphysema - its redundancy, sometimes deformation, since pulmonary emphysema is usually combined with pneumosclerotic changes. Some authors consider the redundancy of the pulmonary pattern to be a consequence of peribronchial and perivascular pneumosclerosis, others - the result of an increase in the contrast of vascular shadows against the background of increased pneumatization of the lung, and others - a consequence of stagnation of blood in the arterial vessels as a result of narrowing of the capillary bed of the pulmonary circulation. Apparently, all these factors are important both on their own and in their mutual combinations.

With emphysema, the diaphragm also undergoes changes. Its dome is located lower than usual, flattens, and in rare cases may even bend down slightly. The costophrenic sinuses dilate. In severe cases of pulmonary emphysema, the dome of the diaphragm takes the shape of a tent or a pointed roof, with the top of which merges the shadow of the so-called hanging, centrally located, small-sized heart (Fig. 5).

The most important X-ray functional symptom of pulmonary emphysema - impaired pulmonary ventilation - is associated with loss of elasticity of lung tissue and a decrease in vital capacity of the lungs (VC).

The fluoroscopic density (transparency of the lung fields) of normal lungs varies significantly with the phases of breathing. During inhalation, there is a significant clearing of the lungs compared to exhalation. This difference is especially noticeable in the basal parts of the lungs, which take a more active part in the process of pulmonary ventilation compared to other parts. With pulmonary emphysema, this difference is reduced to one degree or another, and in severe cases almost completely disappears. In these changes in the transparency of the lungs during maximum inhalation and exhalation, vital vital capacity is radiologically displayed.

The simplest and most effective way of x-ray assessment of pulmonary ventilation during transillumination is to limit by diaphragming on the x-ray screen a section of the lung above the right dome of the diaphragm measuring approximately 5 x 10 cm so that in the lower third of this vertical rectangle there is an edge of the dome of the diaphragm, which allows you to simultaneously monitor the respiratory excursions of the diaphragm.

With emphysema, along with a decrease in the difference in the transparency of the lungs during deep breathing, there is a significant decrease in the amplitude of movements of the diaphragm, which in severe cases of emphysema can become completely motionless, and sometimes make paradoxical movements (upward with a deep breath) due to upward movements of the anterior parts ribs

For radiographic recording of pulmonary ventilation disorders in pulmonary emphysema, Yu. N. Sokolov proposed the following method (Fig. 6). Using a tunnel cassette, a series of three photographs are taken on a small film (13x18 cm) under identical exposure conditions, but in different phases of breathing: respiratory pause, maximum inhalation, maximum exhalation.

In a healthy person, there is a noticeable difference in photographic density between all three photographs (especially between inhalation and exhalation). With pulmonary emphysema, this difference decreases sharply, and in severe cases almost disappears.

Recognition of pulmonary emphysema using x-ray kymography and electrokymography is also based on identifying x-ray functional symptoms reflecting disturbances in pulmonary respiration and circulation.

Rice. 3. Chronic emphysema; typical barrel-shaped chest deformity. Kyphosis of the thoracic spine. A pronounced protrusion of the sternum anteriorly and a “gaping” of the anterior mediastinum.

Rice. 4. Severe chronic emphysema, hourglass-shaped chest.

Rice. 5. Severe chronic emphysema. The area of ​​the lung fields is increased mainly due to the vertical size. Low aperture position; its dome looks like a tent. In the right lung there is a picture of limited hilar pneumosclerosis and dense interlobar mooring.

Rice. 6. Test for pulmonary ventilation using the method of targeted serial images (negative): 1 - basal section of the right lung of a healthy person with normal vital capacity (4200 ml); 2 - basal section of the right lung of a patient with chronic emphysema (VC 2100 ml). The right picture is the moment of the respiratory pause; medium - extremely deep breath; left photo - deep exhalation. The squares indicate the fields of the radiograph that were subjected to photometry in order to more accurately determine the photographic density.

Emphysema, x-ray diagnostics

Pulmonary emphysema is a pathological condition of the lungs. It is characterized by an increased content of air in them or a persistent increase in the size of the air spaces located distal to the terminal bronchioles. Accompanied by destructive changes in the walls of the alveoli.

From an etiopathogenetic point of view, one should distinguish:

a) primary diffuse emphysema not associated with previous airway obstruction;

c) various types of localized emphysema, the cause of which may be a congenital anomaly of the lung tissue, localized bronchostenosis with the formation of a valve mechanism, cicatricial changes in the pulmonary parenchyma and pleura, a decrease in the volume of adjacent parts of the lung (vicarious emphysema) and other conditions.

X-ray examination plays a significant role in recognizing pulmonary emphysema. With this disease, one can quite often observe changes in the chest in the form of a barrel- or bell-shaped shape with horizontally running posterior segments of the ribs and widened intercostal spaces; a symptom of gaping of the anterior mediastinum (expansion of the loaded space) is noted. The transparency of the lung tissue is increased, and its change during maximum inhalation and exhalation is insignificant. The excursion of the diaphragm during forced breathing is reduced.

The pulmonary pattern is sparse and depleted. The roots of the lungs are expanded and look like commas. Patients have cor pulmonale. A uniform increase in the transparency of the lower pulmonary fields, a depleted pulmonary pattern, a low diaphragm and a hanging heart are more characteristic of diffuse emphysema. With obstructive bronchitis, accompanied by obstructive emphysema, the upper parts of the lungs look more transparent; the transparency of the lower sections is much less due to peribronchitis, pneumosclerosis associated with previous pneumonia, as well as microatelectasis and dilation of the pulmonary arteries.

Bullous emphysema is a morphological variant of pulmonary emphysema with the formation of large air bubbles in the marginal regions. Emphysematous bullae are usually small in size, mostly up to 3 cm in diameter, often multiple, irregularly oval in shape, located subpleurally in 1 - 2 segments. The upper or outer walls of the bullae fuse

with visceral pleura; the remaining walls are thin, uniform in thickness, with clear, even contours. Often, along with emphysematous bullae, old tuberculous and sclerotic changes are noted. With bronchography, small bullae are not contrasted; only the deformation of the bronchi in the affected area is determined. Giant bullae (usually more than 10 cm in diameter) appear radiographically as single irregularly oval-shaped cavities located closer to the periphery of the lungs. One of the walls merges with the visceral pleura. The remaining walls are thin, uniform, with fairly clear contours. Bronchographic examination establishes contrasting of all bronchial branches and their pushing back without filling the bulla itself.

Vicarious pulmonary emphysema - develops with a significant decrease in the volume of functioning lung tissue, for example after the removal of one lung or massive lung damage by some pathological process.

Congenital lobar emphysema - pulmonary emphysema in the form of an expansion of one of the lobes, caused by an anomaly in the development of the adductor bronchus and its branches. Often accompanied by surprise in neighboring areas of the lung. Clinically manifested by symptoms of respiratory failure, the severity of which depends on the degree of overextension of the affected area of ​​the lung and the compensatory capabilities of the body. X-ray picture: sharply increased transparency of one lobe of the lungs, usually the upper left, low standing and decreased excursion of the dome of the diaphragm on the affected side, displacement of the mediastinum to the opposite side, no changes in the degree of transparency of the emphysematous lobe during the child’s breathing (cry).

Congenital unilateral pulmonary emphysema - pulmonary emphysema in the form of increased airiness of one lung, caused by an anomaly in the development of lung tissue. X-ray usually reveals an increase in the transparency of one lung, the disappearance of the vascular pattern in it, a shift of the mediastinum during inspiration to the affected side, a lack of contrasting of small bronchial and arterial trunks

Interstitial pulmonary emphysema - occurs as a result of air entering the interstitial tissue of the lung through ruptures in the walls of the alveoli, for example, during strong coughing impulses.

Emphysema is focal - only certain areas of the lung tissue are affected; caused by destruction and stretching of the walls of the alveoli adjacent to areas of atelectasis, foci of inflammation or scars

Emphysema of the subcutaneous chest - develops most often when air enters the tissue from a damaged lung, less often caused by gas bubbles formed as a result of the vital activity of pathogens of anaerobic or putrefactive infection. The radiograph shows round and layered clearings, against which individual groups of muscles and muscle fibers of the chest stand out cells.

Pulmonary emphysema: etiology, classification, clinical picture, laboratory diagnosis, treatment

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X-ray characteristics of pulmonary emphysema

Chronic pulmonary diseases last a long time and ultimately lead to the development of a condition such as emphysema. Emphysema is successfully detected by a simple but reliable diagnostic method, such as an x-ray. What features of X-ray diagnostics of this condition exist today? The article discusses the main signs of emphysema in photographs.

Briefly about the essence of the disease

Emphysema is considered the final stage of many chronic diseases accompanied by inflammation. In addition, an increase in the airiness of lung tissue is characteristic of bronchial asthma and occupational diseases of the organ parenchyma. Thus, there are factors for the development of emphysematous disorganization of the lungs:

• Long history of smoking.
• Chronic obstructive pulmonary disease.
• Bronchial asthma.
• Chronic bronchitis, including with an obstructive component.
• Long-term professional contact with dust and other pollutants.
• The birth defect is alpha-antitrypsin deficiency, which is expressed in the weakness of the walls of the terminal structures of the respiratory functional unit.

Deficiency of this compound (congenital pathology) or chronic exposure to the above factors lead to the inability of bronchioles and alveoli to perform their functions. Their walls become deformed and expand. An air trap occurs - a condition in which air passes freely into the respiratory tract, but it cannot move back in the opposite direction. Vast spaces appear that are filled with air and are completely or partially excluded from the act of breathing. Emphysematous bullae may develop.

Features of X-ray diagnostics of emphysematous changes

Emphysema is a pathology that contains not only signs of structural damage to the lung tissue, but also the functional failure of this organ. Intact areas of lung tissue do not take part in respiration and gas exchange. Therefore, a symptom of progressive respiratory failure occurs.

There are two groups of signs of pathology during X-ray examination:

In order to appreciate and see them, one photo will not be enough. It is necessary to conduct a study in two projections, because it is the lateral projection (laterogram) that will be informative in terms of visualizing X-ray morphological signs.

Radiography using the Sokolov method provides a lot of information.

This is an x-ray method that allows you to assess the functionality of the lungs. That is, the patient is forced to inhale as much as possible, hold his breath, and then forcefully exhale as much as possible. At all these stages, images are recorded. With the help of a tunnel cassette, it becomes possible to examine the lung tissue, pulmonary pattern and other signs in the context of the functional state.

X-ray morphological symptoms

It should first be mentioned that this group of symptoms refers to secondary changes and is characteristic of a long, protracted course of emphysema. They affect the size of the chest, its spatial deformation, changes in the syntopy of the organs and tissues contained in it, expressed quantitatively (degrees or centimeters).

Representatives of the old therapeutic and propaedeutic schools also said that with a long course of pulmonary pathology with the formation of respiratory failure, a deformation of the chest develops, which can be seen even during examination. X-ray examination only confirms the guesses of outstanding clinicians. Emphysematous deformity is called barrel-shaped. That is, the anterior-posterior size of the chest increases significantly. Moreover, this increase can be seen throughout the entire chest cavity.

Radiologists note the following signs of barrel-shaped emphysematous deformity:

• Sternum protruding anteriorly.
• Horizontal course of costal spaces and ribs.
• Kyphotic change in the thoracic spine.

Changes in mediastinal structures are an important sign in the diagnosis of pulmonary pathology. The anterior mediastinum widens due to the protruding sternum. Radiologists call this change an anterior mediastinal gap. The shadows of the heart, aorta and its branches, and large venous highways are moved posteriorly due to an increase in lung volume due to altered pathological airiness. The heart itself may take on an atypical appearance. In some cases, it resembles an hourglass or a teardrop (droplet-shaped deformity), which requires differential diagnosis with diseases such as acquired or congenital heart valve disease.

The next classic sign of emphysema is a change in the transparency of the lung tissue, which increases diffusely. This phenomenon is formed due to excess air in the terminal sections of the bronchial and acinar tree. If there is a bullous deformation of the lung tissue, then the radiologist will see clearing at this place.

You need to pay close attention to the aperture dome. With emphysema, it is located lower than in a healthy person. Sometimes there may be a slight downward deflection.

Due to the fact that emphysema cannot occur in isolation from other pathological processes in the lungs, signs of sclerotic changes are very often observed.

Pneumosclerosis with emphysema is suspected when the pulmonary pattern becomes “excessive” and deformed. Sometimes the root of the lung is even pulled up.

X-ray symptoms

Respiratory failure is also reflected in the X-ray diagnosis of the disease. Usually, during fluoroscopy of the lungs, a specialist in this imaging technique very clearly sees a decrease in the mobility of the diaphragm. In a healthy person, the amplitude of movements performed by this muscle is sufficient. With emphysema, this value progressively decreases.

According to the previously described method Yu.N. Sokolov, you can assess the functional state of the lung tissue. Normally, the intensity and contrast of structures during imaging varies greatly depending on the phases of breathing. At the same time, the opposite picture is typical for emphysema. These indicators do not change significantly. This is a rather specific sign of emphysematous disorganization of lung tissue.

Emphysema– a chronic lung disease characterized by the expansion of small bronchioles (the terminal branches of the bronchi) and the destruction of the partitions between the alveoli. The name of the disease comes from the Greek emphysao - to swell. Air-filled voids form in the lung tissue, and the organ itself swells and increases significantly in volume.

Manifestations of emphysema– shortness of breath, difficulty breathing, cough with a small amount of mucous sputum, signs of respiratory failure. Over time, the chest expands and takes on a characteristic barrel shape.

Reasons for the development of emphysema divided into two groups:

• Factors that impair the elasticity and strength of lung tissue are inhalation of polluted air, smoking, congenital deficiency of alpha-1-antitrypsin (a substance that stops the destruction of the walls of the alveoli).
• Factors that increase air pressure in the bronchi and alveoli are chronic obstructive bronchitis, blockage of the bronchus by a foreign body.

Prevalence of emphysema. 4% of the world's inhabitants have emphysema, many are unaware of it. It is more common in men aged 30 to 60 years and is associated with chronic bronchitis of a smoker.

Risk of developing the disease some categories are higher than other people:

• Congenital forms of pulmonary emphysema associated with whey protein deficiency are more often detected in residents of Northern Europe.
• Men get sick more often. Emphysema is detected at autopsy in 60% of men and 30% of women.
• People who smoke have a 15 times higher risk of developing emphysema. Passive smoking is also dangerous.

Without treatment, changes in the lungs due to emphysema can lead to loss of ability to work and disability.

Anatomy of the lungs

Lungs- paired respiratory organs located in the chest. The lungs are separated from each other by the mediastinum. It consists of large vessels, nerves, trachea, and esophagus.

Each lung is surrounded by a two-layer membrane, the pleura. One of its layers fuses with the lung, and the other with the chest. Between the sheets of pleura there remains a space - the pleural cavity, in which there is a certain amount of pleural fluid. This structure helps the lungs stretch during inhalation.

Due to anatomical features, the right lung is 10% larger than the left. The right lung consists of three lobes, and the left lung has two. The lobes are divided into segments, which in turn are divided into secondary lobules. The latter consist of 10-15 acini.
The hilum of the lung is located on the inner surface. This is the place where the bronchi, arteries, and veins enter the lung. Together they form the root of the lung.

Lung functions:

• ensure blood saturation with oxygen and removal of carbon dioxide
• participate in heat exchange due to liquid evaporation
• secrete immunoglobulin A and other substances to protect against infections
• participate in the transformation of the hormone angiotensin, which causes vasoconstriction

Structural elements of the lungs:

1. bronchi, through which air enters the lungs;
2. alveoli, where gas exchange occurs;
3. blood vessels that carry blood from the heart to the lungs and back to the heart;

1. Trachea and bronchi- called the respiratory tract.

   The trachea at the level of 4-5 vertebrae is divided into 2 bronchi - right and left. Each of the bronchi enters the lung and forms a bronchial tree there. The right and left are the bronchi of the 1st order; at the place of their branching, the bronchi of the 2nd order are formed. The smallest are bronchi of the 15th order.

   Small bronchi branch, forming 16-18 thin respiratory bronchioles. Alveolar ducts depart from each of them, ending in thin-walled vesicles - alveoli.

   Bronchial function– ensure the passage of air from the trachea to the alveoli and back.

   Structure of the bronchi.

   1. Cartilaginous base of the bronchi
      • large bronchi outside the lung consist of cartilaginous rings
      • large bronchi inside the lung - cartilaginous connections appear between the cartilaginous half-rings. Thus, the lattice structure of the bronchi is ensured.
      • small bronchi - cartilage looks like plates, the smaller the bronchus, the thinner the plates
      • the terminal small bronchi do not have cartilage. Their walls contain only elastic fibers and smooth muscles
   2. Muscular layer of the bronchi– smooth muscles are arranged circularly. They provide narrowing and expansion of the lumen of the bronchi. At the site of the branching of the bronchi there are special bundles of muscles that can completely block the entrance to the bronchus and cause its obstruction.
   3. ciliated epithelium, lining the lumen of the bronchi, performs a protective function - protects against infections transmitted by airborne droplets. Small villi remove bacteria and small dust particles from distant bronchi into larger bronchi. From there they are removed when coughing.
   4. Lung glands
      • single-celled glands that secrete mucus
      • small lymph nodes connected to larger lymph nodes in the mediastinum and trachea.
2. Alveolus – a bubble in the lungs, entwined with a network of blood capillaries. The lungs contain more than 700 million alveoli. This structure allows you to increase the surface area in which gas exchange occurs. Atmospheric air enters the bubble through the bronchi. Oxygen is absorbed into the blood through the thinnest wall, and carbon dioxide is released into the alveoli during exhalation.

   The area around the bronchiole is called the acinus. It resembles a bunch of grapes and consists of branches of the bronchioles, alveolar ducts and the alveoli themselves

3. Blood vessels. Blood enters the lungs from the right ventricle. It contains little oxygen and a lot of carbon dioxide. In the capillaries of the alveoli, the blood is enriched with oxygen and releases carbon dioxide. After this, it collects in the veins and enters the left atrium.

Causes of emphysema

The causes of emphysema are usually divided into two groups.

1. Impaired elasticity and strength of lung tissue:
   • Congenital α-1 antitrypsin deficiency. In people with this abnormality, proteolytic enzymes (whose function is to destroy bacteria) destroy the walls of the alveoli. While normally α-1 antitrypsin neutralizes these enzymes within a few tenths of a second after their release.
   • Congenital defects in the structure of lung tissue. Due to their structural features, the bronchioles collapse and the pressure in the alveoli increases.
   • Inhalation of polluted air: smog, tobacco smoke, coal dust, toxic substances. The most dangerous in this regard are cadmium, nitrogen and sulfur oxides emitted by thermal power plants and transport. Their smallest particles penetrate the bronchioles and are deposited on their walls. They damage the ciliated epithelium and vessels feeding the alveoli and also activate special cells, alveolar macrophages.

     They help increase the level of neutrophil elastase, a proteolytic enzyme that destroys the walls of the alveoli.

   • Hormonal imbalance. An imbalance between androgens and estrogens impairs the ability of bronchiole smooth muscles to contract. This leads to stretching of the bronchioles and the formation of cavities without destruction of the alveoli.
   • Respiratory tract infections: chronic bronchitis, pneumonia. Immune cells, macrophages and lymphocytes, exhibit proteolytic activity: they produce enzymes that dissolve bacteria and the protein that makes up the walls of the alveoli.

     In addition, clots of sputum in the bronchi allow air into the alveoli, but do not release it in the opposite direction.

     This leads to overfilling and overstretching of the alveolar sacs.

   • Age-related changes associated with poor circulation. In addition, older people are more sensitive to toxic substances in the air. With bronchitis and pneumonia, lung tissue recovers worse.
2. Increased pressure in the lungs.
   • Chronic obstructive bronchitis. The patency of the small bronchi is impaired. When you exhale, air remains in them. With a new breath, a new portion of air enters, which leads to overstretching of the bronchioles and alveoli. Over time, disturbances occur in their walls, leading to the formation of cavities.
   • Occupational hazards. Glassblowers, wind players. A feature of these professions is an increase in air pressure in the lungs. The smooth muscles in the bronchi gradually weaken, and blood circulation in their walls is disrupted. When you exhale, all the air is not expelled; a new portion is added to it. A vicious circle develops, leading to the appearance of cavities.
   • Blockage of the lumen of the bronchus a foreign body leads to the fact that the air remaining in the segment of the lung cannot escape out. An acute form of emphysema develops.
   Scientists have not been able to establish the exact cause of the development of emphysema. They believe that the appearance of the disease is associated with a combination of several factors that simultaneously affect the body.

Mechanism of lung damage in emphysema

1. Stretching of bronchioles and alveoli - their size doubles.
2. Smooth muscles are stretched, and the walls of blood vessels become thinner. The capillaries become empty and the nutrition in the acinus is disrupted.
3. Elastic fibers degenerate. In this case, the walls between the alveoli are destroyed and cavities are formed.
4. The area in which gas exchange occurs between air and blood decreases. The body experiences oxygen deficiency.
5. The enlarged areas compress healthy lung tissue, further impairing the ventilation function of the lungs. Shortness of breath and other symptoms of emphysema appear.
6. To compensate and improve the respiratory function of the lungs, the respiratory muscles are actively involved.
7. The load on the pulmonary circulation increases - the vessels of the lungs become overfilled with blood. This causes disturbances in the functioning of the right side of the heart.

Types of emphysema

There are several classifications of pulmonary emphysema.

According to the nature of the flow:

• Acute. It develops during an attack of bronchial asthma, a foreign object entering the bronchi, or sudden physical exertion. Accompanied by overstretching of the alveoli and swelling of the lung. This condition is reversible but requires urgent medical attention.
• Chronic. Develops gradually. At an early stage, the changes are reversible. But without treatment, the disease progresses and can lead to disability.

By origin:

• Primary emphysema. An independent disease that develops in connection with the congenital characteristics of the body. It can even be diagnosed in infants. It progresses quickly and is more difficult to treat.
• Secondary emphysema. The disease occurs against the background of chronic obstructive pulmonary diseases. The onset often goes unnoticed, and symptoms intensify gradually, leading to decreased ability to work. Without treatment, large cavities appear that can occupy an entire lobe of the lung.

By prevalence:

• Diffuse form. The lung tissue is uniformly affected. Alveoli are destroyed throughout the lung tissue. In severe forms, a lung transplant may be required.
• Focal form. Changes occur around tuberculosis foci, scars, in places where a blocked bronchus approaches. Manifestations of the disease are less pronounced.

According to anatomical features, in relation to the acinus:

• Panacinar emphysema(vesicular, hypertrophic). All acini in the lung lobe or the whole lung are damaged and swollen. There is no healthy tissue between them. The connective tissue in the lung does not grow. In most cases there are no signs of inflammation, but there are manifestations of respiratory failure. Formed in patients with severe emphysema.
• Centrilobular emphysema. Damage to individual alveoli in the central part of the acinus. The lumen of the bronchioles and alveoli expands, this is accompanied by inflammation and mucus secretion. Fibrous tissue develops on the walls of damaged acini. Between the changed areas, the parenchyma (tissue) of the lungs remains intact and performs its function.
• Periacinar(distal, perilobular, paraseptal) - damage to the extreme parts of the acinus near the pleura. This form develops with tuberculosis and can lead to pneumothorax - rupture of the affected area of ​​the lung.
• Okolorubtsovaya– develops around scars and areas of fibrosis in the lungs. Symptoms of the disease are usually mild.
• Bullous(bubble) shape. In place of the destroyed alveoli, bubbles form, ranging in size from 0.5 to 20 cm or more. They can be located near the pleura or throughout the lung tissue, mainly in the upper lobes. Bullae can become infected, compress surrounding tissue, or rupture.
• Interstitial(subcutaneous) - characterized by the appearance of air bubbles under the skin. The alveoli rupture, and air bubbles rise through the lymphatic and tissue gaps under the skin of the neck and head. Bubbles may remain in the lungs, and when they rupture, spontaneous pneumothorax occurs.

Due to the occurrence:

• Compensatory– develops after removal of one lobe of the lung. When healthy areas swell, trying to take up the vacant space. Enlarged alveoli are surrounded by healthy capillaries, and there is no inflammation in the bronchi. The respiratory function of the lungs does not improve.
• Senile– caused by age-related changes in the vessels of the lungs and the destruction of elastic fibers in the wall of the alveoli.
• Lobarnaya– occurs in newborns, more often boys. Its appearance is associated with obstruction of one of the bronchi.

Symptoms of emphysema

Diagnosis of emphysema

Examination by a doctor

If symptoms of pulmonary emphysema appear, consult a therapist or pulmonologist.

Instrumental methods for diagnosing pulmonary emphysema

1. Radiography- a study of the condition of the lungs using x-rays, as a result of which an image of the internal organs is obtained on film (paper). A general X-ray of the chest is taken in a direct projection. This means that the patient faces the device during the shooting. An overview image allows you to identify pathological changes in the respiratory organs and the extent of their spread. If the image shows signs of disease, then additional tests are prescribed: MRI, CT, spirometry, peak flowmetry.

   Indications:

   • Once a year as part of a preventive examination
   • prolonged cough
   • dyspnea
   • wheezing, pleural friction noise
   • decreased breathing
   • pneumothorax
   • suspected emphysema, chronic bronchitis, pneumonia, pulmonary tuberculosis
   Contraindications:
   • breastfeeding period
   Symptoms of pulmonary emphysema:
   • the lungs are enlarged, they compress the mediastinum and overlap each other
   • affected areas of the lung appear excessively transparent
   • expansion of intercostal spaces during active muscle work
   • the lower edge of the lungs is drooping
   • low aperture
   • reduction in the number of blood vessels
   • bullae and areas of tissue airing
2. Magnetic resonance imaging (MRI) of the lungs- a study of the lungs based on the resonant absorption of radio waves by hydrogen atoms in cells, and sensitive equipment records these changes. MRI of the lungs provides information about the condition of large bronchi, vessels, lymphoid tissue, the presence of fluid and focal formations in the lungs. Allows you to obtain sections 10 mm thick and view them from different positions. To study the upper parts of the lungs and areas around the spine, a contrast agent called gadolinium is injected intravenously.

   Disadvantage: air prevents accurate visualization of small bronchi and alveoli, especially at the periphery of the lungs. Therefore, the cellular structure of the alveoli and the degree of destruction of the walls are not clearly visible.

   The procedure lasts 30-40 minutes. During this time, the patient must lie motionless in the magnetic tomograph tunnel. MRI does not involve radiation, so the study is permitted for pregnant and breastfeeding women.

   Indications:

   • there are symptoms of the disease, but no changes can be detected on an x-ray
   • tumors, cysts
   • suspicion of tuberculosis, sarcoidosis, in which small focal changes are formed
   • enlarged intrathoracic lymph nodes
   • abnormal development of the bronchi, lungs and their vessels
   Contraindications:
   • presence of a pacemaker
   • metal implants, staples, fragments
   • mental illnesses that do not allow lying for a long time without moving
   • patient weight over 150 kg
   Symptoms of emphysema:
   • damage to the alveolar capillaries at the site of destruction of lung tissue
   • circulatory disorders in small pulmonary vessels
   • signs of compression of healthy tissue by expanded areas of the lung
   • increase in pleural fluid volume
   • increase in the size of the affected lungs
   • cavities-bulls of different sizes
   • low aperture
3. Computed tomography (CT) of the lungs allow you to obtain a layer-by-layer image of the structure of the lungs. CT is based on the absorption and reflection of X-rays by tissues. Based on the data obtained, the computer creates a layer-by-layer image with a thickness of 1mm-1cm. The study is informative in the early stages of the disease. When a contrast agent is administered, CT provides more complete information about the state of the pulmonary vessels.

   During a CT scan of the lungs, the X-ray emitter rotates around the patient lying motionless. The scan lasts about 30 seconds. The doctor will ask you to hold your breath several times. The whole procedure takes no more than 20 minutes. Using computer processing, X-ray images taken from different points are summarized into a layer-by-layer image.

   Flaw– significant radiation exposure.

   Indications:

   • if symptoms are present, no changes are detected on the x-ray or they need to be clarified
   • diseases with the formation of foci or diffuse damage to the lung parenchyma
   • chronic bronchitis, emphysema
   • before bronchoscopy and lung biopsy
   • decision on the operation
   Contraindications:
   • allergy to contrast agent
   • extremely serious patient condition
   • severe diabetes mellitus
   • renal failure
   • pregnancy
   • patient weight exceeding the capabilities of the device
   Symptoms of emphysema:
   • an increase in the optical density of the lung to -860-940 HU – these are airy areas of the lung
   • expansion of the roots of the lungs - large vessels entering the lung
   • dilated cells are noticeable - areas of alveolar fusion
   • reveals the size and location of bullae
4. Lung scintigraphy – injection of labeled radioactive isotopes into the lungs, followed by a series of images taken with a rotating gamma camera. Preparations of technetium - 99 M are administered intravenously or in the form of an aerosol.

   The patient is placed on a table around which the sensor rotates.

   Indications:

   • early diagnosis of vascular changes in emphysema
   • monitoring the effectiveness of treatment
   • assessment of lung condition before surgery
   • suspected lung cancer
   Contraindications:
   • pregnancy
   Symptoms of emphysema:
   • compression of lung tissue
   • disturbance of blood flow in small capillaries


5. Spirometry – functional study of the lungs, study of the volume of external respiration. The procedure is carried out using a spirometer device, which records the amount of air inhaled and exhaled.

   The patient puts into his mouth a mouthpiece connected to a breathing tube with a sensor. A clamp is placed on the nose to block nasal breathing. The specialist tells you what breathing tests need to be performed. And an electronic device converts the sensor readings into digital data.

   Indications:

   • breathing disorder
   • chronic cough
   • occupational hazards (coal dust, paint, asbestos)
   • smoking experience over 25 years
   • lung diseases (bronchial asthma, pneumosclerosis, chronic obstructive pulmonary disease)
   Contraindications:
   • tuberculosis
   • pneumothorax
   • hemoptysis
   • recent heart attack, stroke, abdominal or chest surgery
   Symptoms of emphysema:
   • increase in total lung capacity
   • increase in residual volume
   • decreased vital capacity of the lungs
   • reduction in maximum ventilation
   • increased resistance in the airways during exhalation
   • reduction in speed indicators
   • decreased compliance of lung tissue
   With pulmonary emphysema, these indicators are reduced by 20-30%
6. Peak flowmetry - measurement of maximum expiratory flow to determine bronchial obstruction.

   Determined using a device - a peak flow meter. The patient needs to tightly clasp the mouthpiece with his lips and exhale as quickly and forcefully as possible through his mouth. The procedure is repeated 3 times with an interval of 1-2 minutes.

   It is advisable to carry out peak flowmetry in the morning and evening at the same time before taking medications.

   Disadvantage: the study cannot confirm the diagnosis of pulmonary emphysema. The exhalation rate decreases not only with emphysema, but also with bronchial asthma, pre-asthma, and chronic obstructive pulmonary disease.

   Indications:

   • any diseases accompanied by bronchial obstruction
   • evaluation of treatment results
   Contraindications does not exist.

   Symptoms of emphysema:

   • reduction in expiratory flow by 20%
7. Determination of blood gas composition – a study of arterial blood during which the pressure in the blood of oxygen and carbon dioxide and their percentage, the acid-base balance of the blood are determined. The results show how effectively the blood in the lungs is cleared of carbon dioxide and enriched with oxygen. For research, a puncture of the ulnar artery is usually done. A blood sample is taken from a heparin syringe, placed on ice, and sent to the laboratory.

   Indications:

   • cyanosis and other signs of oxygen starvation
   • breathing disorders due to asthma, chronic obstructive pulmonary disease, emphysema
   Symptoms:
   • oxygen tension in arterial blood is below 60-80 mmHg. st
   • blood oxygen percentage less than 15%
   • increase in carbon dioxide tension in arterial blood over 50 mmHg. st
8. General blood analysis - a study that includes counting blood cells and studying their characteristics. For analysis, blood is taken from a finger or from a vein.

   Indications- any diseases.

   Contraindications does not exist.

   Deviations for emphysema:

   • increased number of red blood cells over 5 10 12 / l
   • increased hemoglobin level over 175 g/l
   • increase in hematocrit over 47%
   • decreased erythrocyte sedimentation rate 0 mm/hour
   • increased blood viscosity: in men over 5 cP, in women over 5.5 cP

Treatment of emphysema

Treatment of pulmonary emphysema has several directions:

• improving the quality of life of patients - eliminating shortness of breath and weakness
• prevention of the development of heart and respiratory failure
• slowing the progression of the disease

Treatment of emphysema necessarily includes:

• complete cessation of smoking
• exercise to improve ventilation
• taking medications to improve the condition of the respiratory tract
• treatment of the pathology that caused the development of emphysema

Treatment of emphysema with medications

Group of drugs	Representatives	Mechanism of therapeutic action	Mode of application
α1-antitrypsin inhibitors	Prolastin	The introduction of this protein reduces the level of enzymes that destroy the connective fibers of lung tissue.	Intravenous injection at the rate of 60 mg/kg body weight. 1 time per week.
Mucolytic drugs	Acetylcysteine ​​(ACC)	Improves the removal of mucus from the bronchi, has antioxidant properties - reduces the production of free radicals. Protects the lungs from bacterial infection.	Take 200-300 mg orally 2 times a day.
	Lazolvan	Liquefies mucus. Improves its removal from the bronchi. Reduces cough.	Used orally or inhaled. Orally during meals, 30 mg 2-3 times a day. In the form of inhalations using a nebulizer, 15-22.5 mg, 1-2 times a day.
Antioxidants	Vitamin E	Improves metabolism and nutrition in lung tissues. Slows down the process of destruction of the walls of the alveoli. Regulates the synthesis of proteins and elastic fibers.	Take 1 capsule per day orally. Take courses for 2-4 weeks.
Bronchodilators (bronchodilators) Phosphodiesterase inhibitors Anticholinergics	Teopek	Relaxes the smooth muscles of the bronchi, helps to expand their lumen. Reduces swelling of the bronchial mucosa.	The first two days take half a tablet 1-2 times a day. Subsequently, the dose is increased - 1 tablet (0.3 g) 2 times a day after 12 hours. Take after meals. The course is 2-3 months.
	Atrovent	Blocks acetylcholine receptors in the bronchial muscles and prevents their spasm. Improves external respiration indicators.	In the form of inhalations, 1-2 ml 3 times a day. For inhalation in a nebulizer, the drug is mixed with saline solution.
Theophyllines	Long-acting theophylline	It has a bronchodilator effect, reducing systemic pulmonary hypertension. Increases diuresis. Reduces fatigue of the respiratory muscles.	The initial dose is 400 mg/day. Every 3 days it can be increased by 100 mg until the required therapeutic effect appears. The maximum dose is 900 mg/day.
Glucocorticosteroids	Prednisolone	Has a strong anti-inflammatory effect on the lungs. Promotes the expansion of bronchi.	Used when bronchodilator therapy is ineffective. At a dose of 15–20 mg per day. Course 3-4 days.

Therapeutic measures for emphysema

1. Transcutaneous electrical stimulation diaphragm and intercostal muscles. Electrical stimulation with pulsed currents with a frequency of 5 to 150 Hz is aimed at facilitating exhalation. At the same time, the energy supply to the muscles, blood and lymph circulation improves. In this way, fatigue of the respiratory muscles, followed by respiratory failure, is avoided. During the procedure, painless muscle contractions occur. The current strength is dosed individually. The number of procedures is 10-15 per course.
2. Oxygen inhalation. Inhalation is carried out for a long time, 18 hours a day. In this case, oxygen is supplied to the mask at a rate of 2–5 liters per minute. In case of severe respiratory failure, helium-oxygen mixtures are used for inhalation.
3. Breathing exercises- training of the respiratory muscles, aimed at strengthening and coordinating muscles during breathing. All exercises are repeated 4 times a day for 15 minutes.
   • Exhale with resistance. Exhale slowly through a cocktail straw into a glass filled with water. Repeat 15-20 times.
   • Diaphragmatic breathing. On the count of 1-2-3, take a strong, deep breath, drawing in your stomach. On the count of 4, exhale - inflating your stomach. Then tense your abdominal muscles and cough loudly. This exercise helps to expel mucus.
   • Lying push-up. Lying on your back, bend your legs and clasp your knees with your hands. As you inhale, draw in lungs full of air. As you exhale, stick your stomach out (diaphragmatic exhalation). Straighten your legs. Tighten your abs and cough.

When is surgery needed for emphysema?

Surgical treatment for emphysema is not often required. It is necessary when the lesions are significant and drug treatment does not reduce the symptoms of the disease.

Indications for surgery for emphysema:

• shortness of breath leading to disability
• bullae occupying more than 1/3 of the chest
• complications of emphysema - hemoptysis, cancer, infection, pneumothorax
• multiple bullae
• permanent hospitalizations
• diagnosis of severe pulmonary emphysema

Contraindications:

• inflammatory process – bronchitis, pneumonia
• asthma
• exhaustion
• severe deformation of the chest
• age over 70 years

Types of operations for emphysema

1. Lung transplant and its variants: lung transplantation together with a heart; transplantation of a lung lobe. Transplantation is performed in case of large diffuse lesions or multiple large bullae. The goal is to replace the diseased lung with a healthy donor organ. However, the waiting list for transplantation is usually too long and problems with organ rejection may arise. Therefore, such operations are resorted to only as a last resort.


2. Reduced lung volume. The surgeon removes the most damaged areas, approximately 20-25% of the lung. At the same time, the function of the remaining part of the lung and respiratory muscles improves. The lung is not compressed, its ventilation is restored. The operation is performed in one of three ways.

Opening the chest. The doctor removes the affected lobe and places stitches to seal the lung. Then a suture is placed on the chest.

3. Minimally invasive technique (thoracoscopy) under the control of video equipment. 3 small incisions are made between the ribs. A mini-video camera is inserted into one, and surgical instruments are inserted into the others. The affected area is removed through these incisions.
4. Bronchoscopic surgery. A bronchoscope with surgical equipment is inserted through the mouth. The damaged area is removed through the lumen of the bronchus. Such an operation is possible only if the affected area is located near large bronchi.

The postoperative period lasts about 14 days. Significant improvement is observed after 3 months. Shortness of breath returns after 7 years.

Is hospitalization necessary to treat emphysema?

In most cases, patients with emphysema are treated at home. It is enough to take medications according to the schedule, adhere to a diet and follow the doctor’s recommendations.

Indications for hospitalization:

• sharp increase in symptoms (shortness of breath at rest, severe weakness)
• the appearance of new signs of illness (cyanosis, hemoptysis)
• ineffectiveness of the prescribed treatment (symptoms do not decrease, peak flow measurements worsen)
• severe concomitant diseases
• newly developed arrhythmias
• difficulties in establishing a diagnosis;

Nutrition for emphysema (diet).

Therapeutic nutrition for pulmonary emphysema is aimed at combating intoxication, strengthening the immune system and replenishing the patient’s high energy costs. Diets No. 11 and No. 15 are recommended.

Basic principles of diet for emphysema

1. Increasing calorie content to 3500 kcal. Meals 4-6 times a day in small portions.
2. Proteins up to 120 g per day. More than half of them must be of animal origin: animal and poultry meat, liver, sausages, fish of any kind and seafood, eggs, dairy products. Meat in any culinary preparation, excluding excessive frying.
All complications of pulmonary emphysema are life-threatening. Therefore, if any new symptoms appear, you should immediately seek medical help.

• Pneumothorax. Rupture of the pleura surrounding the lung. In this case, air escapes into the pleural cavity. The lung collapses and becomes unable to expand. Fluid accumulates around it in the pleural cavity, which needs to be removed. Severe chest pain appears, intensifying when inhaling, panic, rapid heartbeat, the patient takes a forced position. Treatment must be started immediately. If the lung does not expand within 4-5 days, surgery will be required.
• Infectious complications. Decreased local immunity increases the sensitivity of the lungs to bacterial infections. Severe bronchitis and pneumonia often develop, which become chronic. Symptoms: cough with purulent sputum, fever, weakness.
• Right ventricular heart failure. The disappearance of small capillaries leads to an increase in blood pressure in the vessels of the lungs - pulmonary hypertension. The load on the right parts of the heart increases, which become overstretched and wear out. Heart failure is the leading cause of death in patients with emphysema. Therefore, at the first signs of its development (swelling of the neck veins, pain in the heart and liver, swelling), it is necessary to call an ambulance.

The prognosis for pulmonary emphysema is favorable under a number of conditions:

• complete cessation of smoking
• prevention of frequent infections
• clean air, no smog
• good nutrition
• good sensitivity to drug treatment with bronchodilators.

Patients with lung diseases are familiar firsthand with the manifestations of respiratory failure. Shortness of breath, decreased exercise tolerance, dry cough and cachexia can be caused by increased pulmonary airiness. What is pulmonary emphysema, why does it develop, how is it diagnosed and treated? You will find answers to these questions in our detailed review and video in this article.

The term “pulmonary emphysema” in medicine combines a number of pathological processes characterized by an increased content of air in the lung tissue. This chronic disease is accompanied by disruption of external respiration processes, as well as gas exchange in the alveoli.

As a result:

• the partitions between the alveoli are destroyed;
• the diameter of the distal branches of the bronchi and bronchioles increases;
• The volume of lung tissue increases, and air voids appear in it.

The lungs literally inflate, stretching the chest along with them, which takes on a characteristic barrel-shaped shape.

This is interesting. The name of the pathology comes from the Greek word “emphysao” - “to inflate”, “to blow”.

Emphysema – ICD 10 code – J43.9 – is a fairly common pathology among the elderly. Along with bronchial asthma and chronic obstructive bronchitis, it is included in the COPD group.

All of them are accompanied by disturbances in air conduction through the respiratory tract, which determines the similarity of their clinical manifestations. However, each of the nosologies has its own distinctive features, which must be taken into account during differential diagnosis.

Causes and pathogenesis

All significant causes of pulmonary emphysema can be divided into two large groups.

Table 1: Possible causes of emphysema:

Group	Etiological factor	Description
Disorders associated with loss of elasticity of lung tissue	Congenital malformations of the respiratory system	Various defects in the formation of bronchioles during the prenatal period can lead to collapse of bronchioles and increased pressure in the alveoli
	Hereditary alpha-1 antitrypsin deficiency	A decrease in the concentration of the substance causes pathological activation of proteases and destruction of the pulmonary alveoli
	Hormonal imbalance	Violation of the physiological relationship between male and female sex hormones leads to stretching of the bronchioles
	Living in an environmentally unfavorable region	Tobacco smoke, smog, coal dust, nitrogen and sulfur oxides are deposited on the walls of small bronchi, causing destruction and “bloating” of lung tissue
	Frequent lung infections	The development of pneumonia or bronchitis triggers a cascade of immune reactions designed to destroy pathogenic bacteria. A side effect of this activity is the destruction of the alveolar wall by its own macrophages or neutrophils
	Age-related changes	In older people, blood circulation in the lung tissue deteriorates and the regenerative capabilities of the body decrease
Disorders caused by increased pressure in the lungs	Occupational hazards	Increased pressure in the alveoli is created during work at: glass blowers; wind instrument musicians.
	Chronic obstructive bronchitis	Thick, viscous sputum and broncho-obstruction cause obstruction in the pulmonary tree, as well as overstretching of the bronchioles
	Blockage of the bronchial lumen by a foreign body	Prevents the escape of air from a particular segment or lobe of the lung and causes acute emphysema

In the pathogenesis of the disease, several sequential processes can be distinguished:

1. Increased lumen, overstretching of alveoli and bronchioles.
2. Thinning of the walls of the vessels supplying the acinus, circulatory disorders.
3. A decrease in the area for gas exchange formation due to the filling of some alveoli with a gas mixture containing a high percentage of CO2.
4. Increasing phenomena of local hypoxia.
5. Compression of functioning lung tissue by expanded areas, ventilation disturbances.
6. Increased intrapulmonary pressure, restructuring of the circulatory system and the formation of chronic pulmonary heart disease.
7. Hypoxia of all organs and tissues, signs of respiratory failure.

Simply put, with emphysema, a kind of “stagnation” of air in the lungs occurs. Due to the reasons described, it enters the alveoli, but cannot leave them in the same volume. At later stages, both the process of exhalation and the process of inhalation are disrupted.

Classification

In medicine, it is customary to distinguish several classifications of pathological syndrome.

Depending on the origin it is:

• vicarious (compensatory), which develops after resection of part of the lung;
• senile, developing against the background of age-related involution of the body;
• primary, which is rare and is accompanied by severe atrophy of the alveolar wall;
• interstitial, occurring when the alveoli rupture (for example, with a strong cough).

According to prevalence, pathology is divided into diffuse and focal. In the focal form, changes in the pulmonary parenchyma occur around pathological foci of tuberculosis and cicatricial changes.

Widespread emphysema is characterized by the destruction of alveoli throughout the lung surface and is associated with severe chronic diseases. Diffuse emphysema in children appears due to obstruction of one of the large bronchi.

Depending on the anatomical features, the following pathology development options are distinguished:

• armored– is severe, characterized by widespread lesions and the absence of healthy lung tissue between the swollen acini;
• centrilobular, in which destructive processes affect only the central area of ​​the acinus;
• panlobular emphysema characterized by uniform damage to the pulmonary lobule and more extensive areas of destruction;
• periaciar(more common in tuberculosis) – accompanied by damage to mainly the distal parts of the acinus near the pleura;
• bullous– characterized by the formation of bullae – large bubbles, the diameter of which can reach 5-200 mm.
• interstitial, in which the alveoli rupture and air accumulates in the tissues of the interstitium (interlobular tissue along the bronchi);
• subpleural, accompanied by the accumulation of air under the pleura;
• interstitial (subcutaneous), characterized by the accumulation of released air under the skin.

Symptoms: how does increased airiness of the lung tissue manifest?

Depending on the form and extent of the lesion, the symptoms of the pathology may have different severity.

Common signs of the disease include:

• shortness of breath;
• sometimes – cough with light mucous sputum;
• barrel chest;
• decrease in the amplitude of movement of the HA during breathing;
• decreased breathing;
• manifestations of respiratory failure:
  1. expansion of intercostal spaces;
  2. bulging of the supraclavicular fossa;
  3. cyanosis;
  4. swelling of the neck veins;
  5. puffiness of the face.

Note! In patients with primary emphysema, one can often observe the “puffing” syndrome - covering the mouth while exhaling with swelling of the cheeks.

The primary increase in airiness in the alveoli is always more severe than the secondary one. It is accompanied by severe shortness of breath and severe discomfort for the patient. However, the gas composition of the blood in secondary forms of the disease has more pronounced disturbances.

The progressive course of pulmonary emphysema can lead to complications such as:

• respiratory failure;
• pulmonary hypertension;
• heart failure(mainly due to dilatation of the right ventricle): hepatomegaly, ascites, edema.

Important! Bullous emphysema can cause repeated episodes of spontaneous pneumothorax.

Diagnostic principles

Diagnosis of pulmonary emphysema requires a comprehensive approach. If the patient has complaints or clinical manifestations of the disease, he should be examined by a doctor: a therapist or a pulmonologist.

Standard medical instructions imply the following diagnostic algorithm:

• Collection of complaints and medical history. At this stage, it is important for the specialist to find out whether the patient has shortness of breath and cough, and how long they last.
• Percussion. Using a special technique of tapping the chest with your fingers, the doctor can determine:
  1. limited mobility of lung tissue;
  2. “boxy” sound when percussing over areas of increased airiness;
  3. reducing the boundaries of relative dullness of the heart;
  4. prolapse of the lower pole of the lungs.
• Auscultation with a medical stethoscope. Revealed:
  1. Increased exhalation;
  2. Tachypnea – increases
  3. Muffling of heart sounds;
  4. Decreased breathing;
  5. Sometimes – dry wheezing over the entire pulmonary surface;
  6. Compensatory tachycardia.
• Instrumental studies:
  1. Radiography;
  2. Scintigraphy;
  3. Spirometry;
  4. Peak flowmetry;
  5. Study of blood gas composition.

Note! If it is difficult to make a diagnosis based on the results of R-graphy, the patient may be assigned a more modern type of examination. On a CT or MRI, the images are clearer, and it is also possible to take a layer-by-layer image of the lungs.

Features of treatment

Among the main goals of treatment of emphysema are:

• combating the underlying pulmonary disease;
• prevention of complications;
• improving the patient's quality of life.

Mandatory treatment measures for all patients with increased airiness of the alveoli include treatment of the underlying disease, prevention of respiratory system infections and smoking cessation. The therapeutic diet for pulmonary emphysema involves split meals in small portions.

Useful products are considered:

• all kinds of cereals;
• unprocessed seasonal vegetables and fruits - carrots, zucchini, pumpkin, broccoli, all citrus fruits, etc.;
• dried fruits (figs, prunes, dried apricots);
• seafood;
• sources of quality protein - lean meat, fish, dairy products, legumes;
• herbal teas and decoctions of hawthorn, rose hip, and linden leaves.

Regular exercise therapy is also useful, as it will improve lung ventilation and reduce hypoxia.

Table 2: Exercise therapy:

Note! This series of exercises should be performed 3-4 times a day.

In addition, walking, swimming, and cycling can reduce the manifestations of respiratory failure and saturate the body with the necessary oxygen. At the same time, during physical activity you should breathe through your nose, not your mouth.

Medications

The drug therapy plan is drawn up by the doctor individually for each patient. The main groups of drugs used in treatment are presented in the table below.

Table 3: Main medications for emphysema:

Pharmacological group	Mechanism of action	Representatives
α1-antitrypsin inhibitors	Reducing the number of proteases that destroy pulmonary alveoli	Prolastin
Mucolytics	Improved mucus removal; Reduced cough.	Alethylcysteine
		Ambroxol
Antioxidants	Prevention of lipid peroxidation; Slowing down the process of destruction of the walls of the alveoli.	Tocopherol
Phosphodiesterase inhibitors	Relaxation of bronchial smooth muscles; Reducing swelling of the mucous membrane.	Teopek
Anticholinergic drugs	Preventing spasm of the bronchial muscles; Improvement in FEV, vital capacity, etc.	Atrovent
Theophyllines	Dilation of the bronchi; Reducing the severity of pulmonary hypertension.	Theophilus
GCS (according to indications)	Pronounced bronchodilator effect; Reducing inflammation.	Prednisolone

Inhalations

Inhalations are also important. To eliminate hypoxia, breathing through an oxygen mask is indicated. For maximum effect, it is important to continue the procedure for at least 18 hours in a row.

Concomitant chronic inflammation requires inhalation with a nebulizer: with emphysema in combination with bronchitis, you can breathe a solution of Ambroxol, Belodual or other bronchodilators.

When surgery may be required

Surgical treatment of emphysema is rarely performed, only if drug therapy is ineffective.

The main indications for surgery are:

• multiple bullae occupying more than 1/3 of the lung area;
• shortness of breath that cannot be controlled with medications;
• development of acute complications of the disease: pneumothorax, hemoptysis, malignant neoplasm;
• the need for frequent hospitalizations;
• progressive deterioration of the condition.

Among the surgical techniques used in the treatment of emphysema, the most common are:

• lung transplantation;
• removal of part of the lung tissue through thoracoscopy or abdominal surgery.

As a result of surgical intervention, lung ventilation is restored, shortness of breath is reduced, and tolerance to physical activity significantly increases.

Important! Severe cachexia, concomitant diseases in the stage of decompensation, and old age may be considered contraindications for surgery.

According to statistics, emphysema and pulmonary pneumosclerosis are the most common diseases that cause chronic respiratory failure. Moreover, the pathological changes that occur with them are mostly irreversible. Therefore, all that remains for the pulmonologist is to slow down their progression, reduce the severity of DN and alleviate the patient’s condition.

The prognosis for pulmonary emphysema largely depends on:

• timely diagnosis and adequate treatment of the underlying disease;
• an integrated approach to the treatment of hyperairy lung syndrome and its complications;
• compliance by the patient with all prescribed recommendations;
• features of the course and duration of the disease.

Typically, the manifestations of emphysema are easily corrected if the patient gives up bad habits (in particular smoking), and timely prevention of complications and pulmonary infections. Living in a clean air environment is also important for the success of therapy.

Questions for the doctor

Causes of shortness of breath

My dad is 78 years old. He complains of severe shortness of breath, which prevents him from moving around the house calmly. We took dad to the clinic, did a cardiogram - everything was normal. The therapist suggested that he had emphysema and sent him for examination (X-rays, tests). What kind of disease is this? Isn't this cancer?

Hello! Pulmonary emphysema is a serious condition accompanied by increased airiness of the alveoli and their subsequent destruction. It is most often diagnosed in older men.

It has many different causes. These include genetic defects, long-term smoking, and chronic bronchitis. The statement that emphysema is lung cancer is incorrect, but sometimes these serious diseases are diagnosed together in patients.

Therefore, it is possible to make an accurate diagnosis for your dad and establish the cause of shortness of breath only after a comprehensive diagnosis.

Disease prevention

My friend has been coughing for several months now, and recently he has been experiencing severe shortness of breath. I went to the doctors, was examined, and was diagnosed with emphysema. He explained to me that this was due to the accumulation of air in the lungs. But I'm worried. Is emphysema contagious? And how to protect yourself from this disease?

Hello! No, emphysema is not an infectious disease, so the risk of catching it from a friend is zero. Prevention of the disease consists of quitting smoking, timely treatment of respiratory tract infections, maintaining a healthy lifestyle, and walking in the fresh air.

What features of X-ray diagnostics of this condition exist today? The article discusses the main signs of emphysema in photographs.

Briefly about the essence of the disease

Emphysema is considered the final stage of many chronic diseases accompanied by inflammation. In addition, an increase in the airiness of lung tissue is characteristic of bronchial asthma and occupational diseases of the organ parenchyma. Thus, there are factors for the development of emphysematous disorganization of the lungs:

• Long history of smoking.
• Chronic obstructive pulmonary disease.
• Bronchial asthma.
• Chronic bronchitis, including with an obstructive component.
• Long-term professional contact with dust and other pollutants.
• The birth defect is alpha-antitrypsin deficiency, which is expressed in the weakness of the walls of the terminal structures of the respiratory functional unit.

Deficiency of this compound (congenital pathology) or chronic exposure to the above factors lead to the inability of bronchioles and alveoli to perform their functions. Their walls become deformed and expand. An air trap occurs - a condition in which air passes freely into the respiratory tract, but it cannot move back in the opposite direction. Vast spaces appear that are filled with air and are completely or partially excluded from the act of breathing. Emphysematous bullae may develop.

Features of X-ray diagnostics of emphysematous changes

Emphysema is a pathology that contains not only signs of structural damage to the lung tissue, but also the functional failure of this organ. Intact areas of lung tissue do not take part in respiration and gas exchange. Therefore, a symptom of progressive respiratory failure occurs.

There are two groups of signs of pathology during X-ray examination:

In order to appreciate and see them, one photo will not be enough. It is necessary to conduct a study in two projections, because it is the lateral projection (laterogram) that will be informative in terms of visualizing X-ray morphological signs.

Radiography using the Sokolov method provides a lot of information.

This is an x-ray method that allows you to assess the functionality of the lungs. That is, the patient is forced to inhale as much as possible, hold his breath, and then forcefully exhale as much as possible. At all these stages, images are recorded. With the help of a tunnel cassette, it becomes possible to examine the lung tissue, pulmonary pattern and other signs in the context of the functional state.

X-ray morphological symptoms

It should first be mentioned that this group of symptoms refers to secondary changes and is characteristic of a long, protracted course of emphysema. They affect the size of the chest, its spatial deformation, changes in the syntopy of the organs and tissues contained in it, expressed quantitatively (degrees or centimeters).

Representatives of the old therapeutic and propaedeutic schools also said that with a long course of pulmonary pathology with the formation of respiratory failure, a deformation of the chest develops, which can be seen even during examination. X-ray examination only confirms the guesses of outstanding clinicians. Emphysematous deformity is called barrel-shaped. That is, the anterior-posterior size of the chest increases significantly. Moreover, this increase can be seen throughout the entire chest cavity.

Radiologists note the following signs of barrel-shaped emphysematous deformity:

• Sternum protruding anteriorly.
• Horizontal course of costal spaces and ribs.
• Kyphotic change in the thoracic spine.

Changes in mediastinal structures are an important sign in the diagnosis of pulmonary pathology. The anterior mediastinum widens due to the protruding sternum. Radiologists call this change an anterior mediastinal gap. The shadows of the heart, aorta and its branches, and large venous highways are moved posteriorly due to an increase in lung volume due to altered pathological airiness. The heart itself may take on an atypical appearance. In some cases, it resembles an hourglass or a teardrop (droplet-shaped deformity), which requires differential diagnosis with diseases such as acquired or congenital heart valve disease.

The next classic sign of emphysema is a change in the transparency of the lung tissue, which increases diffusely. This phenomenon is formed due to excess air in the terminal sections of the bronchial and acinar tree. If there is a bullous deformation of the lung tissue, then the radiologist will see clearing at this place.

You need to pay close attention to the aperture dome. With emphysema, it is located lower than in a healthy person. Sometimes there may be a slight downward deflection.

Due to the fact that emphysema cannot occur in isolation from other pathological processes in the lungs, signs of sclerotic changes are very often observed.

Pneumosclerosis with emphysema is suspected when the pulmonary pattern becomes “excessive” and deformed. Sometimes the root of the lung is even pulled up.

X-ray symptoms

Respiratory failure is also reflected in the X-ray diagnosis of the disease. Usually, during fluoroscopy of the lungs, a specialist in this imaging technique very clearly sees a decrease in the mobility of the diaphragm. In a healthy person, the amplitude of movements performed by this muscle is sufficient. With emphysema, this value progressively decreases.

According to the previously described method Yu.N. Sokolov, you can assess the functional state of the lung tissue. Normally, the intensity and contrast of structures during imaging varies greatly depending on the phases of breathing. At the same time, the opposite picture is typical for emphysema. These indicators do not change significantly. This is a rather specific sign of emphysematous disorganization of lung tissue.

How does pulmonary emphysema appear on x-ray?

Clearing on an x-ray with pulmonary emphysema reflects the severity of the disease. This radiological syndrome indirectly indicates the severity of the pathological process.

What does a radiologist see on an x-ray for emphysema?

On an X-ray of the chest organs (CH) in frontal and lateral projections, with an increase in the airiness of the lungs, the following radiological syndromes are observed:

• enlightenment;
• expansion of intercostal spaces;
• barrel chest;
• deformation of the pulmonary pattern;
• decreased structure of the roots of the lungs;
• smoothness of the contours of the diaphragm domes;
• drip heart.

Attention! The barrel-shaped chest with emphysema is clearly visible in the lateral projection image, which visualizes an increase in the anteroposterior size (the distance between the sternum and the spine).

X-ray of the lungs in a lateral projection: an increase in the anteroposterior size with emphysema is clearly visualized

X-ray morphological symptoms are secondary. They appear due to the expansion of the chest due to an increase in lung capacity.

Other radiomorphological symptoms of excess air in the lung tissue:

• forward deviation of the sternum;
• horizontal arrangement of ribs;
• expansion of the anterior mediastinum;
• symmetrical protrusion of the chest anteriorly.

Radiological symptoms of emphysema are also observed in the lungs:

1. Increase in the area of ​​the lung fields.
2. Diffuse transparency enhancement.
3. Local areas of clearing in places of accumulation of emphysematous bullae.
4. Redundancy of the pulmonary pattern.

During the disease, the dome of the diaphragm deviates downwards due to the pressure on it from the increased size of the lungs. With severe disease, the dome of the diaphragm becomes like a “tent” - a pointed roof, with which the shadow of the heart merges.

Functional X-ray diagnostic syndromes

Functional X-ray diagnostic syndromes arise due to increased ventilation in the lung tissue. As the elasticity of the alveoli decreases, their volume increases. As a result, the internal cavity of the alveolar acini is filled with air. X-rays, passing through such anatomical formations, are not delayed, so a clearing is formed in the image.

The difference in X-ray contrast is clearly visible in the lower (basal) parts of the lungs, where active ventilation occurs.

To correctly read a picture of emphysema, radiologists perform the following tests:

1. When exposing the patient's chest, the right dome of the diaphragm is covered with a screen so that its upper edge is in the lower part of the rectangle. With emphysema, there is a restriction in the mobility of the diaphragm in a rectangle measuring 5x5 cm.
2. Sokolov's method: a series of photographs are taken on a small film (13x18 cm) in different phases of breathing (inhalation, exhalation and while holding the breath). In a healthy person, there is a difference in contrast between these images. With emphysematous lesions of the lung tissue, the difference is not noticeable.
3. The method of targeted images involves taking a series of targeted radiographs in areas of pronounced airiness during maximum inhalation, exhalation and respiratory pause.

Sight image of the right half of the chest with emphysema. It shows a total increase in transparency (clarification)

What does an x-ray tell you about increased transparency?

X-rays provide the clinician with a lot of information about the state of the lung fields. Classic plain radiography of the lungs makes it possible to establish a diagnosis, but it does not always correctly reflect the nature of the pathological process that formed the airiness of the pulmonary fields. In such a situation, a non-standard OGK x-ray is used, and computed tomography is used. It is more informative, but is characterized by increased radiation exposure, so it is used only in cases of extreme necessity.

Maximum benefit from computed tomography in cases of suspected bullous emphysema (with the formation of large air cavities). To identify the characteristics of the course of other forms of pathology, it is better to use magnetic resonance imaging.

X-rays can also be used to differentiate between the following types of emphysema:

The primary form is not associated with narrowing of the bronchi. Detecting it early can prevent complications, so radiologists must be very careful when reading images of the lungs.

In the secondary form of the disease, x-rays are less informative, since during the study it is impossible to view the internal structure of the bronchi, where chronic inflammatory changes accumulate.

The localized type of the disease is even more difficult to diagnose. Local small foci of increased airiness are very difficult to identify on images, since the affected areas are small, and X-rays are not reflected from the airy tissue.

No matter how informative an x-ray is when diagnosing emphysema, you cannot rely only on its signs, since the layer-by-layer image is quite deceptive.

3. Clinical and radiological signs of pulmonary emphysema.

Emphysema is characterized by increased airiness of the lungs, as a result of expansion of the respiratory bronchioles, alveolar ducts and alveoli. The most common in practice is diffuse pulmonary emphysema (bronchitis diffuse emphysema), caused by chronic obstructive bronchitis. With bronchospasm and coughing impulses, exhalation becomes sharply difficult, the interalveolar pores expand and the walls of the alveoli rupture; At the same time, the capillaries are compressed, which leads to degeneration of the walls of the bronchi and alveoli. The pressure in the pulmonary artery increases, i.e. the pulmonary heart is formed. Large blisters - bullae - may appear, more often in the upper sections (bullous emphysema).

Emphysema Clinic

With emphysema, expiratory shortness of breath and swelling of the neck veins are observed, first in a horizontal position, then in a sitting position, and finally even in a vertical position. A persistent, unproductive cough is very characteristic, in which whistling wheezing in the lungs is heard at a distance from the patient. Cyanosis is observed, in severe cases a “cast iron” hue (due to erythrocytosis). The chest is expanded, its anterior-posterior size is increased, up to barrel-shaped, the costal angle is more than 90°, the course of the ribs is almost horizontal, the neck is shortened due to the high position of the shoulder girdle, the sclera is injected, the eyes are bulging (“frog face”). The act of breathing involves auxiliary muscles: sternocleidomastoid (on inhalation), abdominal (on exhalation).

Characterized by a boxed percussion sound of unequal severity in different zones under the lungs (“variegation”), drooping of the lower border of the lungs, and a decrease in the respiratory excursion of the pulmonary edge. When listening, breathing is diffusely weakened (“cotton-like”), exhalation is prolonged, whistling (usually few) wheezes are heard. With exacerbation of bronchitis, with bronchiectasis, moist rales are noted. With long-term existence of pulmonary emphysema, in most cases cor pulmonale is formed.

Pulmonary emphysema is characterized by a slow, steadily progressing course with increasing shortness of breath, cyanosis, and more frequent attacks of unproductive cough. Often a bronchopulmonary infection is associated, which is accompanied by an increase in temperature, sweating of the upper half of the body at night, purulent sputum, and inflammatory changes in the blood. Gas exchange disorders and secondary infection in pulmonary emphysema lead to pneumosclerosis. Bullous emphysema may be complicated by spontaneous pneumothorax.

Radiography with emphysema: there is increased transparency of the lungs, depletion of the pulmonary pattern, barrel-shaped chest (in the lateral projection), protrusion of the sternum, bulging of the lower parts of the chest up to the formation of an “hourglass”, flattening and low standing of the domes of the diaphragm. A study of external respiration in pulmonary emphysema reveals an increase in residual lung volume (early sign) to 35-55% vital capacity (normal - 25%), a decrease in expiratory power and Tiffno test, a progressive decrease in vital capacity (relatively late sign).

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Emphysema photo

Bullous emphysema of the lungs: certain groups of alveoli are expanded in the form of large thin-walled bubbles containing air - bullae (a, b - preparations I.N.

X-ray of emphysema

Tsentroatsinaren emphysema. Surface of the lungs.

Bullous emphysema, spontaneous pneumothorax. Thoracoscopy.

X-ray images of bullous emphysema of the lung.

X-ray of the chest cavity of a patient with emphysema and chronic cor pulmonale (direct projection): the heart is relatively small.

Emphysema on x-ray

Pulmonary emphysema u2013 folk treatment with milk and tar

Smoker's Body Emphysema

PULMONARY EMPHYSEMA SYMPTOMS Emphysema is accompanied by increased fatigue, increased heart rate, and decreased performance. In acute

Propaedeutics of internal diseases (fb2) | Kullib - Cool library! Download books for free

DEVELOPMENT MECHANISM increased permeability Allergic edema develops urticaria acute pulmonary emphysema develops erythematous scarlatinopods

Emphysema

X-ray diagnostics. The X-ray semiotics of pulmonary emphysema is very diverse and reflects certain pathomorphological and pathophysiological changes at various stages of this disease. Currently, most authors divide all radiological symptoms of pulmonary emphysema into morphological and functional.

X-ray morphological symptoms, reflecting changes in the shape and size of the difficult cell, are secondary and, as a rule, indicate advanced phases of the course of pulmonary emphysema. The most characteristic sign of severe pulmonary emphysema is the so-called barrel-shaped deformation of the chest (Fig. 3), especially clearly identified when examined in the lateral projection due to the predominant increase in the anteroposterior size, i.e., the distance between the sternum and the spine. Three factors contribute to this: a more horizontal position of the ribs than normal, kyphosis of the thoracic spine and anterior protrusion of the sternum. Protrusion of the sternum - a frequent and important symptom of pulmonary emphysema - is usually combined with another significant symptom - expansion of the anterior mediastinum and its increased transparency (“gaping” of the anterior mediastinum). At the same time, in the lateral projection, a noticeable increase in the distance between the sternum, on the one hand, and the shadow of the heart and great vessels, on the other, is noted. This occurs as a result of the heart and great vessels being pushed posteriorly by the expanded anterior sections of the lungs.

In the anterior projection, a noticeable symmetrical protrusion of the lower parts of the chest can be observed, over which, in severe cases of pulmonary emphysema, a kind of “waist” is formed, as a result of which the chest takes the shape of a bell or an hourglass (Fig. 4).

X-ray morphological symptoms are also observed in the lungs. Along with a general increase in the area of ​​the lung fields (mainly due to expansion of the vertical dimensions) and a diffuse increase in their transparency, local areas of increased transparency may be detected due to the formation of multiple large emphysematous bullae, local emphysema or acute swelling of individual areas of the lung (lobe, segment). These local areas of clearing, observed more often in the basal parts of the pulmonary fields, are of great diagnostic importance.

Most authors consider changes in the pulmonary pattern to be characteristic of pulmonary emphysema - its redundancy, sometimes deformation, since pulmonary emphysema is usually combined with pneumosclerotic changes. Some authors consider the redundancy of the pulmonary pattern to be a consequence of peribronchial and perivascular pneumosclerosis, others - the result of an increase in the contrast of vascular shadows against the background of increased pneumatization of the lung, and others - a consequence of stagnation of blood in the arterial vessels as a result of narrowing of the capillary bed of the pulmonary circulation. Apparently, all these factors are important both on their own and in their mutual combinations.

With emphysema, the diaphragm also undergoes changes. Its dome is located lower than usual, flattens, and in rare cases may even bend down slightly. The costophrenic sinuses dilate. In severe cases of pulmonary emphysema, the dome of the diaphragm takes the shape of a tent or a pointed roof, with the top of which merges the shadow of the so-called hanging, centrally located, small-sized heart (Fig. 5).

The most important X-ray functional symptom of pulmonary emphysema - impaired pulmonary ventilation - is associated with loss of elasticity of lung tissue and a decrease in vital capacity of the lungs (VC).

The fluoroscopic density (transparency of the lung fields) of normal lungs varies significantly with the phases of breathing. During inhalation, there is a significant clearing of the lungs compared to exhalation. This difference is especially noticeable in the basal parts of the lungs, which take a more active part in the process of pulmonary ventilation compared to other parts. With pulmonary emphysema, this difference is reduced to one degree or another, and in severe cases almost completely disappears. In these changes in the transparency of the lungs during maximum inhalation and exhalation, vital vital capacity is radiologically displayed.

The simplest and most effective way of x-ray assessment of pulmonary ventilation during transillumination is to limit by diaphragming on the x-ray screen a section of the lung above the right dome of the diaphragm measuring approximately 5 x 10 cm so that in the lower third of this vertical rectangle there is an edge of the dome of the diaphragm, which allows you to simultaneously monitor the respiratory excursions of the diaphragm.

With emphysema, along with a decrease in the difference in the transparency of the lungs during deep breathing, there is a significant decrease in the amplitude of movements of the diaphragm, which in severe cases of emphysema can become completely motionless, and sometimes make paradoxical movements (upward with a deep breath) due to upward movements of the anterior parts ribs

For radiographic recording of pulmonary ventilation disorders in pulmonary emphysema, Yu. N. Sokolov proposed the following method (Fig. 6). Using a tunnel cassette, a series of three photographs are taken on a small film (13x18 cm) under identical exposure conditions, but in different phases of breathing: respiratory pause, maximum inhalation, maximum exhalation.

In a healthy person, there is a noticeable difference in photographic density between all three photographs (especially between inhalation and exhalation). With pulmonary emphysema, this difference decreases sharply, and in severe cases almost disappears.

Recognition of pulmonary emphysema using x-ray kymography and electrokymography is also based on identifying x-ray functional symptoms reflecting disturbances in pulmonary respiration and circulation.

Rice. 3. Chronic emphysema; typical barrel-shaped chest deformity. Kyphosis of the thoracic spine. A pronounced protrusion of the sternum anteriorly and a “gaping” of the anterior mediastinum.

Rice. 4. Severe chronic emphysema, hourglass-shaped chest.

Rice. 5. Severe chronic emphysema. The area of ​​the lung fields is increased mainly due to the vertical size. Low aperture position; its dome looks like a tent. In the right lung there is a picture of limited hilar pneumosclerosis and dense interlobar mooring.

Rice. 6. Test for pulmonary ventilation using the method of targeted serial images (negative): 1 - basal section of the right lung of a healthy person with normal vital capacity (4200 ml); 2 - basal section of the right lung of a patient with chronic emphysema (VC 2100 ml). The right picture is the moment of the respiratory pause; medium - extremely deep breath; left photo - deep exhalation. The squares indicate the fields of the radiograph that were subjected to photometry in order to more accurately determine the photographic density.

Symptoms and treatment of emphysema

Almost every disease of the respiratory system is life-threatening. One of these pathologies, accompanied by unpleasant symptoms, is pulmonary emphysema.

If you experience shortness of breath, wheezing when breathing, or symptoms of shortness of breath, you should immediately seek qualified help.

After a comprehensive examination, the doctor will be able to make an accurate diagnosis and, if necessary, prescribe therapy.

The main causes of the disease

What is emphysema? To understand the essence of the presented pathological process, it is necessary to delve a little deeper into the anatomy. The disease occurs against the background of disruption of natural breathing. This system in the human body performs a gas exchange function. When it works correctly, oxygen received from outside enters the blood directly from the lungs. Then it spreads throughout the body. After oxidation, oxygen is transformed into carbon dioxide. At the final stage, it exits through the lungs.

With severe emphysema, the gas exchange function fails. As a result, some of the oxygen remains in the lungs and is not carried along with the bloodstream. The organs gradually increase in volume. Breathing becomes very difficult because there is simply not enough space in the lungs to receive the required portion of oxygen. The development of this defect is usually preceded by an increase in the size of the alveoli. These sacs stop contracting fully, so some air settles in them.

Pulmonary emphysema is commonly understood as a chronic disease of the respiratory system, which, if not properly treated, can lead to disability. Most often it is diagnosed in women. People over 60 years of age who abuse smoking are also at risk.

Emphysema is a consequence of various types of diseases of the respiratory system, characterized by a chronic course. First of all, we are talking about obstructive bronchitis. With this pathology, inflammation quickly spreads from the bronchi to the alveoli, which is accompanied by the appearance of favorable conditions for their deformation. This type of emphysema is classified as secondary.

The primary variant of the disease is also identified. Its development is usually preceded by a persistent deficiency in the body of the protein alpha-1-antitrypsin. As a result of such a violation, damage to the structure of organ tissue occurs. They lose their former elasticity.

The occurrence of emphysema is not preceded by any diseases of the respiratory system. Protein deficiency is usually caused by a genetic predisposition. In rare cases, the disorder is a consequence of exposure to irritating factors, among which it should be noted:

• prolonged smoking;
• inhalation of toxic substances;
• living in an unfavorable environmental environment.

Only a doctor can determine the root cause of emphysema after a comprehensive examination.

Clinical picture and diagnostic methods

Emphysema of the lung at the initial stage of its development practically does not manifest itself in any way. Shortness of breath may occur after intense physical activity. Over time, it becomes constant and does not leave the patient even during rest.

With this disorder, there is a rapid shallow inhalation, which is replaced by a problematic exhalation. The skin on the cheeks takes on a pink tint. As emphysema progresses, the clinical picture becomes more pronounced.

Severe shortness of breath is accompanied by more and more new symptoms:

• cyanosis of lips, nails and tongue;
• the so-called emphysematous chest appears (against the background of an increase in volume, it acquires a barrel-shaped silhouette);
• widening the spaces between the ribs;
• the fingers on the hands become like drumsticks.

In some cases, patients with emphysema begin to rapidly lose weight. This symptom is caused by fatigue of the respiratory muscles, which experience enormous stress when exhaling. A noticeable weight loss indicates the aggressiveness of the pathological process.

Pulmonary emphysema has quite characteristic symptoms. However, the same signs may indicate other pathological processes in the body. If the patient has previously been diagnosed with bronchitis or asthma, he may not pay due attention to shortness of breath.

That is why emphysema is very often detected in the later stages of development, when the clinical picture is especially pronounced. Attacks of suffocation are now repeated so often that the patient develops a fear of death.

If you suspect emphysema, you should seek help from a physician. If necessary, he will refer you for additional consultation with a pulmonologist. For this disease, the initial examination includes a physical examination and listening to the pulmonary system. At the next stage, they move on to instrumental options for diagnosing emphysema.

First, the doctor tests your breathing functions. Using specialized instruments, he evaluates the severity of respiratory failure and narrowing of the bronchi, and the approximate volume of the lungs. These parameters are studied not only in a quiet position, but also after several deep exhalations.

In particularly serious cases, testing is carried out using so-called bronchodilator medications. Such a detailed diagnosis of pulmonary emphysema makes it possible to differentiate it from asthma and bronchitis.

A potential patient is always additionally prescribed a chest x-ray.

With its help, a qualified specialist will be able to determine the presence of defects, assess lung volume, and the degree of change in the vascular pattern. Downward displacement of the diaphragm helps confirm the diagnosis of pulmonary emphysema.

X-ray is considered the most informative examination method in this matter. It is second only to CT.

Therapeutic options

The treatment regimen for emphysema is determined by a pulmonologist or therapist. Every patient must understand that it is not possible to completely overcome the disease. Therapy is carried out at home and has only one goal - to relieve symptoms. The following methods can be used for this:

1. Drug treatment of emphysema. This implies the use of antibacterial agents (Eufillin, Salbutamol, Berodual). The choice of specific drugs and their dosage are determined by the doctor. Antibiotic treatment is usually prescribed for a long time. After a certain time, medications need to be changed, since many of them are addictive. Strong medications often contribute to the development of complications.
2. Breathing exercises. This procedure involves alternately inhaling the most ordinary air and one in which the oxygen level is within the lower limit of normal. The frequency is approximately 5 minutes. During one treatment session, a patient with emphysema can make 6-7 such changes. Full therapy includes daily repetition of the listed procedures for 3 weeks.
3. Low flow oxygen therapy. This treatment is especially effective in the presence of not only emphysema, but also concomitant respiratory failure. Low-flow oxygen therapy sessions can be performed both in a medical facility and at home. For non-aggravated emphysema, massage is recommended. It promotes the removal of mucus and dilation of the bronchi. As a rule, classic or segmental massage options are used.

Emphysema is a fairly serious disease. When it occurs, the patient requires not only medication treatment, but also lifestyle adjustments. What advice do doctors give? First of all, they recommend reviewing working conditions and the intensity of physical activity.

If the work activity of a patient with emphysema is related to the chemical industry or other hazardous production, it is necessary to change the place of work. As for sports hobbies, now you need to approach this issue with special attention. Preference should be given to dosed physical activity that corresponds to the patient’s condition.

Nutrition is of particular importance. For some time, doctors advise following a diet. It implies the exclusion of allergenic foods from the diet. The emphasis should be on nutritious and fortified dishes.

After confirming the diagnosis of emphysema, and even better before this time, you need to stop smoking.

This bad habit is not beneficial for the body. It only slowly destroys the human body, including the respiratory system.

Emphysema in children is diagnosed extremely rarely. Its appearance is caused in most cases by hereditary predisposition. If this diagnosis has previously been confirmed in close relatives, you need to pay special attention to the health of the children.

For preventive purposes, doctors recommend undergoing spa treatment twice a year. In this case, you should choose vacation spots with a warm and dry climate. If there are salt mines near the region of residence, the child can undergo health procedures in them.

Any changes in the lung tissue are characterized by the irreversibility of the process. It is impossible to cure the pathology completely, you can only slow down its course and try to stop the unpleasant symptoms. In this case, you should follow the doctor's treatment instructions.

The prognosis for pulmonary emphysema also depends on a combination of the following factors:

• timeliness of therapy;
• compliance with the recommendations of the attending physician;
• duration of the disease.

With significant impairment of bronchial function and severe emphysema, the prognosis in most cases is unfavorable. Such patients have to artificially maintain respiratory function through expensive medications. The severity of the pathological process increases significantly with complicated emphysema.

The development of negative consequences may be associated with cardiac or respiratory failure, pneumothorax, and pulmonary hemorrhage. In this case, a more serious therapeutic effect is required, and in some cases even surgical intervention. Patients with complicated emphysema often seek support from psychologists and psychotherapists.

• nervousness, sleep and appetite disturbances.
• frequent colds, problems with the bronchi and lungs.
• headache.
• bad breath, plaque on teeth and tongue.
• change in body weight.
• diarrhea, constipation and stomach pain.
• exacerbation of chronic diseases.

Read better what Honored Doctor of the Russian Federation Victoria Dvornichenko says about this. For several years I suffered from poor health - constant colds, problems with the throat and bronchi, headaches, weight problems, abdominal pain, nausea, constipation, weakness, loss of strength, weakness and depression. Endless tests, visits to doctors, diets, pills did not solve my problems. The doctors no longer knew what to do with me. BUT thanks to a simple recipe, headaches, colds, gastrointestinal problems in the past, my weight has returned to normal and I feel HEALTHY, full of strength and energy. Now my attending physician is surprised how this is so. Here is a link to the article.

• Alveolar, interstitial pulmonary edema on chest x-ray
• Venous stagnation of blood in the lungs. Pulmonary hypertension. X-ray diagnostics
• Hypoventilation pulmonary syndrome. Diagnosis using X-ray
• Pulmonary infarction on chest x-ray. Detection of blood clots in the vessels of the lungs using radiation diagnostic methods

Where can I get a lung x-ray?

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Obstructive pulmonary diseases on x-ray. Cicatricial changes in the lungs on x-ray ( pneumosclerosis). X-ray of a smoker's lungs

Obstructive ( obstruction – blockage, obstruction) lung diseases are characterized by a chronic course and similar symptoms with a wide variety of x-ray patterns. Smoking is one of the main factors that lead to this group of diseases. As a result of the lack of oxygen and chronic inflammation, connective tissue develops in the lungs, also called pneumosclerosis.

Diseases that have an obstructive component include:

• Chronical bronchitis ;
• bronchial asthma and some others.

Diagnosis of this group of diseases using X-ray of the lungs is carried out first, but it is not always the only one. Thus, in case of bronchial asthma, doctors confirm the allergic component of the disease using special tests. Particular attention is paid to functional tests, since airway obstruction significantly reduces the ability to inhale and exhale sufficiently.

Chronic obstructive pulmonary disease. Diagnosis using X-ray

Chronic obstructive pulmonary disease is an inflammatory disease, which is accompanied by a violation of the passage of air through the bronchi and is manifested by chronic cough, shortness of breath and sputum discharge. Impaired bronchial obstruction consists of several factors, including increased mucus production, spasm of the muscle wall, and swelling of the mucous membrane. Chronic obstructive pulmonary disease and chronic bronchitis are observed in almost all smokers with a smoking history of 2 or more years, as well as in people who have contact with air pollution ( e.g. gaseous chemicals) by type of professional activity.

Chronic obstructive pulmonary disease is distinguished by a number of radiological signs:

• in the initial stage of the disease, significant changes in the lungs and bronchi may be absent, but a slight increase in the pulmonary pattern is determined;
• subsequently, a narrowing of the lumen of the bronchi and a simultaneous thickening of their walls appears;
• the lungs increase in volume by x-ray this is reflected in the clearing of the pulmonary fields;
• the diaphragm occupies a lower position - at the level of the seventh or eighth rib;
• the difference in the area of ​​the lung fields in the image during inhalation and exhalation is almost invisible;
• the diameter of the pulmonary arteries in the region of the lung root is increased ( right artery – more than 17 mm, left – more than 27 mm);
• the pulmonary pattern becomes reticular in nature due to pronounced fibrosis of the vascular walls;
• in the late stage of the disease, deformations of the walls of the bronchi are detected ( so-called bronchiectasis).

Chronic obstructive pulmonary disease develops very slowly and often unnoticed by the patient, but it is dangerous because it provokes a large number of complications, both local and general. Pneumonia, emphysema, pulmonary hypertension, respiratory failure, and heart failure may develop as a result of chronic obstructive disease. X-ray examination is one of the main methods for diagnosing this disease, however, at an early stage, a more accurate method is to assess the function of external respiration ( measurement of maximum air volumes during inhalation and exhalation).

Emphysema on x-ray of the lungs

Emphysema is a pathological condition in which the alveoli of the lung expand due to deformation of the walls. Emphysema is one of the complications of chronic obstructive pulmonary disease. Inflammation of the terminal sections of the respiratory tract is accompanied by the release of enzymes that destroy the alveoli. At the same time, they stretch due to the fact that the mucus that fills the lumen of the bronchi acts as a valve - air enters the lungs when inhaling, and when exhaling it remains blocked in the alveoli. As a result, the lung tissue is stretched, and expansions of various shapes and sizes are formed.

The following types of pulmonary emphysema are distinguished:

• acinar emphysema– the alveolar part of the lung is affected ( acini);
• uneven ( irregular) emphysema– appears in the area of ​​scar changes in the lungs;
• bullous emphysema– combines several acini into large saccular extensions – bullae.

On x-ray, emphysema is characterized by extensive clearing of the pulmonary field. The pulmonary pattern is weakened, the dome of the diaphragm is lower than usual, and it is inactive during breathing. The ribs are located almost horizontally, due to the fact that the chest is increased in volume. The mediastinum and cardiac shadow are narrowed. Using computed tomography ( CT) with good resolution, bullae and septal deformations in the lung tissue can be detected.

X-ray signs of bronchial asthma

Bronchial asthma, like obstructive pulmonary disease, is characterized by impaired bronchial patency due to swelling of the mucous membrane, spasm of the muscular wall of the bronchi. However, in bronchial asthma this phenomenon is observed as a result of an allergic reaction. In asthma, the bronchial wall is extremely sensitive to contact with allergens such as pollen, wool, and molds.

Bronchial asthma is diagnosed using a set of procedures, the main one of which is the study of external respiratory function. Unlike chronic obstructive bronchitis, in bronchial asthma the functional volumes of the lungs increase when the allergic component is removed by inhalation of medications. In addition, a series of allergy tests are performed to determine allergens.

X-ray examination for bronchial asthma is carried out, first of all, to exclude other diseases, mainly of an inflammatory nature ( pneumonia, acute bronchitis). In patients with bronchial asthma, X-rays show an increase in the transparency of the lung fields on X-rays. If an x-ray is taken during or immediately after an asthma attack, shadows may be found in the image that quickly disappear. They are accumulations of mucus in narrowed areas of the bronchi.

Pneumosclerosis ( fibrosis) on an x-ray of the lungs. Scar changes in the lungs on x-ray

Pneumosclerosis is an overgrowth of connective tissue in the lungs. This phenomenon is a protective reaction to an inflammatory or dystrophic process in the lungs. Connective tissue limits the source of inflammation and, at the same time, protects the remaining part of the lung from pathogenic factors. The disadvantage of pneumosclerosis is the inability of connective tissue to participate in gas exchange.

Pneumosclerosis can develop due to various reasons:

• pneumonia;
• inhalation of toxic and poisonous substances;
• hemodynamic disturbances in the pulmonary circulation;
• some hereditary diseases.

X-ray examination allows you to detect morphological changes in the lung tissue, identify the prevalence, nature and degree of pneumosclerosis. Pneumosclerosis can be local or diffuse. Focal pneumosclerosis is observed with lobar or segmental pneumonia, infarction of a portion of the lung. With focal pneumosclerosis, an almost uniform shading of part of the pulmonary field is determined, which corresponds to the location of the scar. This shading is stable and is observed on x-rays of the lungs in different projections.

The main signs of diffuse pneumosclerosis are strengthening and deformation of the pulmonary pattern. An increase in the pulmonary pattern looks like an increase in the number of mesh and linear shadows corresponding to the vessels and strands of connective tissue in the area of ​​the pulmonary field. Deformation of the pulmonary pattern consists in the unevenness of the contour of the vessels, its expansion and changes in their direction. It is necessary to distinguish between age-related changes in the lungs and pathological pneumosclerosis, since with the aging of the body, similar changes can be observed on x-rays.

Calcifications in the lungs. Detecting calcifications using x-rays

Calcifications are dense formations in the lungs filled with calcium salts. Their localization in the lung is atypical, representing a protective reaction of the body in various diseases. The inflammatory process is surrounded by salts in order to limit the spread of pathogenic agents within the primary focus. This reaction is effective, but preserves the focus of chronic inflammation.

Calcifications appear at the site of the following formations:

• tuberculous granuloma;
• lung abscess;
• cysts containing worms or their larvae;
• pneumonia;
• tumor process;
• congenital calcifications.

Disorders of calcium metabolism in the body very rarely lead to the formation of calcifications, since in this case there is no place of inflammation in the lungs, which serves as the nucleus for their formation. Radiologically, calcifications in the lungs are characterized by a high-density shadow. They are lighter than inflammatory infiltrates, their shade matches the color of the bones. Calcifications in the lung are discovered during a random examination and usually do not require treatment. However, it is worth considering that it is necessary to establish the root cause of their formation. Most often, calcifications are formed during tuberculosis, so in this case it is worth undergoing additional diagnostics.

X-ray of smokers' lungs

Smoking causes a large number of lung diseases. Almost all smokers with a six-month smoking history have specific changes in the lungs. Chronic bronchitis is the most common disease among this category of people, but with a longer period of smoking, smokers develop chronic obstructive pulmonary disease and its complications.

An x-ray of a smoker's lungs shows the following changes:

• strengthening of the pulmonary pattern;
• the appearance of additional shadows up to 2 millimeters, which correspond to mucus plugs and small inflammatory infiltrates in the lungs;
• deformation of the contours of the lung root;
• thickening of the walls of the bronchi.

Smoking causes the following diseases of the respiratory system:

• Chronical bronchitis;
• pneumonia;
• emphysema;
• chronic obstructive pulmonary disease;
• pneumosclerosis;
• cancer of the lungs, larynx and upper respiratory tract.

Smoking has a very negative impact on human health. An X-ray examination, as well as a consultation with a pulmonologist, should convince any person to quit smoking. This habit harms not only the person who uses cigarettes, but also those around him, since the harm from passive smoking is no less great.

Sarcoidosis on x-ray of the lungs

Sarcoidosis is a disease that can affect various organs and systems, but most often it is observed in the lungs and intrathoracic lymph nodes. With sarcoidosis, granulomas form, which subsequently die ( as a result of necrosis) and are replaced by connective tissue. The cause of sarcoidosis has not been established. Pulmonary sarcoidosis is characterized by shortness of breath, cough, chest pain, and in the terminal stage it threatens respiratory failure.

There are four types of pulmonary sarcoidosis using the X-ray diagnostic method:

• Mediastinal variant ( lat. mediastinum - mediastinum). It is characterized by uniform bilateral expansion of the roots of the lung. The roots of the lung are tuberous, heterogeneously colored, granulomas in the region of the lung root have the appearance of denser rounded shadows.
• Disseminated variant. It is distinguished by the dispersion of granulomas over the entire area of ​​the pulmonary field. They look like shadows ranging in size from 2 millimeters to 1 centimeter. The lesions are located mainly in the upper and middle parts of the lungs. The pulmonary pattern is also deformed; loops and networks can be found in it.
• Parenchymal variant. It is characterized by the simultaneous presence of areas of clearing and shading in the lungs. This is due to the fact that simultaneously with the phenomenon of fibrosis, enlarged areas are formed, as in emphysema.
• Interstitial variant. It is characterized mainly by changes in the pulmonary pattern. Fibrosis occurs around the partitions between the alveoli, in the wall of the bronchi and blood vessels.

Plain radiography is the most accessible method for assessing the condition of lung tissue in sarcoidosis, but its disadvantage is its low resolution. Shadows measuring less than 2 mm may not be available for study, while most changes in sarcoidosis are of this size. Therefore, more accurate methods such as computed tomography or magnetic resonance imaging are used to diagnose sarcoidosis ( MRI) .

Radiation diagnostics for emergency conditions of the lungs. Edema, pulmonary infarction. Hydrothorax, pneumothorax

The lungs are a vital organ. When breathing stops in the absence of oxygen, a person cannot survive for long. That is why some lung lesions are of great importance and require immediate assistance. First of all, this applies to injuries, but there are other causes of acute respiratory dysfunction.

Emergency conditions caused by lung pathology include:

• pulmonary edema;
• pulmonary infarction;
• pneumothorax;
• hemothorax;
• pulmonary atelectasis;
• shock lung.

Due to the fact that in these conditions there is a threat to the patient’s life, the time for performing various procedures is limited. Diagnosis of these conditions is carried out in accordance with the time available to the doctor and the patient. However, X-ray examination is one of the first in a number of diagnostic procedures, as it allows one to obtain the most complete information on the patient’s condition.

Alveolar, interstitial pulmonary edema on chest x-ray

Pulmonary edema is a phenomenon in which the fluid content in the lung tissue and alveoli increases. Pulmonary edema can occur due to damage to the lungs or heart. Most often, pulmonary edema is observed in people suffering from heart failure, damage to the valves or heart wall. In this case, a large amount of fluid is retained in the lungs, part of which, under the influence of pressure, leaves the vascular bed. On the other hand, pulmonary edema occurs due to pneumonia, the action of toxic substances, or blood clots entering the blood vessels of the lungs.

There are two types of pulmonary edema:

• Interstitial edema. It is characterized by the accumulation of fluid leaving the vascular bed in the intercellular space. Interstitial edema occurs when pulmonary venous pressure increases above 25 mmHg. Art. Patients complain of the inability to take a deep breath, worsening of the condition in a horizontal position.
• Alveolar edema. With alveolar edema, fluid from the intercellular space enters the alveoli. At the same time, breathing becomes bubbling, and copious frothy sputum is released.

On X-ray, pulmonary edema is characterized by a total decrease in the transparency of the pulmonary fields, which is also called the “ground glass” symptom. The pulmonary pattern is enhanced, while the root of the lung loses its structure. A characteristic sign of interstitial pulmonary edema are Kerley lines. They are thin linear opacities, 1 to 5 centimeters long, that extend from the root of the lung to the edge of the organ. At the root of the lung it is very difficult to distinguish the pulmonary artery, but if this is possible, then an increase in its diameter can be observed.

The X-ray picture of alveolar edema is somewhat different from interstitial edema. With alveolar edema, rounded shadows, multiple, merging with each other, are found in the lungs. Shadows in the lower parts of the lung combine with the shadow of the root of the lung, which creates a characteristic radiographic appearance of “butterfly wings”. When eliminating pulmonary edema, it is necessary to influence the cause of this condition.

Venous stagnation of blood in the lungs. Pulmonary hypertension. X-ray diagnostics

Pulmonary congestion is a condition in which the flow of blood from the blood vessels of the lungs is impaired. At the same time, the pressure in the blood vessels of the lungs increases significantly, which is called pulmonary hypertension. This formulation most often implies cardiac pathology. The fact is that blood circulation through the vessels of the lungs is regulated by the heart muscle, and if the contractility of the heart is insufficient, the blood moves more slowly, which is why the fullness of the vessels and the pressure in them are higher than normal. The extreme degree of pulmonary hypertension is manifested by the release of fluid from the vascular bed and leads to pulmonary edema.

The following causes of pulmonary hypertension are distinguished:

• congenital pulmonary hypertension ( primary);
• heart valve defects;
• left ventricular failure;
• chronic lung diseases;
• sarcoidosis;
• the effect of some medications.

The only characteristic radiological sign of pulmonary hypertension is dilation of the pulmonary artery trunk and the root of the lung. The lower branch arising from the pulmonary artery dilates more than 20 mm with hypertension. This condition is indirectly indicated by an increase in the pulmonary pattern, but this sign is not constant. Since pulmonary hypertension often has additional pathologies, x-rays may show signs of inflammatory or other diseases. If they are absent, doctors examine the heart using electrocardiography ( ECG) .

Pneumothorax on x-ray

Pneumothorax is a condition in which there is air in the pleural cavity. Normally, the pleural cavity, enclosed between two layers of pleura, contains a small amount of fluid. Negative pressure is maintained in the pleural cavity, which allows the lungs to be in an expanded state. With pneumothorax, gas enters the pleural cavity, causing the lungs to collapse and gas exchange does not occur in the required volume.

Pneumothorax is of the following types:

• Open pneumothorax. This type of pneumothorax occurs with chest injuries, due to which the atmospheric pressure in the pleural cavity is compared with the external environment. The collapsed lung is completely excluded from breathing.
• Closed pneumothorax. Characterized by the entry of a limited amount of gas into the pleural cavity. Over time, it can resolve and the lung will return to normal.
• Valvular pneumothorax. The most severe type of pneumothorax, which is characterized by the fact that air penetrates into the pleural cavity in a one-sided direction and its amount gradually increases.

Pneumothorax is characterized by the following radiological signs:

• detection of thin dense ( light shade) line corresponding to the inner layer of the pleura;
• displacement of the mediastinum in the opposite direction from the site of the lesion;
• a slight increase in the amount of pleural effusion, which is characterized by a horizontal level in the lower part of the pulmonary field;
• extensive or local clearing of the pulmonary field.

Pneumothorax may appear similar to emphysema on x-ray with bullae of varying sizes. When establishing differences with pneumothorax, as well as to determine the exact cause of the latter, computed tomography is used.

Hydrothorax on x-ray of the lungs

Hydrothorax is the accumulation of excess fluid in the pleural cavity. The difference between hydrothorax and pulmonary edema is that with edema the fluid is inside the lung tissue, with hydrothorax it is outside. Unlike pleurisy, the fluid in hydrothorax is not of inflammatory origin, but has the same composition as blood plasma.

Normally, the thickness of the pleural fluid layer is no more than a millimeter. The minimum volume of fluid for hydrothorax is 50 ml, but it can be more than 1.5 liters. Hydrothorax can occur due to trauma, liver cirrhosis, ascites, renal failure, tumor processes and a number of other reasons. Depending on the volume of fluid and the cause, hydrothorax looks different on X-rays.

X-rays for hydrothorax are performed in a direct projection. The image reveals a shadow of medium intensity, in which the outer edge is higher than the lower one due to the difference in pressure in the pleural cavity. The dome of the diaphragm and the costophrenic angle are indistinguishable in hydrothorax. When the fluid is localized in the area of ​​the posterior wall of the chest cavity, the pulmonary fields appear blurred. The amount of fluid in the pleural cavity is determined only approximately.

Hydrothorax must be distinguished from pleurisy, pneumonia, and pulmonary edema. For this, an additional X-ray in the lateral projection and computed tomography are performed. With computed tomography, you can see the exact position of the fluid and measure its volume, since with this method the resolution and contrast are higher than with x-rays. Surgeons perform hydrothorax puncture only based on computed tomography data.

Atelectasis of the lung. X-ray picture

The lungs of a newborn are completely empty and are in a “collected” state. From the first minutes after birth, the lung expands, filling with air. Atelectasis is a condition in which part of the lung collapses, the lumen of the alveoli of the lung closes and does not fill with air when inhaling. Atelectasis can occur in the entire lung or in a limited part of it. Sudden atelectasis threatens the patient's life.

The following causes of atelectasis are identified:

• obstructive atelectasis– occurs due to complete closure of the bronchial lumen;
• functional atelectasis– violation of the expansion of the lungs during inspiration;
• compression atelectasis– the most common option, caused by increased pressure on the lung from outside with gas or liquid;
• mixed atelectasis– combines various reasons from the above.

Radiologically, the following signs of atelectasis are distinguished:

• reduction in chest volume;
• upward displacement of the diaphragm;
• the mediastinum and trachea shift towards the affected side;
• uniform darkening of the entire pulmonary field with total atelectasis;
• focal atelectasis has a shape similar to a disk and is observed, as a rule, in the lower parts of the lung.

Atelectasis is not a primary disease. In addition to the main manifestations of atelectasis, other signs that became its cause are also observed on x-rays. These may be inflammatory infiltrates, pleural effusion, tumors or other phenomena. Establishing the exact cause is necessary to eliminate relapses ( repeated exacerbations) atelectasis. This may require more advanced techniques, such as a CT scan.

Hypoventilation pulmonary syndrome. Diagnosis using X-ray

Hypoventilation is a decrease in air flow into the lungs. This condition has some similar features to pulmonary collapse and is therefore also called subatelectasis. Hypoventilation is characterized by less severe symptoms than atelectasis, since the condition is reversible, and the passage of air is still partially preserved. Hypoventilation of the lungs is accompanied by a sharp increase in the level of carbon dioxide in the blood ( about 50 – 80 mm. rt. Art.).

Hypoventilation can develop as a result of the same reasons as atelectasis. These include blockage of the lumen of large bronchi, increased pressure from outside on the lung, and the presence of foreign bodies. On an x-ray, hypoventilation syndrome is manifested by a decrease in lung volume and decreased mobility of the diaphragm. Just as with pneumothorax, with this syndrome a valve may form in the bronchi that allows air to pass in only one direction, so on an x-ray, part of the lung may have increased transparency.

Pulmonary infarction on chest x-ray. Detection of blood clots in the vessels of the lungs using radiation diagnostic methods

A heart attack is the death of a section of the lung caused by an acute circulatory disorder. A pulmonary infarction occurs when a vessel is blocked by a thrombus or embolus and develops within a few hours. Pulmonary infarction is a dangerous condition, as it very often leads to death. A pulmonary infarction can be recognized by severe pain in the chest and the passage of blood during coughing.

In case of pulmonary infarction, x-ray examination should be performed urgently. In the first 12 hours, shadows are detected at the sites of embolism, corresponding to the sites of vascular blockage. A characteristic sign of a heart attack is a wedge-shaped shadow corresponding to the part of the lung that was fed by the affected vessel. It has a connection with the root of the lung. In addition, X-rays show other signs of a heart attack. X-ray reveals pleural effusion, expansion and deformation of the lung root. Pulmonary infarction may also be accompanied by interstitial edema. The best outcome of a pulmonary infarction is scarring of the affected area ( so-called focal pneumosclerosis).

Unfortunately, pulmonary infarction is an irreversible condition. It is possible to prevent necrosis of lung tissue when a vessel is blocked only if it is removed within the first few hours. Therefore, recently, special attention has been paid to methods for detecting blood clots in the vessels of the lung. This method is computed tomography using contrast agents.

Shock lung. Diagnosis using X-ray

Shock lung is a lung lesion that develops in various extreme conditions, accompanied by acute pulmonary failure and impaired blood circulation in the lungs ( injuries, severe operations, massive bleeding). Shock lung combines various pathological mechanisms - edema, necrosis, atelectasis ( decline) alveoli. Increasing changes in the lung lead to increased pulmonary failure and thickening of the organ tissue.

Radiologically, there are 5 stages of development of shock lung:

• Stage I. Uniform strengthening of the pulmonary pattern. It is deformed with the formation of cells and loops.
• Stage II. The deformation of the pulmonary pattern increases, however, small focal shadows appear against its background ( up to 3 millimeters). The pulmonary field remains transparent.
• Stage III. The transparency of the pulmonary field decreases, starting from the lower sections. In the middle and upper part of the lung, focal shadows merge and range in diameter from 4 to 8 millimeters. The pulmonary pattern is less visualized.
• Stage IV. The condition of patients at this stage is very serious. The entire pulmonary field is darkened; against their background, the lumen of the bronchi is clearly visualized. The pulmonary pattern is not visible.
• V stage. At this stage, acute phenomena subside. As residual effects, the lung tissue is replaced by connective tissue over almost the entire area of ​​the lung, and the pattern of the lung is made up of strands of connective tissue ( diffuse pneumosclerosis is observed).

Shock lung is one of the most severe forms of damage to the respiratory system. Treatment of this condition is carried out in intensive care with the use of a ventilator. X-ray examination is carried out only if the patient's condition is stable.

Where can I get a lung x-ray?

X-rays of the lungs are performed in most existing medical centers, clinics and hospitals. X-ray of the lungs is a widespread diagnostic procedure, so it can be performed in both public and private clinics. Prices for lung x-rays depend, first of all, on the quality of the equipment used, and may also differ in different cities. In public clinics, an X-ray examination of the lungs can be performed under a compulsory health insurance policy.

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