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Abnormal chest x-ray: what is it, symptoms, causes, prevention and treatment

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Hazy on Ground-Glass Opacities? Here’s What They Are

The COVID-19 pandemic has brought radiologists’ penchant for descriptive terms front-and-center, with frequent references to one feature in particular: ground-glass opacities.

The term refers to the hazy, white-flecked pattern seen on lung CT scans, indicative of increased density. It’s not quite as dense as the “crazy-paving” pattern, which looks like a mosaic or pavers, and less confounding than the “head cheese sign,” a juxtaposition of three or more densities present in the same lung.

Essentially, a ground-glass opacity describes the “shades of grey” in between a normal lung scan and one from an extremely diseased lung that shows up nearly all white because it’s full of puss or fluid, said Henry Guo, MD, PhD, of Stanford University in Palo Alto, California.

The term has its origins in the way old movies shot their flashback scenes, through a ground-glass lens that gave the film a hazy appearance, Guo said. Chest radiologists adopted it in the 1980s, with a first appearance in the Fleischner Society Glossary of Terms for Thoracic Radiology in 1984.

“We see [ground-glass opacities] so often in chest imaging,” Guo told MedPage Today. They come in different shapes, sizes, quantities, and locations, and they can indicate many different underlying pathologies — including other viral infections, chronic lung disease, fibrosis, other inflammatory conditions, and cancers.

“Clinical context matters for interpreting these findings,” said Javad Azadi, MD, of Johns Hopkins University in Baltimore.

Ground-glass opacities aren’t likely to be found in healthy lungs, though, and wouldn’t result from exposures like air pollution or smoking, radiologists said.

“It’s safe to say that if you are a healthy person, you shouldn’t have ground-glass opacities,” said Paras Lakhani, MD, of Thomas Jefferson University in Philadelphia, speaking on behalf of the Radiological Society of North America (RSNA).

Lakhani noted that a study of more than 200,000 patients found ground-glass opacities were present in 15% — but these are patients “who have or are more likely to have cancer so this data isn’t reflective of the prevalence in the general population.

Given how common ground-glass opacities can be in various diseases, researchers have taken a hard look at their clinical features in COVID-19.

Adam Bernheim, MD, of the Mount Sinai system in New York City, authored one of the early papers on chest CT findings in COVID-19. He and his colleagues studied images captured from 121 patients at four centers in China mostly in late January.

“There are a lot of diseases that can cause ground-glass opacities, but in COVID-19, there’s a distinct distribution, a preference for certain parts of the lung,” chiefly in the lower lobes and periphery, and it appears multifocally and bilaterally, Bernheim said.

COVID-related ground-glass opacities also have a very round shape that’s “really unusual compared with other ground-glass opacities,” he said.

“Influenza or other pneumonias don’t often have that pattern,” he said. “Patients with flu can have ground-glass opacities, but they won’t be in that distribution. It would be more in the middle parts of the lungs. And flu doesn’t have these round, circular shapes.”

Soon after their study published, New York’s coronavirus case count started to rise, and Bernheim’s team saw those features borne out in their own practice.

“Before long, we had cases here in our hospital in New York, and it turned out to be the same pattern,” he said. “It substantiated and confirmed what we were seeing in the Chinese patients.”

They also had many cases where COVID-19 wasn’t initially suspected but was detected incidentally. For instance, patients who had gastrointestinal issues but no respiratory symptoms were sent for abdominal CT, which catches the bottom of the lungs. “In many cases we saw ground-glass opacities” and those patients were subsequently diagnosed with COVID-19, he said.

Yet chest CT has not panned out as an official diagnostic tool for COVID-19.

Matthew Cham, MD, of the University of Washington in Seattle, said there was initial hope as one study determined that CT can show ground-glass opacities during the first few days of COVID infection, when PCR testing may be especially susceptible to false negatives.

“This initial observation led to substantial excitement around the potential usefulness of chest CTs for the early detection of COVID-19,” Cham told MedPage Today.

Subsequent studies, however, showed some COVID patients have normal chest CTs with no ground-glass opacities during the first few days of the infection, Cham said.

No radiological society has recommended diagnostic chest CT for COVID-19. Instead, RSNA, the American College of Radiology, and the Society of Thoracic Radiology issued a consensus statement to help radiologists recognize COVID-19 pneumonia and communicate their findings to others.

Chest CT is still useful in detecting additional bacterial infections that appear on top of COVID-19, and will probably play a more important role in managing patients who have residual scarring after recovering from COVID-19, Bernheim said.

“The role of chest CT in COVID-19 is evolving,” he said, “and it can be useful in providing a lot of helpful information for diagnosing and managing patients.”

  • Kristina Fiore leads MedPage’s enterprise & investigative reporting team. She’s been a medical journalist for more than a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others. Send story tips to [email protected] Follow

How Does COVID-19 Appear in the Lungs?

March 6, 2020 — While COVID-19, previously known as the novel coronavirus, was first reported in China, it was recently declared a global health emergency by the World Health Organization. Because most cases have been in China, clinicians elsewhere may be unfamiliar with how the virus appears in the lungs.  

Here is a VIDEO Example of COVID-19 Pneumonia Chest CT Scan Scroll Through

Find more radiology images of the various COVID presentations in this PHOTO GALLERY – How COVID-19 Appears on Medical Imaging

And reports are now showing the importance of computed tomography (CT) in diagnosis and monitoring of the infection.

“As COVID-19 continues to evolve on a global scale, it is important for radiologists to be familiar with the imaging appearance of the virus in patients,” said Prachi Agarwal, MBBS, M.D., a professor of radiology at Michigan Medicine. “Radiologic work here is extremely crucial when it comes to making diagnoses for patients.”

This inspired Agarwal to team up with Weifang Kong, M.D., a radiologist at Sichuan Provincial People’s Hospital in Chengdu, China, to examine the appearance of COVID-19 in three separate case studies involving patients with the condition.

Their research was recently published in Radiology: Cardiothoracic Imaging.

“Our work focused on the imaging appearance of COVID-19,” said Agarwal. “The radiographic and CT appearance is not specific to the disease and can be seen with other infections, too.”

The pair discovered that while the imaging appearance of COVID-19 is not specific, the presence of bilateral nodular and peripheral ground glass opacities and consolidation should serve as an alert to radiologists that COVID-19 may actually be present in certain patients.

For example, individuals who have a defined travel history to areas where others are infected by COVID-19, or have been directly exposed to others with the virus, should be examined carefully.

Agarwal adds that in radiologic terms, ‘ground glass’ means that a hazy lung opacity shows up on imaging that is not dense enough to obscure any underlying pulmonary vessels or bronchial walls. While consolidation, on the other hand, refers to dense opacities obscuring vessels and bronchial walls.

Since ground glass opacities are common in COVID-19, Agarwal notes that chest CT scans are preferred over chest radiographs, which may have limited sensitivity in picking up early changes within the lungs.

“Chest CT scans can be helpful in suggesting the diagnosis for a patient and also, for monitoring patient responses,” said Agarwal. “It’s important to note that there is a spectrum of clinical manifestations and clinical course in COVID-19. And the clinical presentation of the virus can overlap with other respiratory illnesses.”

Some patients who tested positive for COVID-19 were either asymptomatic or had minimal symptoms. And while the reference standard for making the diagnosis is a real-time reverse transcription polymerase chain reaction (RT-PCR) test, false negative results can occur.

“It has been shown that an abnormal chest CT scan can predate a positive RT-PCR, highlighting the important role of CT in the management of these patients,” said Agarwal.   

To learn more about COVID-19, visit: What Can You Do to Protect Against Coronavirus?

How COVID-19 Appears on Medical Imaging

 

Additional COVID-19 Resources for Clinicians:

World Health Organization (WHO) COVID-19 situation reports

World Health Organization (WHO) coronavirus information page

U.S. Food and Drug Administration (FDA) COVID-19 information page

Centers for Disease Control (CDC) COVID-19 information page

 

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Find more related clinical content Coronavirus (COVID-19)

Chest X-rays Can Predict COVID-19 Severity in Young and Middle-Age ER Patients

Although the Centers for Disease Control & Prevention has recommended against using chest X-ray for COVID-19 diagnosis, new research has revealed the scans, when performed on young and middle-aged adults in the emergency room, can effectively predict which patients with the virus will be at higher risk for developing more severe illness and requiring intubation.

Published today in Radiology, this first-of-its-kind study pinpoints the patients who will likely need to be hospitalized and put on a ventilator according to the severity of the coronavirus patterns seen in the lungs via X-ray. Researchers from Mount Sinai developed a unique scoring system to assess severity, and they said physicians could use the results for quicker identification, triage, and treatment for these high-risk patients.

“This is the first study looking at how we can use chest X-rays from the emergency room to predict how sick COVID-19 patients will get,” said first study author Danielle Toussie, M.D., a resident in the Icahn School of Medicine at Mount Sinai radiology department. “We demonstrate how valuable X-rays can be during this pandemic because, by evaluating disease in different portions of the lungs, we can predict outcomes, which can potentially help appropriately allocate resources and expedite treatment in the most severe cases.”

The team developed the scoring system to help referring clinicians better understand what the scan findings mean for individual patients, she said.

“We would tell [clinicians], ‘We see this opacity here or that opacity there,’ but, then, they would ask, ‘What does that mean for my patient?’” Toussie said. “That’s what we set to find out, and we started noticing that while most patients had disease in the lower lobes only, the patients who had multiple areas of disease, or disease in the upper lobes, seemed to be doing worse.”

Consequently, their classification system divided up the lungs, scored them for severity of disease, and correlated that with what the patients actually experienced as the disease progressed or resolved.

To devise the system, the team evaluated the records of 338 COVID-19-positive patients, between the ages of 21 and 50, at The Mount Sinai Hospital and Mount Sinai Brooklyn between March 10 and March 26. The average age was 39, and 62 percent were male. In the records review, investigators looked at race, pre-existing conditions, including asthma, diabetes, hypertension, HIV, and obesity. Additionally, each patient underwent a chest X-ray in the emergency room.

Researchers examined the patterns of coronavirus in the lungs of every patient, identifying the opacities and where those patterns were located. They divided the X-rays into six zones – upper right, upper left, middle right, middle left, lower right, and lower left. They also created a 0-to-6 scoring system to quantify severity. They considered scores between 0 and 2 to be lower severity and between 3 and 6 to be higher severity. Mount Sinai’s cardiothoracic radiologists have already implemented this scoring system to help emergency physicians appropriately classify patients. 

Overall, 145 patients included in the study were admitted to the hospital. The researchers determined that those with the highest severity scores were 6.2 times more likely to require hospitalization and 4.7 times more likely to be intubated. Men were more likely to have higher chest X-ray scores and to be admitted. However, they were not more likely to be intubated. Additionally, obese patients were also more likely to have higher severity scores and to require hospitalization.

Specifically, this is how the patients scored:

  • 0: 34 patients, 2 intubations
  • 1: 15 patints, 1 intubation
  • 2: 38 patients, 6 intubations
  • 3: 14 patients, 2 intubations
  • 4: 32 patients, 10 intubations
  • 5: 7 patients, 3 intubations
  • 6: 5 patients, 4 intubations

Although previous reports have indicated worse outcomes among African American and Latino patients, the researchers said this study showed there was no significant difference in outcomes between patients of different races and ethnicities when findings were adjusted for other factors, including age, gender, co-morbid conditions, and weight.

According to co-author Yogesh Sean Gupta, M.D., Icahn associate professor of diagnostic, molecular, and interventional radiology, the study results provide insight into how younger individuals – who make up a good proportion of affected patients – may ultimately fare. That knowledge can help providers efficiently gather and implement necessary treatment resources.

Senior author Adam Bernheim, M.D., Icahn assistant professor of diagnostic, molecular, and interventional radiology, agreed.

“These findings underscore how COVID-19, despite its many manifestations, is largely a respiratory illness and the lung changes identifiable on X-ray are a primary predictor of disease progression,” he said. “This work is foundational for demonstrating the role of radiology not only in diagnosis, but also in predicting, triaging, and risk-stratifying COVID-19 patients so that those at highest risk for severe disease can be immediately identified from the moment of the very first chest X-ray upon presentation.”

COVID-19 long haulers share experiences of inhalers, hazy lung scans

COVID-19 long haulers share experiences of inhalers, hazy lung scans

PHOENIX – People who recover from COVID-19 may still feel the impact of the virus even several months later, says doctors and those who are being  referred to as “long haulers.”

Recovering from COVID-19 is one battle, but how you adapt to how your body operates afterward can be another challenge.

A Valley pulmonologist, a lung doctor, says the damage done to your lungs by the virus is just as bad, if not worse, than smoking cigarettes.

Valley residents talk about long-term COVID-19 symptoms

“It has truly affected every aspect of my life,” says 38-year-old Tiffany Jumper. She spent two weeks in the ICU back in July fighting COVID-19.

Six months later, she’s attached to supplemental oxygen day and night.

RELATED: Arizona reports record deaths, leads nation in new case rate

“I wanna live in the pre-COVID state of my body where I could do all things. I was unstoppable. I’ve got four kids, I’m a librarian, I could do everything and I get really exhausted really fast,” Jumper explained, adding that her memory is foggy and she hasn’t been cleared to go back to work.

Also feeling the fatigue is 33-year-old Candie Flemm who was infected around Thanksgiving. She struggles going up the stairs and now relies on her inhaler daily.

“Even when I talk now, I take a lot a lot more breaths than normal and deeper breaths and I’m a singer. Now I’m having to retrain myself how to sing because I can’t get enough air to come in,” she said.

Seen in a scan of lungs that have been through COVID-19, a haze of white patches caused by the virus, according to Dr. Heemesh Seth, a pulmonologist with HonorHealth.

LIST: Coronavirus testing locations in Arizona

He says the white haze represents the “inflammation the virus is causing inside the lung” and that this type of inflammation is not seen in smokers’ lungs.

“The amount of damage it does initially, way worse than in somebody who smoked, but it can be exponential in patients who already have underlying smoker’s lungs or emphysema or damaged lungs,” Seth explained.

A full recovery of the lungs simply takes time, he said.

But for now, life remains different for Flemm and Jumper. Flemm uses an inhaler when she tries to fall asleep at night and Jumper fears this could be her new normal.

Wondering how you can improve your lung health? Seth says to do your best to exercise within your limits to improve lung capacity and stay healthy.

CDC: How coronavirus spreads, symptoms, prevention, treatment, FAQ

Tips for keeping a strong immune system

Exercising and eating right are vital.

Arcot J Chandrasekhar, M.D.













Q1: Describe the characteristic pathologic features of heart and lungs in congestive heart failure. 

  • Heart is enlarged.
  • Changes in cardiac chambers and myocardium depend on the etiology of heart failure.
  • Irregular fibrosis replaces myocardium.  
  • Lung shows severe, chronic passive congestion.  
  • Vessels, including alveolar capillaries, are congested as a result of pulmonary venous hypertension.
  • Alveoli contain numerous hemosiderin laden macrophages.

The frothy liquid oozing from the cut surface of the lung is caused by air moving through water in the respiratory tree.

 

Q2: Anticipated findings in chest x-ray in a patient with congestive heart failure. The following images exemplify findings of congestive heart failure in CXR.

 

Cardiomegaly: 

  • The heart is considered enlarged if the transverse diameter of the heart is larger than diameter of the
    hemi thorax.
  • Cardiac width is larger than half trans thoracic diameter.  Cardiothoracic ratio >0.5.
  • You can encounter normal size heart in acute myocardial infarction or in volume overload.

Vascular phase:

  • This is the first phase of congestive heart failure.
  • It represents pulmonary venous hypertension.
  • Cephalization: Vessels in upper chest is more prominent as a manifestation of pulmonary venous hypertension.
  • Note the blood vessels are more prominent in the upper lung fields compared to the lung base,  just the opposite of normal.
  • In supine film the vessels are same size in upper and lower lung fields.
  • You see increased (>1) artery to bronchus ratio at hilar level.

Hilar fullness with haziness:

  • Enlarged pulmonary veins with perivascular fluid collection leads to full hazy hilum and vessels.

Interstitial phase:

  • Kerley lines are 2-3 cm long horizontal lines in the base of lungs close to chest wall.
  • They are the result of interstitial edema and increased lymphatic drainage.
  • This is the second phase of congestive heart failure.

Alveolar phase:

  • This x-ray shows normal size heart with bilateral diffuse soft fluffy alveolar infiltrates coalescing with each other in  a butterfly distribution typical of pulmonary edema.
  • The heart can be normal and develop failure, as is in this case, due to acute MI.
  • Pulmonary edema is the primary manifestation of heart failure when the left ventricle acutely fails.
  • In chronic heart failure is where you see vascular, interstitial, alveolar phases and pleural effusions.

Pleural effusions:

This x-ray shows:

  • Cardiomegaly
  • Basal congestion: This is gravity dependent accumulation of fluid in the lungs and alveoli are filled with fluid.
  • Fuzzy full hilum: Represents enlarged pulmonary veins and fluid around them. 
  • Bilateral pleural effusions. Due to increased hydrostatic pressures.
 

Rapid changes in CXR: CXR can dramatically change in CHF rapidly as in this case in one day, unlike other chronic diseases.

 

Q4: How do you distinguish Pulmonary edema from ARDS in CXR?

  • In ARDS the heart is normal in size and there are no pleural effusions.
  • Clinical setting and the wedge pressure are necessary in some cases.
  • ARDS is always preceded by a major event like trauma, surgery, bleeding etc. If there is no preceding major event do not consider ARDS.

Q5: What did you understand by the terms congestive heart failure and pulmonary edema?

In chronic heart failure we see lungs going through three phases: Vascular (Cephalization), Interstitial phase (Kerley lines) and alveolar phase (pulmonary congestion).

In acute left ventricular failure we see pulmonary edema. You do not see the vascular and interstitial phase.

In CHF you see basal congestion (dependent portion) while in pulmonary edema you see diffuse white out of lungs.

 

Steps in reading a CXR, suspected to have CHF


Chronic heart failure

  1. Decide whether it is PA or AP view: Many of the findings will change
    in AP film
  2. Decide on the transverse diameter of the heart
  3. Look for pleural effusion
  4. Compare the diameter of the vessels in the upper third of lungs to
    lower thirds
  5. Compare the size of the end on view of vessel to the adjacent
    bronchus
  6. Look for hilar fullness and congestion
  7. Look for kerley lines
  8. Look for basal congestion

Acute heart failure

  1. Heart may be of normal size
  2. Diffuse white out of lungs
  3. Butterfly pattern: Medullary or central distribution of density
  4. Will not see the findings noted in chronic heart failure

How to distinguish from other acute alveolar disease

  • Hemorrhage: hemoptysis, sudden drop in hemoglobin
  • ARDS: Prior major event (trauma, bleeding, sepsis etc),
    progressive hypoxia resistant to therapy requiring ventilator management
  • Pneumonia: High fever , oddball infections (influenza,
    mycoplasma, pneumocystis etc)

Radiology of COVID-19 infection in children: Imaging findings and recommendations

New research shows that the lung images of children with COVID-19 have different features than those in adults. Radiologists suggest a set of guidelines for when to perform imaging studies in children with the disease. (Image: Adobe Stock/Sebastian Stankiewicz, Boston Children’s Hospital)

Key takeaways:
·       Lung images in children with COVID-19 show unique features, including the halo sign.
·       Chest X-ray and CT images differ significantly from early to late infection.
·       New imaging guidelines recommend when to perform imaging studies on children with COVID-19.

As more children become infected with the coronavirus causing COVID-19, lung imaging shows that the disease has characteristic imaging findings in the pediatric population. And since the disease is so new, information about the most appropriate use of imaging has been lacking.

In a pair of original peer-reviewed papers, pediatric radiologists from Boston Children’s Hospital and other international pediatric thoracic imaging experts provide some details about what COVID-19 infection looks like in the lungs of children. And they provide a set of practical imaging guidelines for COVID-19 in children.

Five lung disorders compared

In the first paper, the authors compared the characteristic images of five new pediatric lung disorders: COVID-19, SARS, h2N1, MERS, and e-cigarette or vaping product use-associated lung injury (EVALI).  They discovered that even though COVID-19 is caused by the same virus in adults and children, images of the lungs of children with the illness show some unique findings that are different from those seen in adults.

Their findings derive from studying COVID-19 imaging studies from other researchers as well as several cases treated at Boston Children’s and other co-authors’ hospitals around the world. This original work was published in the American Journal of Roentgenology.  In addition, a podcast, “Pediatric COVID-19: What Radiologists Need to Know”, with first author Alexandra Foust, DO, and senior author Edward Y. Lee, MD, MPH, chief of the Division of Thoracic Imaging at Boston Children’s, summarizes the team’s findings.

Characteristic halo sign

Edward Y. Lee

“One of the main differences with COVID-19 in children is the presence of a “halo” sign on a chest image,” says Lee. “So far, they are only seen in pediatric cases, not in adults, and it appears early.”

The halo sign includes two parts: a central opacity (consolidation) which blocks out underlying lung structure with a ring-like surrounding hazy area referred to as ground-glass opacity (GGO). 

Alexandra Foust

The “halo” sign also appears in infectious aspergillosis or other fungal infections, particularly in immunocompromised children, so care should be taken when making a diagnosis.

“On chest X-ray, the most suggestive imaging pattern for COVID-19 in children is bilateral peripheral predominant GGO, or consolidation, in the mid and lower lung zones,” says Foust. However, X-rays may be normal also. 

Frontal chest X-ray of 16-year-old girl with COVID-19 and known history of tuberous sclerosis treated at Boston Children’s Hospital. Image shows bilateral lower lung zone–predominant consolidations and ground-glass opacities. (Source: https://www.ajronline.org/doi/full/10.2214/AJR.20.23267)

Chest computed tomography (CT) tends to provide more detail than X-ray and often shows a greater extent of disease.

“On chest CT, the most typical pattern includes bilateral GGO, or consolidation, in a peripheral subpleural location, predominantly in the mid and lower lung zones,” adds Foust.

Signs change as disease progresses

The authors also learned that the lung images change over time.  In early stages, the halo sign may be the first indication of localized inflammation. As the disease spreads to surrounding alveoli, images take on patterns of diffuse ground glass. As the alveoli become filled with fluid or inflammatory cells, the ground glass becomes more consolidated until the infection appears to overwhelm lung structures.

Three different phases (early, progressive, and developed) of COVID-19 pneumonia in three different pediatric patients. A. Early phase of pediatric COVID-19 pneumonia in a 14-year-old female with Hodgkin’s lymphoma and positive COVID-19 RT-PCR. Axial lung window CT image shows a rounded ground-glass opacity (arrow) with subtle area of central consolidation in keeping with the “halo” sign. B. Progressive phase of pediatric COVID-19 pneumonia in a 15-year-old female. Axial lung window CT image demonstrates rounded ground glass opacities (arrows) with subtle area of central consolidation. Between these areas, ground-glass opacities (asterisks) start to fill the lung parenchyma. C. Developed phase of pediatric COVID-19 pneumonia in a 16-year-old female with positive COVID-19 RT-PCR test. Axial lung window CT image shows predominantly confluent consolidation (arrow) in the posterior left lower lobe. (Source: https://pubs.rsna.org/doi/10.1148/ryct.2020200214)

International perspective for imaging guidelines

To help guide the appropriate use of imaging for COVID-19 in children, authors from Boston Children’s  participated in creating new recommendations on when to conduct imaging studies for COVID-19 in children. Their findings are published in the journal Radiology: Cardiothoracic Imaging.

“These recommendations are a practical guide for clinicians and radiologists that can properly optimize the use of imaging for possible screening and diagnosis of a child for COVID-19,” says Lee, who is corresponding author of the pediatric COVID-19 imaging guidelines.  

The authors for these guidelines — which also includes experts from Hong Kong, Europe, Brazil, United Arab Emirates, and South Africa — created a set of five criteria to consider when deciding if an X-ray or CT should be ordered for a pediatric patient. “For consideration of imaging evaluation, we emphasize that you have to look at individual pediatric patients and situations as a whole rather than just focusing on disease itself,” says Lee.

The authors of the guidelines stress that the underlying medical problems in children to consider in COVID-19 are usually different from those in adults.  “It’s not cardiovascular disease and diabetes like we see in adults,” says Lee. “Instead, it’s premature birth, underlying congenital disorders, or other infectious diseases like TB or HIV in some parts of the world.”

When to image?

To further guide treatment decisions, the authors created three separate recommendations for obtaining an initial image, performing images over time during COVID-19 infection, and imaging after recovery.  

Over time, imaging studies should only be repeated when assessing a response to therapy, evaluating clinical deterioration, or assessing positioning of life support devices.

After a child recovers from infection — meaning symptoms disappear or test results are consistently negative — imaging is not recommended for asymptomatic patients with a mild disease course. It might be appropriate in children who initially had moderate-severe disease in the hospital and the clinician is concerned about permanent lung damage. And the authors recommend that post-recovery imaging is appropriate for children whose symptoms persist, resurface, or worsen to check for post-infectious lung injury.


Get more answers about Boston Children’s response to COVID-19.

90,000 symptoms, diagnosis and examination, treatment (stone crushing) – Urology

Urolithiasis is a chronic, recurrent metabolic disease characterized by the presence of a stone in the urinary system (kidneys, ureters, bladder), which is caused by various causes.

The main cause of the onset and development of urolithiasis is considered to be a metabolic disorder, which leads to the formation of insoluble salts that form stones.The number of stones and their location can be very different.

The main predisposing factors for the development of urolithiasis include:

  • food (drinking water, food, uniform food, etc.)
  • climatic (hot climate)
  • medicinal (cytostatics, glucocorticoids, antacids, acetylsalicylic acid, tetracyclines, etc.)
  • developmental anomalies of the urinary system, strictures of the ureter
  • hyperparathyroidism, A and D avitaminosis, idiopathic acidosis
  • chronic inflammatory diseases of the urinary system (pyelonephritis, cystitis)
  • hereditary nephritis-like or nephrosis-like syndromes

Types of kidney stones, ureters, bladder

It is important not only to diagnose the presence of kidney stones, but also to recognize as accurately as possible from the view – the correct choice of treatment for urolithiasis or crushing of stones depends on this.The effectiveness of the therapy chosen by the urologist directly depends on the composition and form of solid formation.

  • Oxalates and phosphates. This is the most common category of “stones” in urology, based on calcium salts. They are diagnosed in 70% of patients with urolithiasis.
  • Phosphate-ammonium-magnesium and struvite stones – occur due to infectious processes in the urinary tract. Another name – infectious stones, are diagnosed in 15% of patients.
  • Urates – a uric acid stone in the kidney is diagnosed in 10% of patients, and its formation is explained by an excess of uric acid.
  • Cystine stones – formations are rarely diagnosed, in 2-3% of patients. The causes are genetic and congenital pathologies of the urinary system.

To diagnose solid formations, you must make an appointment with a urologist at the Central Clinical Hospital of the Russian Academy of Sciences.

Clinical manifestations urolithiasis:

Depending on the location of the stone, the patient may complain of different symptoms, but the main ones for this disease are:

  • Paroxysmal pain. Depending on the size and location of the stone, pain is localized in different ways. A stone in the kidney and in the upper part of the ureter is usually characterized by pain in the back or in the side just below the ribs. The pain can be sharp and dull, the intensity can vary at intervals lasting from 20 to 60 minutes. Often this is preceded by physical activity, taking large amounts of fluids or diuretic drugs. As the stone moves along the ureter, the location of the pain changes, the pain passes from the lower back to the abdomen, radiating down the abdomen, into the perineum, the inner thigh, and into the scrotum.Frequent urge to urinate is added to these complaints. It is very important not to confuse renal colic with acute surgical diseases, such as acute appendicitis, acute cholecystitis, acute pancreatitis, intestinal obstruction, strangulated hernia, ectopic pregnancy, perforated stomach ulcer, duodenal ulcer, therefore, it is so urgent to consult a doctor with the above symptoms.
  • Often, patients note an admixture of blood in the urine. In urolithiasis, blood impurities are preceded by renal colic.Cloudy urine with sediment or a foul-smelling odor may also indicate a stone has passed.
  • Deterioration of general health , nausea, vomiting. This is especially pronounced if, against the background of a violation of urine from the kidney, inflammation occurs in it – pyelonephritis.
  • Sand or stone discharge

The diagnosis of the disease with the appointment of the necessary tests, examinations and treatment is carried out by the doctors of the Urology Department.

Reasons for the formation of kidney stones

Examination for urolithiasis

With the above complaints, you need to consult a urologist who will conduct an additional examination and decide on further treatment.

Basic examination includes:

  • Complaints, history, examination
  • General clinical blood and urine tests.
  • Ultrasound of the urinary system, in which, in most cases, the diagnostician will see the location, number and size of stones. It is a safe, painless and non-invasive examination method that can be repeated several times during treatment and for dynamic control.
  • Plain and excretory urography.

Additional examinations:

  • Spiral computed tomography allows you to see the stone, calculate its density, volume, see the architectonics of the urinary system, the state of the surrounding tissues. If necessary, it is possible to carry out a 3-D reconstruction.
  • Dynamic and static nephroscintigraphy assess kidney function and, if present, the degree of renal impairment.
  • Urine culture with antibiotic sensitivity can reveal the presence of infection in the urinary tract, the degree of inflammation activity.

Treatment of urolithiasis

After receiving the results of the examination, the urologist will decide what treatment tactics should be used in a particular case.

Currently, the urologist has many different methods of treatment in his arsenal:

  • Medication aimed at self-removal of the stone
  • Drug treatment aimed at dissolving the stone
  • Open surgery
  • Extracorporeal shock wave lithotripsy
  • Endoscopic contact lithotripsy
  • Percutaneous nephrolithotripsy
  • Endoscopic retroperitoneal surgery

Until recently, open operations in the treatment of urolithiasis were of leading importance, however, due to the development of medical technology, they fade into the background, and are used according to strict indications.The increasing importance is given to minimally invasive methods, such as: extracorporeal shock wave lithotripsy, endoscopic methods (contact lithotripsy), percutaneous nephrolithotripsy. The “gold standard” for the treatment of urolithiasis is extracorporeal shock wave lithotripsy, which removes about 90% of urinary stones of any location. When performing remote shock wave lithotripsy, shock waves, penetrating the tissues and without injuring them, destroy the stone to small fragments (sand).In the future, the sand gradually comes out with urine when urinating. All existing methods of treatment are complementary, and each patient with a stone of a certain localization, size, volume, density, a certain anatomy of the urinary system, the presence of concomitant diseases is selected an individual method of treatment. The issue of treatment tactics (operative, conservative, observation) should be decided by inpatient urologists who have the appropriate certification, experience and qualifications, equipment that allows the use of all types of treatment of urolithiasis.

Get a consultation at the urology department

In our clinic, a device of the latest generation of the German company DORNIER MEDTECH is installed for remote stone crushing. The DORIER company, which developed and introduced this type of treatment into clinical practice in 1983, is currently a leader in the implementation of advanced medical technologies. The DORNIER GEMINI apparatus is a set of equipment for the urological X-ray operating room, which allows remote crushing of stones of any composition, size and location.During a lithotripsy session, positioning on the stone can be performed both by X-ray and ultrasound methods, which significantly reduces radiation exposure at the entire stage of examination, treatment and monitoring of the effectiveness of treatment, as well as eliminates the harmful effect of the shock wave on the tissues surrounding the stone. Mild pain, high crushing efficiency allow for outpatient treatment. The indisputable advantage of this device is the presence of a built-in electrocardiograph, which allows synchronizing the frequency of the lithotripter with the heart rate in patients with severe cardiovascular diseases.

In the urology department of the Central Clinical Hospital of the Russian Academy of Sciences, by appointment, consultations are held for patients with urolithiasis on weekdays from 9:30 to 19:00.

X-rays for animals in Nizhny Novgorod

“I would like to express my deep gratitude to doctors Natalya Igorevna and Roman (I do not remember the middle name) for sterilizing the cat on 12/17/18 on Beketova
In my presence, they examined the kitty and underwent anesthesia, took her only in the evening, the cat felt great.We thought that he would get away from the anesthesia while lying down, but in the morning the cat ate and went to the latok herself.
And there are reviews about the poor cleanliness and sterility of the clinic – this is nonsense. Not so in many human hospitals
oh, how is it there. I didn’t notice anything terrible 🙂 Thanks again !!!

lisa

“I would like to leave a lot of words of gratitude to Maria Karezina. A wonderful, sensitive and very animal-loving doctor and specialist in his field! Anxiously treats every four-legged friend, very attentive! My cat did not feel a single gram of excitement next to her, animals are all feel.And also thanks to her assistant Daria Belova for her tenderness, attitude and care! You are great fellows and thank you for your work!

Elena

“At the end of November, our cat Yasya was sterilized in this clinic. We were very worried, because the pet’s character is wayward. The doctors found an approach to our wild beast and competently consulted on all our numerous questions. We were satisfied with the service and want express gratitude to all the staff of the clinic!

Evgeniya

“Good day! We would like to express our gratitude to the doctor of the clinic on Rodionova N.A.
We have been visiting the clinic for several years, and thanks to the professionalism and caring attitude of Nina Alexandrovna, assistance was provided to our animals. Plus, Nina Aleksandrovna will never refuse to consult over the phone. Thanks to you from us and our Chihuahua Alice.

Elena

“We express our deep gratitude to all the staff of the clinic on Kirovskaya 8A for our Kuzya. For the second time we left him at the hotel in this branch for more than 10 days. At first we were very worried.how everything will go, but our fears were in vain. Kuzya was very pleased and did not even want to leave the hotel, so he fell in love with everyone who looked after him, both the doctors, the administrator and the doctors’ assistants. The team is very professional and friendly. Many thanks to all, we will definitely come back to you again. Kuzya says hello.

Elena

“I want to express my deep gratitude to doctors Natalya Igorevna and Roman (I did not remember the middle name) for sterilizing the cat on 12/17/18 on Beketova
In my presence, they examined the kitty and underwent anesthesia, took her only in the evening, the cat felt great.We thought that he would get away from the anesthesia while lying down, but in the morning the cat ate and went to the latok herself.
And there are reviews about the poor cleanliness and sterility of the clinic – this is nonsense. Many human hospitals are not in the same order as there. I didn’t notice anything terrible 🙂 Thanks again !!!

lisa

“I want to express my deep gratitude and appreciation to the entire team of the clinic at 8a Kirovskaya St. We recently performed three operations on our cats. We performed castration of the cat, as well as sterilization of the cat and kitten, and plastic nose surgery for the kitten.We were very worried, but thanks to the experience and professionalism of the doctors, everything went great. The doctor Tasoity Ya.Z. operated on. We will recommend this clinic to everyone.

Yana

“We were at the sterilization operation on Oktyabrya Ave., doctor Alexandra saw us. Before the operation, they examined us and told everything in detail, they also made a hidden suture (it does not need to be removed), which is much better for the animal and to the clinic for removal. In a couple of days the bandage was removed and the cat felt fine. Thank you very much, I recommend it to everyone !!!

Irina

“I express my deep gratitude to the ophthalmologist Yakob Zelimovich for the treatment of our Staffordshire Bull Terrier. We turned to Cat Matroskin after a fruitless, expensive, many months’ visit to another clinic, where they refused further treatment, categorically stating that“ only a difficult eye can be saved and an expensive operation in Moscow, in our city, no one will definitely help! ”
Now I can confidently say that we also have highly qualified specialists, everything went without the operation and the eyes were saved! I would like to note that the doctor very easily explains what stages of treatment we go through and what each medicine is needed for.Due to the lost time, we still have a long treatment, but the eye is open and sees!
We were in the branches on Rodionova and Kirovskaya, reception on time, friendly staff, no imposition of expensive drugs or services.
Thanks for your work!

Svetlana

“Hello!
I would like to thank the staff of the clinic on Kirovskaya St. for the attentive and sensitive attitude towards my cat. We were at your appointment on November 5 (doctor Maria Yuryevna and assistant Alyona) – Margo’s cat was spayed, I think you remember us) Everything is at the level: they gave advice, and what is better to get tested before the operation.. in general, from, as they say, and before … after the operation they told how to care for, what to pay attention to, about food and feed .. The girls are great! For prices – not expensive and not cheap – something average .. but a stingy person pays twice .. We will bring a cat to you, soon) THANKS !!

Vasily

“We would like to express our gratitude to the doctor of the clinic on Rodionov Street Shatarova N.A.
We have been visiting the clinic for several years, and thanks to the professionalism and caring attitude of Nina Alexandrovna, assistance was provided to our animals. Plus, Nina Aleksandrovna will never refuse to consult over the phone. Thanks to you from us and our Chihuahua Alice.

Elena

“Special thanks to the doctor Rostovshchikova Irina Yurievna for the saved life of our pet Dick. Thank you very much !!!

Vladimir

” Special thanks to the doctor Rostovshchikova Irina Yurievna for the saved life of our pet Dick. Thank you very much!!!

Vladimir

“I express my gratitude to your clinic for help in treating our cat.Special thanks to Anastasia Filippova for her attention, responsiveness and professionalism. An excellent specialist in his field and a good person.

Daria

“I want to express my gratitude to Maria Yurievna Karezina! And also to the assistant of this clinic! These are high-class specialists! They provided urgent assistance to our cat in a short time. They calmed not only the pet, but us as well. After the operation, they explained everything clearly, stung valuable advice. Now on any question – only to this doctor. Prices are very adequate!

Alena

“We express our deep gratitude to Olga Sergeevna Belova.Thank you for your professionalism and care!

Svetlana

“I would like to express my deep gratitude to the doctor of the veterinary clinic” Kot Matroskin “Lopatina AA Alexandra Andreevna quickly identified the cause of the disease in our cat. During the treatment, we repeatedly came to the control, which did not reveal the formation of new lesions.In less than a month and the kitty is healthy.Many thanks to Lopatina A.A. – a master of her craft.

Roman

“Our beloved doctor Olga Sergeevna Belova. A great professional in her field !!!! Always competently selects treatment. The best veterinarian!

Anna

” Good afternoon! Thanks to the specialists of this clinic! For a long time they could not cure the cat from lichen. In addition to the main treatment, the doctor advised to treat the house with Tristel Fuse for surfaces. It turns out that it is important not only to cure the cat, but also to treat the house.To prevent re-infection. After treatment, the healing process was noticeably accelerated.

Evgeniy

“They came with a dog complaining of pain in the ear. The doctor took tests and the next day she called back and prescribed treatment. Everything went well, they dripped in, and the smell went away, and the discharge … The doctor called back a week later and another once asked about the health of the dog … Thank you ..

Marina

“Good day!
Yesterday we were at the doctor’s appointment, Ekaterina Yuryevna Anokhina, a very attentive doctor.We have an old cat, a pensioner already..14 years old..and a full bouquet of sores..Katerina Yurievna always devotes a lot of time to us, the whole cat will look at its eyes, ears, and paws … and will remind about the claws that it is necessary to cut … very kind doctor! And if he prescribes medications that are affordable .. not for 2 thousand, as in other clinics .. Although we live on Nartova, we only go to this branch.

Potapova Vera Mikhailovna

“They left two kitties in the hotel during their vacation. Old cats, 17 and 16 years old, never gave them to anyone, during vacations they always stayed at home and were fed by our grandmothers.That is, the cats were taken from the familiar environment for the first time. We were very worried about how everything would go … Everything went well, we received photos of their pets 🙂 Upon arrival home, the cats quickly adapted to their native environment. We express our deep gratitude to the cat hotel Kot Matroskin and personally to the administrator Marina Pletneva!

Aleksey

“We contacted for the first time, they cut the cat from the tangles. Thank you very much! We have shaved so wonderfully, now we have a young lioness!

Tatiana

“In October we were received by the doctor Alexandra. Before the operation, they examined us and told everything in detail, they also made a hidden seam (it does not need to be removed), which is much better for the animal and does not need to be taken to the clinic for removal. After a couple of days, the bandage was removed and the cat felt great. Thank you very much, I recommend it to everyone !!!

Irina

“Many thanks to the clinic doctor Elena Raskova and her assistant Anton. She brought her cat in critical condition. As it turned out, he had heart problems.The doctor immediately warned that the cat was in a borderline state and took up his emergency resuscitation. They practically did not leave Alik. They were interrupted only for the reception of other patients of the clinic. Elena and Anton constantly monitored his condition and, if necessary, provided him with medication.
Elena and Anton were determined to put the cat on its paws.
When you go to the doctors for help, it is very important that you, your pet, are simply treated humanly at the moment when it is needed most of all.And I am very grateful for this and for the fact that we got to these specialists.

Yulia

“A good clinic, we constantly went to Anna Valerievna. It’s a pity that she was transferred. We’ll have to look for another specialist.

Dmitry

” We were on 14.12 at the reception with Nina Alexandrovna Shatarova with a dog – a French bulldog. We are atopic, and have probably already visited all the clinics of Nizhny, in search of a good doctor, so that they wouldn’t get ridiculous amounts of money out of our pockets and treated adequately. The doctor consulted us for about an hour, took smears and wool.. spoke in detail about the possible reasons and how to live with it now, picked up food, medications are inexpensive .. in general, now with Lord only there .. he liked it so much .. and the receptionist girl and the doctor herself) Thank you for the reception, girls!

Anastasia Grigorieva

“I would like to express my gratitude to Maria Yurievna Karezina! And also to the assistant of this clinic! These are high-class specialists! They provided urgent assistance to our cat in a short time. They reassured not only the pet, but also us.After the operation, they explained everything intelligibly, reaped valuable advice. Now on any question – only to this doctor. The prices are very reasonable!

Alena

“Were at the sterilization of the cat in the blade on Beketova 15, doctor Anokhina Ekaterina Yurievna. I really liked the professional approach to work and the sensitive attitude to the pet of the whole family. Thank you so much, all the best and prosperity!

Vasily

” My cat got
in early May 2019
erosion on the left eye.At first, the eye was squinted (this was the case before, since I have two cats and they often fight) Well, squinted and squinted, drops of IRIS began to drip out of habit. I drip for three days, I see that it won’t help. I am going to clinic number 1 (I will not slander anyone, but believe me, this is KINO. In clinic number 1, I am prescribed cyprovet.
I drip for several days, there is no improvement. At some point, I see on the cornea (as it seemed to me then) as if a hair had stuck, trying to remove IT, nifiga. I call the clinic near my house, let’s call it number 2.To my question: “Can they remove adhered hair from a cat’s eye, a man’s voice tells me ATTENTION !!!:” This is only under anesthesia, you understand, this is the eye ”
I almost fell off my chair. I called the clinic number 1 and told about the “hair” / then went to them. They washed it out, rubbed it with a bandage, the “hair” was not washed off.
Then the doctor gave me the following: (spelling and all the words are saved): “This is a scratch on the cornea. It’s okay, it will heal, the eye will grow dim, the wound will heal and, most likely, the cat will go blind in one eye” AND ADDED: “Nothing, with one eye and people live” .The movie continues. Prescribed drops and injections for us (for resorption)
We underwent treatment for three days. Zero effect. The eye does not open. In short, I’m digging the Internet, looking for a luminary in ophthalmology. I find it. A girl of 25 years old. I come to clinic number 3. We are canceling drops and injections from clinic # 1. prescribe all sorts of drops, injections, pills.
Take from TWO !!! paws a lot of blood. They make a MEDICINE from it + some kind of medicine, by mixing in some kind of apparatus. They put us a preliminary diagnosis – corneal erosion. Then we are treated for about three weeks.We come once a week, drip the eye with apparently anesthetic, clean it of dead epithelium. The cat yells all over the area (looking ahead, I want to accuse this doctor of inexperience, because later I learned that after a drop you have to wait at least 5 minutes for anesthesia worked) In short, after three weeks the girl offered us to sew up the third eyelid. And then I decided to try my fate again. I must say right away that once I lost a cat (in 2011) and despite the fact that I still want to blame the doctor and say that the clinic is SUCH shit and the doctors are the same, but I still can’t really talk about everything clinic talk.And now our eye has grown dim, it does not open. A pitiful sight. My family and I have not found a place for ourselves for almost two months now. And then on the Internet I find information about an ophthalmologist from Matroskin’s cat. Were treated for a long time.
Drops were dripped 6-8 times a day, four types of drops + injections and pills. The eye is overgrown with blood vessels.
To be honest, I was already starting to despair.
The eye, despite two and a half months of “killer” treatment, turned into a cloudy, almost closed, with a network of blood vessels that have grown into the cornea.At some point, the doctor even said: “I don’t even know what else to come up with.” At that moment it became really bad. And now for the last two weeks, we have seen that things are getting better. The erosion has resolved. The cornea appeared (it became visible, pupil in the sense) Although the vessels are still partially visible and the film is still a cloudy edge, but this all can not be compared with what was. And although we are still undergoing treatment and we have an appointment in another week, for the first time in two and a half months I see a cat NOT PIRATE and the eyes are much better.I call this a victory. I will not sing laudatory OD. To put it simply, the doctor Tasoity Yakob Zelimovich saved our eyes and many thanks !!!

Alexey

“I would like to express my deep gratitude to the employees of the branch on Beketov Street, and especially to the doctor Sizginova M.G. for the high professionalism, sensitivity, patience shown in the treatment of our no longer young (9 years old) favorite – the cat Masha. Thank you very much , our pussy feels great. Now we are your regular customers!

Olga

“Thank you very much for your work

Vasily

” Thank you very much, Ekaterina Yurievna and the rest of the girls!
Ekaterina Yurievna is a very good specialist! I did everything carefully! Worried about my dog, like her own! I highly recommend it!
06.06.2018 for the first time turned to this veterinary clinic for the castration of a cat. Olga Sergeevna immediately made a positive impression on us, as a person who knows and loves her profession. The question of in whose hands to give your pet for surgery has disappeared by itself !!! Thank you very much, Olga Sergeevna !!!

Elena

“We were here for the first time on 12/21/19 with a sneeze puppy at 2 months old, got a comprehensive vaccination, everything was at the highest level and claws were trimmed for free. Thank you.

Alexey

” We want to thank Nina Alexandrovna for her good, quality work.A very responsible, experienced, patient, empathetic and sympathetic doctor. We have two Maine Coon cats, we have enough worries and troubles with them, and for a year now we have been treated only by Nina Aleksandrovna. She sterilized the cat very carefully, she always does all the vaccinations and injections very carefully and painlessly. Now we are treating the kitty for cystitis and we get complete information about the course of treatment, the etiology of the disease, the medications taken. Nina Aleksandrovna really pays full attention to animals. We recommend it to everyone. An experienced doctor and a professional in his field 10 out of 10!

Masha + Sasha

“We were at the sterilization operation on ave.In October we were received by the doctor Alexandra. Before the operation, they examined us and told everything in detail, they also made a hidden seam (it does not need to be removed), which is much better for the animal and does not need to be taken to the clinic for removal. After a couple of days, the bandage was removed and the cat felt great. Thank you very much, I recommend it to everyone !!!

Irina

X-ray for turtles. How, where to do, how to understand? – Turtles.ru

X-rays can be taken in any clinic or veterinary clinic equipped with an X-ray machine.

What is the X-ray done for:
1. Check for pneumonia (pneumonia)
2. Check for foreign bodies in the stomach of the turtle or eggs in females.
3. See if there is a limb fracture.

Average shooting parameters (for small and medium):

If the image is overview, then from a distance of about 90 cm, the shooting parameters are approximately 40-45 kV and 6-12 mAs.

For an adult red-eater to see eggs: somewhere around 50 kV at 10 mA / s.
If you suspect that the eggshell is poorly formed, then the shooting mode is 45-50-55 kV / 10-15mAs. Eggs and intestinal patency are viewed in dorsal-ventral projection.

When diagnosing fractures: 40-45 kV and 6-12 mAs

The larger the turtle, the “harder” the image.
For a medium-sized Central Asian woman, “medium” mode 40kV x 6-10 mAs.

For medium-sized water and land with suspicion of an X-ray detectable foreign body or obstruction: two X-rays, in the dorso-ventral (from the back) and lateral projection, the imaging mode is approximately 40kV x 10-15 mAs (this is for the radiologist).Ideally, 45 minutes before the shooting, 10% barium sulfate is injected into her stomach, somewhere 5-7 ml, diluted with starch broth (this is with obstruction). For X-ray contrast images, Omnipaque, barium sulfate, or at least urografin (as for urography) are used. Urografin 60% is diluted with water in half and 15 ml / kg of solution is injected. The contrast is introduced by a tube into the stomach.
If there is a suspicion of obstruction, two images are taken – one hour later and after 6-8 hours or 24 hours – or one after 24 hours after the administration of contrast.
The most important image is dorsoventral. The side one is not necessary and most often not needed, there you already need to look at the situation.

Suspected pneumonia:
In normal projection (dorso-ventral), internal organs are projected onto the pulmonary fields, and instead of the lungs, only their fragments are visible. Pneumonia in turtles is established only in the cranio-caudal projection, and in the lateral – an auxiliary image. It makes sense only for large and medium-sized turtles from at least 12 cm. For small ones it will be uninformative.

If you need to see what is wrong with the jaw joint:
An x-ray is needed, but with a very good resolution (for example, on a mammograph). It is best to give the animal a light anesthesia and try to open its mouth under anesthesia. If this fails, insert something like a block as a mouth expander and take a picture in the lateral and dorso-ventral projection with the jaws as open as possible.


Foreign bodies:
1 – ..
2 – Sand in the stomach and small intestine of a Central Asian turtle
3 – Gravel in the intestines of a red-eared turtle
4 – Fishing hook in the throat

Problems with internal organs
1 – Condensed sediment in urine bladder of the Central Asian tortoise
2 – Urolith in the ureter of the red-eared turtle
3 – Stones (urolith) in the urinary bladder

Pneumonia.X-ray shows a dark and light lung. Clean lungs look clear on x-rays, while those affected by infection look sick and cloudy. It is difficult to identify pneumonia in the small turtles in the picture.
Breathing problems can cause eggs in a female to press on her lungs.

Pregnant female
* in the last picture accreted eggs

– Paw fracture
– Carapace fracture in the Central Asian tortoise

Some of the images are taken from the site spbvet.com

How are X-ray images obtained and what do they show?

Keeping fit is part of the daily life of a modern person.Running or Pilates, karate or strength training – everyone chooses the type of activity that suits him. Unfortunately, sport is sometimes unsafe, injuries occur, but any coach will be able to confirm that you should not be afraid of them. Thanks to modern diagnostic methods, almost any “problem” in the human body can be detected and timely treatment can be started. One of the most effective diagnostic methods is radiology. Based on the analysis of the X-ray, the doctor will quickly and accurately detect the problem.

X-ray: what does it show and what does it look like?

More than a hundred years have passed since the discovery of X-rays, but X-ray diagnostics still remains not only convenient and relevant, but sometimes the only possible method of making a diagnosis. Thanks to this study, it is possible to diagnose bone fractures (X-rays for fractures are done in frontal and lateral projections). The radiograph also clearly shows the pathology of the joints: arthritis, arthrosis, dislocations. In order to diagnose tuberculosis, sometimes fluorography is enough, however, if the doctor has doubts when reading the picture, he can prescribe an additional X-ray examination.X-rays are also used to diagnose diseases such as pneumonia, intestinal obstruction (intestinal examination is performed with contrast, the patient has to drink a suspension of barium sulfate), neoplasms (both malignant and benign), aneurysms, spinal pathologies and some heart diseases. Also, thanks to this study, it is possible to determine the presence of a foreign body in the respiratory tract or stomach.

What is an X-ray image? Probably, each of us has seen it at least once in our life – this is a black-and-white image of the internal structures of the body, reminiscent of an ordinary negative.The light areas of the image are characteristic of the denser parts of our body, and the dark areas are for soft organs and hollow structures, for example, the lungs. By the nature of enlightenment and darkening, the doctor makes a diagnosis.

Previously, images were projected only onto a special light-sensitive film, but with the development of digital radiography, it became possible to obtain images in a digital format. That is why lately, this primarily concerns private clinics, the patient is increasingly receiving in his hands not a film image, but a disk or flash card with the results of the study.

How is the fluoroscopy procedure performed?

X-ray is not only painless, but, in contrast to popular opinion, a safe procedure. The radiation dose that a person receives during fluoroscopy is very small and completely harmless.

As a rule, preparation for the X-ray is not required – you just need to follow the doctor’s instructions: put on a protective apron that covers the reproductive organs, and do not move while the X-ray machine takes a picture.However, in some cases, preparation is still needed: for example, when a patient needs to take an X-ray of the chest, spine or gastrointestinal tract. In order for the pictures to be as clear as possible, three days before the date of the examination, the person will be asked to follow a special diet: exclude foods such as milk, brown bread, fresh cabbage, potatoes, beans and other foods that can provoke flatulence from the diet. A spinal x-ray is done only on an empty stomach, and the last meal may be no later than seven in the evening on the eve of the procedure.

How is an X-ray taken?

During the examination, ionizing radiation passes through the human body. Soft tissues transmit rays, and dense ones detain them. The rays passing through the patient’s body are recorded by a detector. When analogue devices are used, a fluorescent screen or film acts as a detector, onto which the image is projected directly. The screen can also act as a kind of amplifier for the received signals. After converting the radiation into an image using a special optical system, the latter can be recorded by a television camera and shown on a monitor (indirect analog method).In the case of digital equipment, the data is recorded by the receiver and immediately converted into binary code, displayed on the computer screen. A digital picture can be recorded on a magnetic carrier, disk, or output the image to film.

As a result of all these manipulations, a planar black and white image of anatomical structures is obtained. Based on the shadows and light areas in the picture, the doctor “reads” it and then makes a conclusion about the state of certain internal organs.

The most modern and safe method today is digital fluorography – during it, the patient receives a dose of radiation one hundred times less than during X-ray.The radiation dose will be only 0.015 mSv, with a prophylactic dose rate of 1 mSv. However, the resolution of such a fluorograph is still inferior to digital radiography: on a radiograph of the lungs, the doctor will be able to see shadows measuring 2 mm, while a fluorographic study will show only shadows of at least 5 mm.

How to do an X-ray correctly and what determines the clarity of the picture?

The clarity of the X-ray image depends on several factors. These include the equipment on which the procedure is carried out, and the correctness of the examination itself.So, for example, if the patient is not motionless during the picture, the contours of the internal organs will be blurred and the doctor will not be able to read the picture with high quality.

If the doctor thinks that one picture is not enough to make an accurate diagnosis, he can prescribe the patient additional X-ray examinations: take a picture of the desired organ in several projections: back-front, front-back, lateral or sighting.

So, for example, during the postero-anterior projection of the thoracic region or spine, the patient stands, his chin is fixed, and his breath is held during the photograph.Anteroposterior projection is done in the supine position and on a deep breath.

Lateral projection is often prescribed by a doctor if lung disease is suspected. It is done as follows: the patient is asked to lie down, put his hands behind his head. His left or right side is fixed, breathing is held, and then a deep breath is taken. Lateral projection is also often used in the definition of sports injuries: for example, sprains, damage to joints. During the procedure, the person will need to transfer weight to the affected leg.

This is interesting
At the beginning of the 20th century, a new trend emerged: the X-ray fashion. Every self-respecting fashionista simply had to have a picture of his own bones at home – arms, legs, skull. In large cities, the so-called ateliers were massively opened, where everyone could take a picture of any part of their body. Since it was not known about the dangers of X-rays at that time, even pregnant women came to the atelier to “photograph” the unborn child. The pictures were expensive, and those who did not have enough money were given the opportunity to simply “shine” in front of the screen – by the way, this is how the world learned about the deformations of the ribs caused by wearing a corset.

Evaluation of the X-ray image

When decoding the X-ray image, the doctor takes into account the fact that it is formed by a diverging beam of X-rays, therefore the size of the structures in the image may not correspond to the actual ones. The diagnostician analyzes the entire spectrum of darkening, enlightenment and other radiological symptoms before giving the patient a conclusion.

At the first stage of decoding the image, its quality is assessed: focus, contrast and clarity of the image.The doctor then analyzes the shadow picture of the patient’s organs. The doctor who sent the patient for an X-ray examination is responsible for decoding the image.

As a sample for decoding an X-ray, we will give an example of evaluating a picture of a person’s lungs. The following criteria are analyzed:

  • Asymmetrical body position, which is assessed by the location of the sternoclavicular joints.
  • Additional shadows in the picture.
  • The hardness or softness of the image.
  • Comorbidities that may affect the image.
  • Lung coverage in the image.
  • The correct position of the shoulder blades in the image is outward, otherwise the image may be read incorrectly.
  • Sharpness of the images of the anterior rib segments. If the images are not clear, it means that the patient was breathing or moving during the x-ray, and the x-ray will have to be done again.
  • Contrast level. It is defined by the presence of shades of black and white. The doctor compares the areas of darkening and clarification – light areas give pulmonary fields, dark areas – anatomical structures.

The quality of the image evaluation depends primarily on the professionalism of the doctor who makes it. An important factor in the analysis and subsequent conclusion is the illumination at which the picture is read: insufficient lighting or too bright light prevents the doctor from giving a correct assessment of the picture.

Issuance of examination results to the patient

The timing of the issue of X-ray images is not regulated. Each clinic, public or private, sets them up individually.But, as a rule, they are ready on the same day. The patient receives the images and the X-ray examination protocol – the conclusion made by the doctor. In the protocol, doctors try not to use highly specialized terms such as “enlightenment”, “darkening”, “superposition of structures” and others. The protocol is certified by a personal signature, and in some clinics – by the seal of a doctor, and is a legal document.

Despite the fact that only a doctor can read an X-ray picture, many patients try to do it on their own – based on the descriptions of X-rays seen on the Internet.This is wrong, since each image is individual, and, in addition, the self-diagnosis is incorrect in almost a hundred percent of cases. Trust your doctor in this matter!

Where can an X-ray be taken?

A high-quality X-ray or fluorography can be done in almost any modern clinic, both public and private. Before visiting a hospital, pay attention to the level and novelty of the equipment – not only the result of the X-ray examination depends on them, but also the dose of radiation exposure that you receive during the X-ray.

We recommend that you pay attention to the independent laboratory “INVITRO”, which has been operating in Russia since 1995. Branches of the laboratory are represented in many large Russian cities, as well as in Ukraine, Belarus and Kazakhstan. All departments are equipped with the latest technology. Thanks to the latest equipment and highly qualified doctors, X-ray examinations of all organs are carried out in the INVITRO clinics quickly and efficiently.

License to carry out medical activities No. LO-50-01-009134 dated October 26, 2017

7. Kidney tuberculosis | 2. Useful information | IMPORTANT ABOUT TUBERCULOSIS

7. Kidney Tuberculosis

Tuberculosis of the kidney

Tuberculosis of the genitourinary system, namely tuberculosis of the kidney, is the most common form of extrapulmonary tuberculosis (15-20% of cases of tuberculosis, excluding pulmonary tuberculosis). In 4-8% of people with pulmonary tuberculosis, the genitourinary system is affected.
Koch’s bacillus – the causative agent of kidney tuberculosis
Mycobacterium tuberculosis – bacillus.It enters the human body by breathing. With reduced immunity, tuberculosis develops, with good immunity, the pathogen goes into a latent state.
How does kidney tuberculosis develop?

Kidney tuberculosis develops as a result of hematogenous (with blood) spread of mycobacteria. In the cortical layer of both kidneys, small cortical granulomas are formed near the glomeruli. In people with good immunity, the reproduction of bacteria is suppressed, and the pathological process does not spread beyond the cortical layer of the kidneys, and the formed granulomas can remain dormant for a long time, i.e.e. latent. With a decrease in immunity, a dormant infection is reactivated, accompanied by an increase in the size of granulomas and their fusion. In this case, damage to the capillaries occurs with the spread of infection to the medulla of the kidneys and the development of papillitis and papillary necrosis.
With the progression of the process, the formation of large granulomas, caseous necrosis, and then cavities (cavities) occurs in turn. As a result, destruction of the entire kidney can occur. In addition, in a descending way, the infection can spread to the calyx-pelvic system (PCS) of the kidneys, ureters, bladder, genitals.At the end of the process, fibrosis and calcification of the renal parenchyma, strictures in the calyx-pelvic system and ureters are formed, which lead to the development of renal failure. Despite the fact that the seeding of the kidneys by mycobacterium tuberculosis is bilateral, the disease develops clinically on one side.
In more than 50% of cases in men, tuberculosis of the genitourinary system affects the genital organs: tuberculosis of the prostate, tuberculosis of the testicles, tuberculosis of the epididymis. In women, genital lesions are much less common: 5-10%.
Symptoms of kidney tuberculosis
• Urinary disorders are typical symptoms of kidney tuberculosis. In 80% of patients, there is an increase in urination from 3-5 to 10-20 times a day. This is due to the fact that tuberculosis bacteria irritate the lining of the bladder, causing inflammation and even ulceration of the bladder mucosa.
• Hematuria (blood in the urine) is an important symptom of kidney tuberculosis, affecting 70% of patients.It usually accompanies the symptoms of dysuria described above. Blood in the urine results from damage to the bladder, but may also result from damage to the renal parenchyma. The severity of hematuria can vary within different limits, the most characteristic is latent (microhematuria) or mild hematuria. In 3% of patients, obvious hematuria is the first and only symptom of renal tuberculosis. As a rule, hematuria is terminal, i.e. blood appears at the end of urination. This is due to tuberculous inflammation and ulcers in the bladder wall.But if blood in the urine is observed during the entire urination, this indicates damage to the renal parenchyma.
• Pyuria in kidney tuberculosis and bladder tuberculosis occurs in 20% of cases. In the analysis of urine, a large number of pus cells (leukocytes) are found, which makes the urine cloudy.
• 10% of people with tuberculosis of the kidney have pain in the lumbar region or back. At the onset of the disease, pain is not typical, they appear when pyelonephritis develops. Pain can also appear when the patient develops hydronephrosis.A small proportion of people develop bouts of renal colic if a clot of blood or pus passes through the ureter.
• Common symptoms of kidney tuberculosis include:
• Loss of appetite, up to and including anorexia;
• Weight loss, even to the point of emaciation;
• Weakness and rapid fatigability;
• Night sweats;
• Anemia;
• Arterial hypertension is the result of renal artery stenosis. This triggers a complex chain of reactions associated with the renin-angiotensin system, which is clinically manifested by an increase in blood pressure.
Diagnosis of renal tuberculosis
Tuberculin test is performed for all patients with suspected renal tuberculosis. A positive result is observed in 90% of patients, but this can only indicate the infection of the body with mycobacterium tuberculosis, and not about an active process.
Culture method for the determination of acid-fast bacteria (in the case of kidney tuberculosis, three times a morning urine culture is performed) is still the standard for the diagnosis of renal tuberculosis.The sensitivity of this method is 65%, the specificity is 100%. The analysis is recommended before starting antibiotic therapy. Mycobacterium tuberculosis is sown in 85-95% of patients with kidney tuberculosis.
Polymerase chain reaction (PCR) has high sensitivity (over 90%), specificity (over 95%) and is fast in execution. The result can be obtained as early as 6 hours after taking the sample.
Also used in diagnostics luminescence and fluorescence microscopy of smears.
X-ray examination
X-ray examination of the chest organs (CT) may reveal tuberculous foci (active process or postponed tuberculosis). In 50% of patients, X-ray examination of the OGK does not reveal any pathology. With plain radiography of the retroperitoneal organs in 50% of patients, calcifications of various sizes are found in the renal parenchyma. In addition, on a plain radiograph, enlarged mesenteric lymph nodes and calcifications in the adrenal glands can be visualized, which can help in the diagnosis of renal tuberculosis.
Intravenous urography is required for renal tuberculosis. The sensitivity of the method is 88-95%. These techniques make it possible to establish the severity and prevalence of the pathological process. The earliest changes detected during these studies: the presence of cavity structures (cavities), which extend up to the papillae and the renal calyx-pelvis system, causing their destruction; stenoses and strictures of the ureters. Late changes include cortical necrosis, calcification, fibrous cavities, strictures, and sometimes abscesses.Some patients have hydronephrosis.
Computed tomography helps to determine the prevalence of the pathological process and indirectly assess the functional state of the damaged kidney in comparison with the healthy one.
Magnetic resonance imaging (MRI) can also be useful for determining the extent of the disease.
At ultrasound of the retroperitoneal organs can be detected cavity formations of the kidney, calcifications, cortical fibrosis, hydronephrosis, increased
Treatment of kidney tuberculosis
The goals of treating tuberculosis of the damaged kidney:

• To level the infection from the body;
• Treatment of concomitant diseases and pathological conditions.
Drug treatment of kidney tuberculosis
Treatment of patients with kidney tuberculosis is carried out in a hospital, and can be conservative or operative (at advanced stages of the disease).
Surgical treatment of kidney tuberculosis
For the last twenty years, surgical operations for tuberculosis of the genitourinary system make up 0.5% of all urological surgical interventions.
Indications for surgical treatment of renal tuberculosis:
• Drainage of hydronephrosis;
• Drainage of an abscess;
• Partial nephrectomy or cavernotomy for confined cavities in the kidney;
• Nephrectomy of a non-functioning kidney;
• Various types of plasty of the PCS and ureters (uretero-calycostomy, stent placement, ureteral reimplantation, etc.)) with strictures of the ureter with impaired renal function.
Prognosis
The prognosis of the disease depends on the prevalence and severity of the pathological process. Patients with good adherence are more likely to benefit from therapy.

If you suspect kidney tuberculosis, your doctor may refer you to a phthisiourologist at the KOCPTD, where you will undergo an in-depth examination for nephrotuberculosis.

Kirov Regional Clinical TB Dispensary

Located at:
Kirov, Stroiteley Avenue, Building 25.
Reception phone:
8 (8332) 62-26-28

When referring to a consultation with a phthisiourologist, you must have:

9075 Referral Results of pulmonary hypertension for a period not exceeding 3 months
Results of general analysis of blood, urine
Results of ultrasound of the kidneys, bladder
For suspected tuberculosis of the male genital organs: ultrasound, TRUS organs of the scrotum
Outpatient card

Kirov Regional State Public Healthcare Institution

Kirov Regional Clinical TB Dispensary

KIDNEY TUBERCULOSIS

INFORMATION AID FOR DOCTORS AND PATIENTS 6000

Slide 1 Implementation of national projects Healthcare and Demography in the Kirov region.Presentation of the Ministry of Health of the Kirov region. July 2019

Slide 2 Combating cardiovascular diseases. The goal is to reduce mortality from diseases of the circulatory system per 100 thousand population from 698.4 to 550.0

Slide 3 Fight against cancer. The goal is to reduce mortality from neoplasms, including malignant ones, per 100 thousand people from 236.5 to 220.0

Slide 4 Children’s health development program. The goal is to reduce infant mortality by 1 thousand.children born from 4.2 to 3.8

Slide 5 Providing qualified personnel for medical organizations of the health care system of the Kirov region. The goal is staffing of units providing medical care on an outpatient basis, doctors – up to 95%, nurses – up to 95%

Slide 6 Export of medical services

Slide 7 Development of primary health care. The goal is to ensure optimal accessibility for the population, optimize the work of medical organizations providing primary health care, the project to create a new model of a medical organization providing primary health care – by 100%

Slide 8 Creation of a unified digital circuit based on the unified state health information system

Slide 9 National project Demography.Older generation. The goal is to increase the expected duration
healthy life of citizens over working age in 2024 up to 67 years

Slide 10 National project Demography. Promotion of public health

90,000 What the lungs of a patient with COVID-19 and a smoker look like: shocking images

Foreign trauma surgeon Brittany Bankhead-Kendall drew shocking conclusions about the damage that coronavirus infection inflicts on the lungs.According to the doctor, the damage from COVID-19 is the worst of all that she has encountered at work. Writes about this edition Mirror .

The specialist noted that in comparison with the respiratory organs of a healthy person, the lungs of a smoker on X-rays look cloudy. While the lungs of a COVID-19 patient have a darker image, indicating the presence of severe scarring.

This can be seen in the image below, where the first image belongs to a healthy person with minor lung damage, the second to a person who smokes, and the third to a patient with coronavirus.

X-rays of the lungs of a healthy person, a smoker and a patient with COVID-19

Photo CBS News

“The lungs after COVID-19 look worse than the lungs of any heavy smoker. And they collapse, stick together. Shortness of breath and other consequences persist, ”wrote Brittany, who is an assistant professor of surgery at the University of Texas Tech, on Twitter.

The doctor warned that scars on the lungs will become a big problem for many who get coronavirus: “Everyone is so worried about mortality, and it’s terrible. But those who have recovered can face big problems. ” Thus, all patients with COVID-19 who were treated by Bankhead-Kendall had serious respiratory damage on x-rays.

Also affected 70-80 percent of asymptomatic patients:

“There are people who say they’re okay and don’t feel any problems.However, the results of X-ray images indicate serious disorders in the lungs, ”the doctor said in an interview with CBS TV channel.

One way or another, studies on the impact of COVID-19 on those who have had the virus in a mild form are just beginning. But already now, some experts believe that the effects of the coronavirus can be felt for many years.

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Spontaneous neoplasia in decorative rats

06 Apr 2016 | Exotics and Rodents

Neoplasia is one of the most common diseases that small pet owners turn to veterinarians for.Epizootic data suggest that the percentage of cancer in small animals is increasing year by year. As in humans, the incidence of neoplasia is correlated with age and geographic location. Decorative rodents, like all multicellular organisms, are also susceptible to oncopathology.

Due to their small size and simplicity in keeping, rodents and lagomorphs are increasingly becoming pets and companions. That is why they have become quite common patients of veterinarians.

The incidence of spontaneous neoplasia in decorative rats is low. Despite the “efforts” of experimental oncology to breed highly cancerous inbred sister-brother lines with selection for neoplasia of various organs and tissues among mouse-like rodents, only such lines were successfully developed in mice (about 200). In rats, however, experimenters “achieved” an increase in the incidence of neoplasia without a stable fixation in the lines. Therefore, rats are used as an experimental model to study induced and transplanted tumors.

Spontaneous tumors are tumors that have arisen without any influence of the experimenter. It is with such neoplasms that ordinary veterinarians face at the reception. From 1995 to 2009, more than 4000 decorative rats with various pathologies were admitted to the veterinary clinic “MiV”. Among them, 58% – with oncopathology. The “palm” belongs to the fibroadenoma of the mammary glands (48%), in second place – other tumors of the skin and its derivatives (21.5%), in third place – pituitary adenoma (15%).The structure of the remaining 15.5% of spontaneous neoplasms of decorative rats is quite diverse and includes both benign and malignant neoplasms of various organs and tissues.

For comparison on the frequency of occurrence, we used data on spontaneous neoplasia of rats obtained in studies conducted in several vivariums in the USA, Canada and Japan Charles River Laboratories from 1991 to 1997.

DIAGRAM .

The most common spontaneous neoplasia in rats.The first column is the MiV Veterinary Clinic’s own studies (both males and females), the second column is the studies of Charles River Laboratories, 2001, females, and the third is males.

Analyzing the data obtained, it can be assumed that a lower percentage of detected pituitary adenomas than laboratory studies is most likely associated with underdiagnosis of this disease and the absence of an autopsy to detect pituitary microadenomas in elderly (functionally inactive) rats.

CLASSIFICATION.

In experimental oncology, the description of neoplasias is based on the anatomy of the affected organ (In veterinary medicine, as in humane medicine, the anatomical classification of single neoplasms according to the TNM nomenclature is used, where T is the primary tumor, N is metastases to regional lymph nodes, M is distant metastases. Digital or letter indices show the size and spread of the tumor to adjacent tissues.Depending on the location, superficial solid tumors, tumors of hollow organs, tumors of body cavities and central nervous system are distinguished.In addition to solid ones, multiple, or disseminated, neoplasias are distinguished. They are classified according to the primary organ affected (lung lymphoma, abdominal lymphosarcoma). A staged classification (according to the clinical stages of the neoplastic process) is also acceptable.

DIAGNOSTICS.

Often, the diagnosis of neoplasia in rats is not difficult, since the owners themselves seek help when a localized neoplasm is found in their pet.However, with the accumulation of clinical experience and the expansion of available diagnostic tests, the detection rate of latent neoplasms has increased. In our clinic, in addition to clinical examination and dynamic monitoring observation, we use laboratory diagnostics to detect paraneoplastic changes in metabolism and blood composition, as well as additional diagnostic imaging methods (X-ray, including angiography, and ultrasound of the abdominal cavity). Additional imaging techniques are used primarily to detect chest and skeletal metastases and to monitor the progression of tumors in the abdomen.To differentiate the diagnosis and clarify the prognosis, we use cytological analysis of punctate or histology of a biopsy specimen of a neoplasm.

CLINICAL EXAMINATION

Collecting anamnesis.

  1. Rodent feeding and keeping conditions, sex, age, “genetic load”.
  2. Time of occurrence of the neoplasm identified by the owner.
  3. Tumor growth pattern
  4. Changes in the general condition of the rodent, behavior in the colony, intake of food and water, feces.

Inspection

  1. Animal weighing, general inspection.
  2. Anatomical localization of neoplasia, structure and size of neoplasia (tumor doubling time).
  3. Invasiveness in adjacent tissues, mobility, soreness.
  4. Paraneoplastic syndromes:

a) hematological: anemia, thrombocytopenia, coagulation disorders, leukocytosis, less often leukopenia; b) metabolic disorders and endocrinopathies: topical syndromes of hormone-producing neoplasias (with adenoma of the pituitary gland, adrenal glands, ovaries) and ectopic paraneoplastic syndromes (non-endocrine).

The most common ectopic paraneoplastic syndromes in rats:

  1. Dehydration and violation of EBV (decreased thirst, diarrhea, polyuria).
  2. Hypercalcemia (from the gastrointestinal tract – anorexia and constipation, pancreatopathy and peptic ulcers, from the CVS – cardiac arrhythmia up to arrest, from the side of the kidneys – polydipsiapolyuria, nephropathy with calcification, tubular damage, decreased GFR, neuromuscular disorders, muscle weakness, weakness slowing down reflexes, stunning).
  3. Hypoglycemia (weakness, cachexia)
  4. Hyperthyroidism is rare (dyspnea, HCM) or hypothyroidism.

CYTOLOGY AND BIOPSY.

The most valuable method for diagnosing neoplasia, allows to differentiate benign and malignant processes, the degree of malignancy, the likelihood of metastasis.

Exfoliative cytological diagnostics – the most acceptable in decorative rats. We use fine-needle puncture aspiration, taking tissue smears, tissue scrapings, examining smears of exudates and effusions, liquid aspirates.Given the small size of the animal, such a diagnostic method is minimally invasive and practically safe, it is carried out without general anesthesia. Cytological analysis provides information about cell populations, “key” cells, and the presence of an inflammatory process.

Biopsy allows us to carry out histological examination of neoplasia. We receive information about the type of cells, the structure of tissues and the rate of mitosis, which allows us to predict the development of the neoplastic process.

Basically, we perform an operating excisional biopsy, less often in the case of an extensive tumor process – an insertion biopsy of a part of the tumor.We do not use needle / puncture biopsy due to the risk of massive bleeding.

Photo. Histo-picture of skin melanoma and squamous cell carcinoma of the gland of Zimbal.

X-RAY

One of the additional methods of diagnostic imaging of neoplasias (especially of the skeletal system), metastatic processes in the lungs. When carrying out differential diagnosis, it is necessary to distinguish between malignant bone pathology and bone infection (osteomyelitis).Lesions can be diffuse, focal, penetrating and indeterminate. The worse the edges of the osteolysis area are delineated, the more aggressive the process is.

Mixed tumors of the skull: soft tissue tumors with bone involvement (squamous cell carcinoma of the Zimbal glands or turbinates). Invasion of the underlying bones with aggressive lesions, osteolysis dominates. Radiography reveals focal osteolysis with clear or indeterminate edges, periosteal reaction (mixed osteoproductive and osteolytic process).Occasionally, osteolysis of the tympanic bladder and adjacent bones with some production of new bone occurs (the bones seem to be “moth-eaten”). Sometimes the temporomandibular joint is involved in the process, then malocclusion of the incisors of the upper and lower jaw is necessarily revealed.

Photo. Malocclusion in case of damage to the temporomandibular joint in a rat with squamous cell carcinoma of the Zimbal gland.

Photo. Osteolysis and periosteal response in a rat with squamous cell carcinoma of the nasal cavity.

The radiopacity of the affected area is increased, tumor tissue is poorly defined, soft tissues are homogeneously darkened. Osteolysis of the bones of the upper jaw, nasal bones, incisors of the upper jaw create a mixed darkening. There is an external periosteal reaction, a change in the configuration of the skull.

Neoplasias of the brain are rarely detected during conventional radiography (sometimes calcification and displacement of the skull bones are visible). Twice we performed vascular contrasting to detect pituitary adenoma (angiography using an intravenous omnipack under anesthesia).Due to the invasiveness of the procedure, as well as the aggravation of the severe condition of the animal, we no longer used angiography in rats.

Photo. Pituitary adenoma and pituitary gland on angiography.

Tumors of the chest. Tumors of the lungs (primary, secondary): usually single or multiple nodules and seals are detected, often lobular consolidation of one or more lobes of the lungs (consolidation by tumor tissue, compression of the bronchi and subsequent atelectasis). Mediastinal or portal lymphadenopathy is a common indicator of neoplasia.

Photo. Thymoma with consolidation and pulmonary atelectasis.

Pleural effusions (intrathoracic tumors) are also detected. Such animals are admitted to the clinic with severe dyspnea. Radiography is performed after oxygen therapy, sometimes the x-ray should be repeated after thoracocentesis (dangerous! We carry out with the obligatory taking of the effusion for cytology!).

Photo. X-ray in rat lung lymphoma. Tracheal compression and displacement, chest effusion, and pericardial effusion.

Photo. Lung lymphoma in two positions.

Photo. Rat lung lymphoma, autopsy.

Tumors of the heart.

Extremely rare, often metastatic. Radiography reveals changes in the shape of the heart. Pericardial effusion masks tumor imaging, leads to thickening of the caudal vena cava shadow, hepatomegaly and ascites are observed. Tumors of the ribs. Osteosarcomas and malignant neoplasias of the soft tissues of the chest wall.X-ray: osteolysis of the affected rib, the appearance of “tumor” bone and periosteal reaction of the adjacent ribs.

Photo. Osteosarcoma of the ribs with metastatic lesions of the lungs and heart.

Photo. Osteosarcoma of the chest.

Tumors of the abdominal cavity. Hepatomegaly, splenomegaly in spontaneous leukemia of rats on radiography: displacement of the abdominal cavity organs caudally and caudodorsally, the small intestine is displaced dorsally, lack of details due to effusions or bleeding “cloudy glass”.Tumors of the mesenteric lymph nodes Undefined soft tissue tumor mass in the mesogastrium (similar to the third kidney). The small intestine is displaced to the periphery.

Photo. Hyperspletion in rat leukemia.

Tumors of hollow organs (uterus, ovaries, accessory gonads) – displacement of the abdominal organs cranially, lack of details due to effusions or bleeding “cloudy glass”.



Photo. Hemangiosarcoma is disseminated, an undefined soft tissue mass, pathological effusion in the chest and abdominal cavity is visualized.

Angiographic examination with vascular contrast (detection of pathological “vascular zone”) is rarely used to differentiate abdominal neoplasms.

Photo. Angiography of the vessels of the abdominal cavity.

ULTRASONIC RESEARCH.

Another type of additional visual diagnostics of neoplasms. We mainly use abdominal ultrasound to differentiate neoplasms of hollow organs and mesenteric lymph nodes.

Photo. Adenocarcinoma of the uterine horn, polycystic ovary, rat 2 g 1 month

METHODS OF TREATMENT OF NEOPLASIA IN RODENTS.

Monitoring

The animal is regularly weighed, the size of the neoplasia is measured, the doubling time, the nature of growth and invasion of the surrounding tissues are monitored. Laboratory research helps to identify paraneoplastic syndromes (hematology, urine OCA). Conducting repeated X-ray studies or ultrasound (for abdominal neoplasia).Conservative therapy.

  1. Treatment of FCM.
  2. Complicated history (concomitant severe pathologies).
  3. Dissemination of neoplasia
  4. Inoperability of neoplasia
  5. Financial insolvency of the owner Cancer surgery.
  6. Excisional surgery (local excision, radical local excision “one block”)
  7. Cytoreductive surgery (local excision + adjuvant therapy) is used when complete local excision is impossible, treatment of sarcomas (chemotherapy, immunotherapy).
  8. Palliative surgery is aimed at maintaining quality of life without improving prognosis and life expectancy (incomplete excision of ulcerated carcinomas of the Zimbal gland, excision of ulcerated fibroadenoma of the mammary gland in multiple FCM).

Immunotherapy

The reality of the existence of an immune response to tumor antigens has been repeatedly confirmed in experiments. Scientific methods have identified two groups of tumor antigens – tumor-specific and tumor-associated antigens.Specific recognition and destruction of tumor cells is carried out by a specialized subpopulation of T-lymphocytes – cytotoxic T-lymphocytes CD8 +, carrying clonal receptors, the specificity of which in recognizing “self” and “alien” is controlled by the processes of intrathymus selection. Adjuvant therapy is used to induce immune responses to tumor cells.

In our clinic, adjuvant pre- and postoperative immunotherapy is used, while we use:

  1. Roncoleukin
  2. Polyoxidonium
  3. Galavit

Chemotherapy.

For focal and leukemic lymphoma, mediastinal lymphadenopathies, we use prednisolone at a dose of 2 mg kg 1 rd.

In lymphosarcoma and lymphoma, intravenous administration of vincristine at a dose of 0.75 mgm2 once a week under general anesthesia was tested. This type of chemotherapy is rarely used by us due to pronounced toxic reactions in most animals, especially of a neurological nature (sensory disturbances, paresis), and a shorter survival and remission period than when using prednisolone.Application of stress adaptogens.

We use ligfall in certain courses depending on the nature of the neoplastic process. We have found that the use of ligfol in lymphoproliferative processes, neoplasia of the mammary glands is more often justified and leads to long-term stabilization of heterostasis. However, the use of ligfol leads to increased tumor growth and increased aggressiveness in soft tissue sarcomas (fibrous, adipose, muscle and vascular tissues).