Picture of lung lobes: Picture Illustration of Anatomical Structures – Lungs
lung | Definition, Function, & Facts
Lung, in air-breathing vertebrates, either of the two large organs of respiration located in the chest cavity and responsible for adding oxygen to and removing carbon dioxide from the blood. In humans each lung is encased in a thin membranous sac called the pleura, and each is connected with the trachea (windpipe) by its main bronchus (large air passageway) and with the heart by the pulmonary arteries. The lungs are soft, light, spongy, elastic organs that normally, after birth, always contain some air. If healthy, they will float in water and crackle when squeezed; diseased lungs sink.
In the inner side of each lung, about two-thirds of the distance from its base to its apex, is the hilum, the point at which the bronchi, pulmonary arteries and veins, lymphatic vessels, and nerves enter the lung. The main bronchus subdivides many times after entering the lung; the resulting system of tubules resembles an inverted tree. The diameters of the bronchi diminish eventually to less than 1 mm (0.04 inch). The branches 3 mm and less in diameter are known as bronchioles, which lead to minute air sacs called alveoli (see pulmonary alveolus), where the actual gas molecules of oxygen and carbon dioxide are exchanged between the respiratory spaces and the blood capillaries.
Human Organs: Fact or Fiction?
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Each lung is divided into lobes separated from one another by a tissue fissure. The right lung has three major lobes; the left lung, which is slightly smaller because of the asymmetrical placement of the heart, has two lobes. Internally, each lobe further subdivides into hundreds of lobules. Each lobule contains a bronchiole and affiliated branches, a thin wall, and clusters of alveoli.
In addition to respiratory activities, the lungs perform other bodily functions. Through them, water, alcohol, and pharmacologic agents can be absorbed and excreted. Normally, almost a quart of water is exhaled daily; anesthetic gases such as ether and nitrous oxide can be absorbed and removed by the lungs. The lung is also a true metabolic organ. It is involved in the synthesis, storage, transformation, and degradation of a variety of substances, including pulmonary surfactant, fibrin, and other functionally diverse molecules (i.e., histamine, angiotensin, and prostaglandins).
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A person not engaged in vigorous physical activity uses only about one-twentieth of the total available gaseous-exchange surface of the lung. Pressure inside the lungs is equal to that of the surrounding atmosphere. The lungs always remain somewhat inflated because of a partial vacuum between the membrane covering the lung and that which lines the chest. Air is drawn into the lungs when the diaphragm (the muscular portion between the abdomen and the chest) and the intercostal muscles contract, expanding the chest cavity and lowering the pressure between the lungs and chest wall as well as within the lungs. This drop in pressure inside the lungs draws air in from the atmosphere.
The lungs are frequently involved in infections and injuries. Some infections can destroy vast areas of a lung, rendering it useless. Inflammation from toxic substances, such as tobacco smoke, asbestos, and environmental dusts, can also produce significant damage to the lung. Healed lung tissue becomes a fibrous scar unable to perform respiratory duties. There is no functional evidence that lung tissue, once destroyed, can be regenerated.
What Is Lung Cancer? | Types of Lung Cancer
Lung cancer is a type of cancer that starts in the lungs. Cancer starts when cells in the body begin to grow out of control. To learn more about how cancers start and spread, see What Is Cancer?
Normal structure and function of the lungs
Your lungs are 2 sponge-like organs in your chest. Your right lung has 3 sections, called lobes. Your left lung has 2 lobes. The left lung is smaller because the heart takes up more room on that side of the body.
When you breathe in, air enters through your mouth or nose and goes into your lungs through the trachea (windpipe). The trachea divides into tubes called bronchi, which enter the lungs and divide into smaller bronchi. These divide to form smaller branches called bronchioles. At the end of the bronchioles are tiny air sacs known as alveoli.
The alveoli absorb oxygen into your blood from the inhaled air and remove carbon dioxide from the blood when you exhale. Taking in oxygen and getting rid of carbon dioxide are your lungs’ main functions.
Lung cancers typically start in the cells lining the bronchi and parts of the lung such as the bronchioles or alveoli.
A thin lining layer called the pleura surrounds the lungs. The pleura protects your lungs and helps them slide back and forth against the chest wall as they expand and contract during breathing.
Below the lungs, a thin, dome-shaped muscle called the diaphragm separates the chest from the abdomen. When you breathe, the diaphragm moves up and down, forcing air in and out of the lungs.
Types of lung cancer
There are 2 main types of lung cancer and they are treated very differently.
Non-small cell lung cancer (NSCLC)
About 80% to 85% of lung cancers are NSCLC. The main subtypes of NSCLC are adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. These subtypes, which start from different types of lung cells are grouped together as NSCLC because their treatment and prognoses (outlook) are often similar.
Adenocarcinoma: Adenocarcinomas start in the cells that would normally secrete substances such as mucus.
This type of lung cancer occurs mainly in people who currently smoke or formerly smoked, but it is also the most common type of lung cancer seen in people who don’t smoke. It is more common in women than in men, and it is more likely to occur in younger people than other types of lung cancer.
Adenocarcinoma is usually found in the outer parts of the lung and is more likely to be found before it has spread.
People with a type of adenocarcinoma called adenocarcinoma in situ (previously called bronchioloalveolar carcinoma) tend to have a better outlook than those with other types of lung cancer.
Squamous cell carcinoma: Squamous cell carcinomas start in squamous cells, which are flat cells that line the inside of the airways in the lungs. They are often linked to a history of smoking and tend to be found in the central part of the lungs, near a main airway (bronchus).
Large cell (undifferentiated) carcinoma: Large cell carcinoma can appear in any part of the lung. It tends to grow and spread quickly, which can make it harder to treat. A subtype of large cell carcinoma, known as large cell neuroendocrine carcinoma, is a fast-growing cancer that is very similar to small cell lung cancer.
Other subtypes: A few other subtypes of NSCLC, such as adenosquamous carcinoma and sarcomatoid carcinoma, are much less common.
Small cell lung cancer (SCLC)
About 10% to 15% of all lung cancers are SCLC and it is sometimes called oat cell cancer.
This type of lung cancer tends to grow and spread faster than NSCLC. About 70% of people with SCLC will have cancer that has already spread at the time they are diagnosed.
Since this cancer grows quickly, it tends to respond well to chemotherapy and radiation therapy. Unfortunately, for most people, the cancer will return at some point.
Other types of lung tumors
Along with the main types of lung cancer, other tumors can occur in the lungs.
Lung carcinoid tumors: Carcinoid tumors of the lung account for fewer than 5% of lung tumors. Most of these grow slowly. For more information about these tumors, see Lung Carcinoid Tumor.
Other lung tumors: Other types of lung cancer such as adenoid cystic carcinomas, lymphomas, and sarcomas, as well as benign lung tumors such as hamartomas are rare. These are treated differently from the more common lung cancers and are not discussed here.
Cancers that spread to the lungs: Cancers that start in other organs (such as the breast, pancreas, kidney, or skin) can sometimes spread (metastasize) to the lungs, but these are not lung cancers. For example, cancer that starts in the breast and spreads to the lungs is still breast cancer, not lung cancer. Treatment for metastatic cancer to the lungs is based on where it started (the primary cancer site).
Anatomical dorsal view to sheep and goat lungs: le ft picture show…
… General Anatomical Structure Lung :The anatomical results illustrated that the lungs of both animals look like spongy soft organ, surrounded the heart which was located in the mediastinum and enveloped by visceral and parietal pleura, it have a pinkish red color and they were filled the thoracic cavity, consequently in situ ,lungs were showed bounded with thoracic wall cavity laterally while mediastinum and heart medially ,the apex of lung opposite the boundaries of the first and second rib cranially and the base of lungs extended to the 10 th -12 th ribs caudally while restricted between the sternum ventrally and thoracic vertebra dorsally . The lungs consisted of many lobes which are apical (cranial and caudal) ,middle caudal and accessory at the right side and the left consisted of apical (cranial and caudal), caudal, in goat the right was similar of the sheep but the apical was undivided only two lobes ,cranial and caudal, these all lobes look like a semi cone shaped to correspond with the thoracic cavity (Fig.4&5), topographically the lung of both animals have a three surfaces; costal surface, medial narrow surface and large concave diaphragmatic surface (basal surface). …
… the lungs of both sheep and goat have a numbers of coordinated lobes separated by clearly deep fissures. In sheep the right lung was consisted of apical, middle, accessory and caudal lobes (Fig.4&5),the apical lobe subdivided into cranial and caudal part, the cranial part of apical lobe was extended through thoracic cavity (Fig.4&5). …
… the lungs of both sheep and goat have a numbers of coordinated lobes separated by clearly deep fissures. In sheep the right lung was consisted of apical, middle, accessory and caudal lobes (Fig.4&5),the apical lobe subdivided into cranial and caudal part, the cranial part of apical lobe was extended through thoracic cavity (Fig.4&5). …
… goat, the right apical lobe was undivided but extended through thoracic cavity to hug the heart. The middle lobe was like the lance head shaped, the accessory lobe was a smallest lobe and look like a cone shape of convex base on the right side which occupied the medial surface between the caudal and middle lobe, the Caudal lobes in both lungs have trapezoidal shape, The left lung composed of apical and caudal lobe, the apical was subdivided into cranial and caudal part (Fig.4&5). …
The characteristics and clinical value of chest CT images of novel coronavirus pneumonia
NCP is characterized by GGO and consolidation in the subpleural area.
Pleural effusions and mediastinal lymphadenopathy are rare in COVID-19 patients.
CT shows abnormal in some patients with negative nucleic acid or laboratory tests.
To investigate the characteristics and clinical value of chest computed tomography (CT) images of novel coronavirus pneumonia (NCP).
MATERIALS AND METHODS
Clinical data and CT images of 80 cases of NCP were collected. The clinical manifestations and laboratory test results of the patients were analysed. The lesions in each lung segment of the patient’s chest CT images were characterised. Lesions were scored according to length and diffusivity.
The main clinical manifestations were fever, dry cough, fatigue, a little white sputum, or diarrhoea. A total of 1,702 scored lesions were found in the first chest CT images of 80 patients. The lesions were located mainly in the subpleural area of the lungs (92.4%). Most of the lesions were ground-glass opacity, and subsequent fusions could increase in range and spread mainly in the subpleural area. Pulmonary consolidation accounted for 44.1% of all of the lesions. Of the 80 cases, 76 patients (95%) had bilateral lung disease, four (5%) patients had unilateral lung disease, and eight (10%) patients had cord shadow.
The chest CT of NCP patients is characterised by the onset of bilateral ground-glass lesions located in the subpleural area of the lung, and progressive lesions that result in consolidation with no migratory lesions. Pleural effusions and mediastinal lymphadenopathy are rare. As patients can have inflammatory changes in the lungs alongside a negative early nucleic acid test, chest CT, in combination with epidemiological and laboratory tests, is a useful examination to evaluate the disease and curative effect.
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© 2020 The Authors. Published by Elsevier Ltd on behalf of The Royal College of Radiologists.
Lung and other Breathing Problems – Managing Side Effects
What Do The Lungs Do?
The lung is an organ found in your chest cavity. Each lung is divided into lobes.
On the left side, you have the left upper- and the left lower- lobe. On the right
side, there are 3 lobes: the right upper-, mid-, and lower lobe. A thin lining,
called the pleura, surrounds the lobes of the lung.
As you breathe, air moves down your windpipe (your trachea), through a tree-like
structure called the bronchi.
Near the end of the branches of the bronchi are the smaller bronchioles.
- At the end of the bronchioles are grape-like structures called alveoli, which open
and close during normal breathing.
- The lung is sterile. Your immune system works hard to prevent foreign invaders from
contaminating its environment.
- Anything that interrupts this system of respiration – including a blockage, such
as a foreign body, infection, inflammation, scarring, or injury, or even some
chemotherapy treatments- can cause you to experience
breathing problems. This page includes lung problems that you
may experience while you are undergoing treatment.
Common Lung Examinations:
Bronchoscopy – Using a thin, flexible tube, called a bronchoscope,
this procedure enables your doctor to look at the air passages to your lungs.
- If your breathing problems result in a bronchoscopy, your
healthcare provider may perform a washing, or a lavage, to collect cells from your
- To wash or lavage the lungs, the specialist will put a small amount of saline solution
down the tube. He or she will then remove the fluid, and examine the fluid for cells
under the microscope.
- Also, if the examiner sees a suspicious finding, such as a tumor, or possible infection,
he or she may take a sample (or biopsy) of the area for examination under the microscope.
You may have a bronchoscopy if:
- Your doctor or healthcare provider suspects that there is a foreign body in your
- Your breathing problems include coughing up blood
- There may be an abnormality in your lungs
- There is a growth or infection in your lungs or airways, which needs to be biopsied.
This will help your healthcare provider determine the best treatment possible for
- You may be required to fast (not eat) after midnight the day of the exam. After
your procedure, your jaw or throat may be a little sore.
- Your healthcare provider will give specific instructions to you before the procedure.
Make sure to ask any questions before your test is performed.
- You may be required to fast (not eat) after midnight the day of the exam. After
Chest X ray – This is a quick and painless procedure where a picture,
or an x-ray, will be taken to look at the internal structures of your chest. The
chest x-ray will look specifically at your lungs, heart, and ribs.
- This one-dimensional view may provide your healthcare provider with important information
about what is happening inside your chest wall, and lung region.
- Chest x-rays may be done routinely, if your healthcare provider wants to “watch”
a certain finding. It may also be done if you have symptoms of breathing problems,
such as a prolonged cough, or chest pain.
- If your healthcare provider or doctor thinks there may be a suspicious finding,
he or she may recommend that a more accurate test be done, such as a CAT scan.
Computerized Tomography (CT) Scan – A CT Scan is often recommended
to diagnose and identify chemotherapy-based breathing problems. This
test is more specific than plain x-rays, as a computer takes x-rays of your chest,
from different angles, to show a cross-sectional view of your chest and lungs. How
- As you lie on a movable table, a scanner inside of a machine moves around you. X-rays
are taken at different angles, as the computer records the pictures. The computer
then puts the pictures in a specific order, so that the specialist can interpret
- Sometimes, you may be given a contrast (dye) solution, either taken by mouth (oral)
or injected into a large vein (IV). This helps to improve the picture, and show
any abnormalities as the dye passes through your body. Your doctor may want you
to drink oral contrast if he or she wants to examine your abdomen or pelvis at the
same time the chest is examined.
- You may be required to fast (not eat) after midnight the day of the exam. Your healthcare
provider will give specific instructions to you.
Lung Scan (Ventilation-Perfusion scan [VQ]) – Your doctor or healthcare
provider will order this test if he or she suspects that you may have developed
a blood clot in your lungs, called a pulmonary embolism (PE). You may have experienced
shortness of breath, or chest discomfort, which may signify that a blood clot may
- A radioactive dye is injected into your vein. A camera photographs how the blood
is flowing through your lungs.
- If there is a blockage in the flow of blood, this may mean that you have a blood
- If a blood clot is present, your doctor or healthcare provider may suggest that
you be hospitalized so that you can receive a blood thinner in the vein (IV), and
be closely monitored.
Pulmonary Function Test (PFT) – If you experience breathing
problems during chemotherapy, a pulmonary function test may be recommended.
This test shows how well your lung function is. It may also be called spirometry.
Your healthcare provider may order many tests, all done at once, which all show
how well you are moving air through your lungs.
You will be asked to blow into a tube (a spirometer), as forcefully as possible.
This amount of air that you blow is then recorded. The machine will measure your:
- Forced Vital Capacity (FVC) – this is the maximum amount (in volume)
of air that can be forcefully exhaled (blown out) with a single breath, which indicates
the size of your lungs.
- Forced expiratory volume (FEV1) – This is the amount of air that
is forcefully blown out of your lungs in one second.
- By looking at the ratio of FVC to FEV1, your healthcare provider may have an indication
of your lung functioning. This may help to diagnose many short-term and long-term
- You may receive this exam if you are experiencing shortness of breath at rest, or
when you perform certain activities. You may also receive this test if you are about
to undergo a certain type of chemotherapy that may cause damage to your lungs.
- By looking at the ratio of FVC to FEV1, your healthcare provider may have an indication
- Sputum Culture – your doctor or healthcare provider will ask you
to cough up a sample of your sputum or phlegm to send to the microbiology lab.
- It is best to submit a sputum specimen in the early morning.
- Normal bacteria that are in your mouth may contaminate the sample, so it will be
easier to see if lung bacteria are present following a deep cough.
- The bacteria that are present in your sample will help your healthcare provider
determine the best treatment for you.
Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
Lungs: Facts, Function and Diseases
Lungs are sacks of tissue located just below the rib cage and above the diaphragm. They are an important part of the respiratory system and waste management for the body.
A person’s lungs are not the same size. The right lung is a little wider than the left lung, but it is also shorter. According to York University, the right lung is shorter because it has to make room for the liver, which is right beneath it. The left lung is narrower because it must make room for the heart.
Typically, a man’s lungs can hold more air than a woman’s. At rest, a man’s lungs can hold around 750 cubic centimeters (about 1.5 pints) of air, while a woman’s can hold around 285 to 393 cc (0.6 to 0.8 pints) of air, according to York University. “The lungs are over-engineered to accomplish the job that we ask them to do,” said Dr. Jonathan P. Parsons, a professor of internal medicine, associate director of Clinical Services, and director of the Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the OSU Asthma Center at The Ohio State University. “In healthy people without chronic lung disease, even at maximum exercise intensity, we only use 70 percent of the possible lung capacity.”
According to the American Lung Association, adults typically take 15 to 20 breaths a minute, which comes to around 20,000 breaths a day. Babies tend to breath faster than adults. For example, a newborn’s normal breathing rate is about 40 times each minute while the average resting respiratory rate for adults is 12 to 16 breaths per minute. [Respiratory System: Facts, Function and Diseases]
Though breathing seems simple, it is a very complex process.
The right lung is divided into three different sections, called lobes. The left lung has just two lobes. The lobes are made of sponge-like tissue that is surrounded by a membrane called pleura, which separates the lungs from the chest wall. Each lung half has its own pleura sack. This is why, when one lung is punctured, the other can go on working.
The lungs are like bellows. When they expand, they pull air into the body. When they compress, they expel carbon dioxide, a waste gas that bodies produce. Lungs do not have muscles to pump air in and out, though. The diaphragm and rib cage essentially pump the lungs.
As a person breathes, air travels down the throat and into the trachea, also known as the windpipe. The trachea divides into smaller passages called the bronchial tubes. The bronchial tubes go into each lung. The bronchial tubes branch out into smaller subdivisions throughout each side of the lung. The smallest branches are called bronchioles and each bronchiole has an air sac, also called alveoli. There are around 480 million alveoli in the human lungs, according to the Department of Anatomy of the University of Göttingen.
The alveoli have many capillary veins in their walls. Oxygen passes through the alveoli, into the capillaries and into the blood. It is carried to the heart and then pumped throughout the body to the tissues and organs.
As oxygen is going into the bloodstream, carbon dioxide passes from the blood into the alveoli and then makes its journey out of the body. This process is called gas exchange. When a person breathes shallowly, carbon dioxide accumulates inside the body. This accumulation causes yawning, according to York University.
The lungs have a special way to protect themselves. Cilia, which look like a coating of very small hairs, line the bronchial tubes. The cilia wave back and forth spreading mucus into the throat so that it can be dispelled by the body. Mucus cleans out the lungs and rids them of dust, germs and any other unwanted items that may end up in the lungs.
Diseases & conditions
The lungs can have a wide range of problems that can stem from genetics, bad habits, an unhealthy diet and viruses. “The most common lung related conditions I see are reactive airways or asthma, as well as smoking-related emphysema, in my general practice,” Dr. Jack Jacoub, a medical oncologist and director of thoracic oncology at Memorial Care Cancer Institute at Orange Coast Memorial Medical Center in Fountain Valley, California, told Live Science.
Asthma, also called reactive airway disease before a diagnosis of asthma, is a lung disease where the air passageways in the lungs become inflamed and narrowed, making it hard to breath. In the United States, more than 25 million people, including 7 million children, have asthma, according to the National Heart, Lung, and Blood Institute.
Lung cancer is cancer that originates in the lungs. It is the No. 1 cause of deaths from cancer in the United States for both men and women, according to the Mayo Clinic. Symptoms of cancer include coughing up blood, a cough that doesn’t go away, shortness of breath, wheezing, chest pain, headaches, hoarseness, weight loss and bone pain.
Chronic obstructive pulmonary disease (COPD) is long-term lung disease that prevents a person from breathing properly due to excess mucus or the degeneration of the lungs. Chronic bronchitis and emphysema are considered COPD diseases. About 11.4 million people in the United States suffer from COPD, with about 80 to 90 percent of COPD deaths attributed to smoking, according to the American Cancer Society.
Sometimes, those with COPD get lung transplants, replacement lungs garnered from organ donors, to save their lives. Research is also being done on growing new lungs from stem cells. Currently, stem cells extracted from the patient’s blood or bone marrow are being used as a treatment to heal damaged lung tissue.
Lung infections, such as bronchitis or pneumonia, are usually caused by viruses, but can also be caused by fungal organisms or bacteria, according to Ohio State University. Some severe or chronic lung infections can cause fluid in the lungs and other symptoms such as swollen lymph nodes, coughing up blood and a persistent fever.
Being overweight can also affect the lungs. “Yes, being overweight does adversely affect the lungs because it increases the work and energy expenditure to breath,” said Jacoub. “In the most extreme form, it acts like a constricting process or vest around the chest such as that seen in the ‘Pickwickian syndrome.'”
One of the best ways to promote good lung health is to avoid cigarette smoke because at least 70 out of the 7,000 chemicals in cigarette smoke damages the cells within the lungs. According to the Mayo Clinic, people who smoke have the greatest risk of lung cancer. The more a person smokes, the greater the risk. Those who smoke are 15 to 30 times more likely to get lung cancer according to the Centers for Disease Control and Prevention. If a person quits, their lungs can heal from much of the damage, said Dr. Norman Edelman, a senior scientific adviser for the American Lung Association and a specialist in pulmonary medicine. [Do Smokers’ Lungs Heal After They Quit?]
The Rush University Medical Center also suggests practicing deep breathing exercises, staying hydrated and regular exercise to keep the lungs healthy. Parsons also recommends having homes tested for radon. “Radon is a naturally occurring radioactive gas produced by the breakdown of uranium in the ground. It typically leaks into a house through cracks in the foundation and walls. Radon is the main cause of lung cancer in nonsmokers, and the second-leading cause of the disease after smoking,” said Parsons.
Atelectasis – Symptoms and causes
Atelectasis (at-uh-LEK-tuh-sis) is a complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid.
Atelectasis is one of the most common breathing (respiratory) complications after surgery. It’s also a possible complication of other respiratory problems, including cystic fibrosis, lung tumors, chest injuries, fluid in the lung and respiratory weakness. You may develop atelectasis if you breathe in a foreign object.
Atelectasis can make breathing difficult, particularly if you already have lung disease. Treatment depends on the cause and severity of the collapse.
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There may be no obvious signs or symptoms of atelectasis. If you do have signs and symptoms, they may include:
- Difficulty breathing
- Rapid, shallow breathing
When to see a doctor
Always seek medical attention right away if you have trouble breathing. Other conditions besides atelectasis can cause breathing difficulties and require an accurate diagnosis and prompt treatment. If your breathing becomes increasingly difficult, seek emergency medical help.
Atelectasis occurs from a blocked airway (obstructive) or pressure from outside the lung (nonobstructive).
General anesthesia is a common cause of atelectasis. It changes your regular pattern of breathing and affects the exchange of lung gases, which can cause the air sacs (alveoli) to deflate. Nearly everyone who has major surgery develops some amount of atelectasis. It often occurs after heart bypass surgery.
Obstructive atelectasis may be caused by many things, including:
- Mucus plug. A mucus plug is a buildup of mucus in your airways. It commonly occurs during and after surgery because you can’t cough. Drugs given during surgery make you breathe less deeply, so normal secretions collect in the airways. Suctioning the lungs during surgery helps clear them, but sometimes they still build up. Mucus plugs are also common in children, people with cystic fibrosis and during severe asthma attacks.
- Foreign body. Atelectasis is common in children who have inhaled an object, such as a peanut or small toy part, into their lungs.
- Tumor inside the airway. An abnormal growth can narrow the airway.
Possible causes of nonobstructive atelectasis include:
- Injury. Chest trauma — from a fall or car accident, for example — can cause you to avoid taking deep breaths (due to the pain), which can result in compression of your lungs.
- Pleural effusion. This condition involves the buildup of fluid between the tissues (pleura) that line the lungs and the inside of the chest wall.
- Pneumonia. Various types of pneumonia, a lung infection, can cause atelectasis.
- Pneumothorax. Air leaks into the space between your lungs and chest wall, indirectly causing some or all of a lung to collapse.
- Scarring of lung tissue. Scarring could be caused by injury, lung disease or surgery.
- Tumor. A large tumor can press against and deflate the lung, as opposed to blocking the air passages.
Factors that make you more likely to develop atelectasis include:
- Older age
- Any condition that makes it difficult to swallow
- Confinement to bed with infrequent changes of position
- Lung disease, such as asthma, COPD, bronchiectasis or cystic fibrosis
- Recent abdominal or chest surgery
- Recent general anesthesia
- Weak breathing (respiratory) muscles due to muscular dystrophy, spinal cord injury or another neuromuscular condition
- Medications that may cause shallow breathing
- Pain or injury that may make it painful to cough or cause shallow breathing, including stomach pain or rib fracture
A small area of atelectasis, especially in an adult, usually is treatable. The following complications may result from atelectasis:
- Low blood oxygen (hypoxemia). Atelectasis makes it more difficult for your lungs to get oxygen to the air sacs (alveoli).
- Pneumonia. Your risk for pneumonia continues until the atelectasis goes away. Mucus in a collapsed lung may lead to infection.
- Respiratory failure. Loss of a lobe or a whole lung, particularly in an infant or in someone with lung disease, can be life-threatening.
Atelectasis in children is often caused by a blockage in the airway. To decrease atelectasis risk, keep small objects out of reach of children.
In adults, atelectasis most commonly occurs after major surgery. If you’re scheduled for surgery, talk with your doctor about strategies to reduce your risk. Some research suggests that certain breathing exercises and muscle training may lower the risk of atelectasis after certain surgeries.
Sept. 05, 2018
90,000 Community-acquired pneumonia. Clinical examples
Transcript of the lecture
XXV All-Russian Educational Internet Session for Doctors
Total duration: 21:21
Oksana Mikhailovna Drapkina, Secretary of the Interdepartmental Scientific Council for Therapy of the Russian Academy of Medical Sciences, Doctor of Medical Sciences, Professor:
– Conclusion of our Internet Session.I want to say right away that this conclusion was not chosen by Academician Vladimir Trofimovich Ivashkin by chance: this is the start of a new project, which will be supervised by Irina Aleksandrovna Sokolina.
Today Irina Aleksandrovna will talk about community-acquired pneumonia and clinical examples.
I want to say that our entire clinic (and not only our clinic, since we are in the same building) in all difficult, and not very difficult cases, when it is necessary to consult in terms of not only diagnostics, but also the management of a patient with pulmonary system pathology and with additional lobules of the spleen (and with what else – I can’t even remember now) … The ninth floor is a favorite place for our consultations.Just the office of Irina Alexandrovna, the head of our department of X-ray diagnostics.
Irina Aleksandrovna Sokolina, Head of the Department of X-ray and Beam Diagnostics of the First Moscow State Medical University named after I.M. Sechenov:
– Good day, dear colleagues! Today, the topic of our first speech will be precisely modern radiation diagnostics of pneumonia.
So. The tasks of radiation diagnostics for any diseases are:
- identification of pathological changes in the lung tissue;
- clarification of localization and prevalence;
- evaluation of the effectiveness of treatment;
- differential diagnostics (most important).
For pneumonia, the following methods of radiation diagnostics are used. Of course, it all starts with an overview X-ray of the chest cavity organs, which is necessarily carried out in two projections – in frontal and lateral projections. This study is used at the onset of the disease and on average after 7-10 days.
In complex clinical cases (for example, with a clinical picture of pneumonia or a high likelihood of developing pneumonia, but with questionable and normal X-ray data), it is advisable to perform a computed tomography study to confirm or exclude this disease and for the purpose of differential diagnosis.
An ultrasound examination is advisable if there is a suspicion of pleural lunge to detect it, as well as to clarify the state of the fluid.
The frequency of X-ray examination for pneumonia depends on the clinical situation. With an unfavorable course of the process, including the development of complications, the frequency and type of X-ray examinations are determined by clinical indications.
The radiation pattern of pneumonia depends on the type of infiltration.
Currently, the alveolar or the so-called pleuropneumonic type of infiltration is distinguished. It develops when the inflammatory process is localized in the alveolar tissue. Most often it is caused by such infectious agents as pneumococci or Friedlander’s bacillus, staphylococci.
X-ray signs of alveolar infiltration are in the form of infiltration sites, as a rule, of a homogeneous structure, of medium intensity. In the infiltration zone, the air gaps of the bronchi are clearly visible (the so-called symptom of “air bronchography”).
The infiltrate with a wide base is adjacent to the costal pleura. Its intensity decreases towards the root of the lung. Pathologically, infiltration is more often localized in the posterior lower parts of the lungs (within 1-2 segments, less often within a whole lobe).
The next type of infiltration: focal (the so-called bronchopneumonic). It occurs with acute inflammation of the alveolar tissue of the lung, which develops on the basis of the arisen bronchitis or bronchiolitis.The most common infectious agents causing bronchopneumonia are streptococci, influenza bacillus, Pseudomonas aeruginosa, and staphylococci.
X-ray signs in bronchopneumonia are varied, but most often this is a site of infiltration of the lung tissue of a heterogeneous structure, which consists of polymorphic (usually confluent) foci with indistinct contours. The infiltration zone can occupy one or two segments. Bilateral localization is more common with this type of infiltration.
At the same time, it should be noted that about 10% of bronchopneumonia are not detected by X-ray examination.
Finally, the most difficult type of infiltration to detect by routine methods, plain radiography: the so-called interstitial type of infiltration. With it, infiltration occurs mainly in the walls of the alveoli (the interstitial structures of the lung tissue are involved).
It should not be confused with interstitial pneumonia within fibrosing alveolitis.
X-ray signs in the interstitial type consist of one or more areas of compaction of the lung tissue, as a rule, of an inhomogeneous structure, of low intensity. This is called the frosted glass symptom. The infiltrate has fuzzy contours. In the zone of these changes, it is possible to enhance the pulmonary pattern due to the infiltration of interstitial structures.
High-resolution computed tomography plays a decisive role in detecting interstitial pneumonia.
As for community-acquired pneumonia, they usually occur in healthy people in the absence of diseases or pathological conditions that contribute to the development of the infectious process. The main infectious agents are pneumococci, mycoplasma.
Pathogens enter the lungs through the respiratory tract (bronchogenic), usually against the background of hypothermia, a stressful situation, or an acute respiratory illness.
As I said, the X-ray picture is determined by the type of infiltration and the stage of the inflammatory process.
The most typical radiological signs are the local area of infiltration of the lung tissue (usually of the alveolar type), the extent of the lesion. Nowadays, lobar infiltrations are already rare. Usually these are 1-2 segments. Change is usually one-sided.
As an example, I can cite pneumococcal pneumonia, which develops as an independent disease. It is characterized by an acute onset and a vivid clinical picture.X-ray signs depend primarily on the stage of development of this pneumonia.
The tide stage will be characterized by a decrease in the transparency of the area of lung tissue without clear boundaries due to hyperemia in the area of inflammation. In the stage of hepatization, we will see a characteristic alveolar infiltrate of lobar or segmental length, against which the air gaps of the bronchi will be visible, the symptom of “air bronchography” will persist. In the stage of resolution, the shadow of the infiltrate may become heterogeneous.
This should not be confused with the appearance of a destruction focus, because areas of normalization of lung tissue will also impart heterogeneity and cellularity to the inflammatory infiltrate.
In a computed tomography study (we see frontal reconstruction on the left and axial sections on the right), pneumococcal pneumonia will look like a seal of varying intensity – consolidation (these areas are located closer to the costal or interlobar pleura).Gradually, the intensity of the infiltration decreases towards the root. It spreads to the root like an oil stain.
The following indications for computed tomography in pneumonia can be distinguished.
In a patient with obvious clinical symptoms of pneumonia, there are no changes in the lungs on the roentgenogram. In this case, to confirm inflammation (perhaps these are some small areas of infiltration), it is advisable to conduct a computed tomographic study.
X-ray examination of a patient with suspected pneumonia revealed, for example, changes atypical for this disease. For the purpose of differential diagnosis, it is advisable to use computed tomography as a clarifying method.
Recurrent pneumonia, of course. With her, pathological changes occur in the same area. Here, too, to clarify the reasons for these changes.
Of course, protracted pneumonia, in which the duration of the existence of infiltrative changes in the lung tissue exceeds one month.Here, too, to clarify the reasons that prevent the resolution of pneumonia, it is advisable to perform a computed tomographic study.
In general, pleuropneumonia is well detected by routine x-ray examination.
As I said, it is better to carry out differential diagnostics using computed tomography. The most important distinguishing feature of pneumonia is the visible air gaps of the bronchi in the structure of the infiltrate.We see this on the left slide: compacted tissues, air gaps of the bronchi.
In contrast to this, with abscesses or tuberculous infiltrates, which can also have the form of compaction of lung tissue, we will not see this main symptom due to the fact that this condition is an abscess of caseous or other fusion of lung tissue.
Let me give you some tricky examples.
Patient, 62 years old, long-term smoker, suffering from chronic obstructive pulmonary disease.In connection with an increase in coughing and the appearance of low-grade fever, she turned to a polyclinic at her place of residence. She had changes in the lower lobe of the right lung, which were initially regarded as pneumonic.
She received appropriate antibacterial and anti-inflammatory treatment for a month. Her temperature returned to normal, but she still retained changes during X-ray examination. Due to the fact that complaints persisted, she was admitted to our clinic.
When performing a computed tomographic study, we see a completely clear picture of the peripheral formation of the middle lobe of the right lung. Already with the phenomena of decay. Such a focus: adjacent to the pleura, with spicular contours, surrounded by a zone of lymphostasis, with the presence of enlarged lymph nodes at the root of the lung.
In a computed tomographic study, this picture was not difficult in the differential diagnostic plan.
One more example. The patient is 56 years old. He had acute pain in the right side of the chest, increased shortness of breath. X-ray examination revealed changes in the middle lobe. They consisted in compaction at the base of the upper lobe (in the third segment). They were also initially classified as pneumonic.
But due to the addition of hemoptysis, he was hospitalized in a hospital. Yes, we can see that during the X-ray examination … On computed tomograms at the base of the upper lobe, the compaction of the lung tissue, adjacent with a wide base, is more intense in the area of the interlobar pleura.But it has the form of impregnation of the lung tissue, which is usually characteristic of hemorrhage.
In the basal regions, we see areas of pleural linear fibrosis. The fact that these changes are bilateral and so numerous, allowed us to assume the presence, to suspect in the patient thromboembolism, which later and … These are the areas of linear fibrosis – as areas of already suffered heart attacks.
When performing CT angiography, we see bilateral perfusion defects, blood clots in both the right and left pulmonary arteries.Against the background of the contrasted vessels, they look more gray structures, which made it possible to change the diagnosis in this patient to recurrent pulmonary embolism and pulmonary infarction.
Of course, the determination of the etiological factor by X-ray examination is impossible. But a number of pathogens have a very characteristic (and pneumonia caused by these pathogens) picture.
Staphylococcal primary pneumonia that develops in children and the elderly.They are characterized by an X-ray picture: they have in the form of one or more areas of bronchopneumonia. As a rule, this is a bilateral lesion, thin-walled destruction cavities. A typical picture.
As for secondary staphylococcal pneumonia, they occur with hematogenous spread of infection or an acute chronic purulent process. They also look like multiple round infiltrates (bilateral, as a rule). They are characterized by polymorphism with the formation of thin-walled destruction cavities, which then dissolve.
The differential diagnosis of these conditions must be carried out with suppurative cysts, true lung abscesses and subacute disseminated tuberculosis. But the main thing in this situation is not the radiation picture in differential diagnosis, but, of course, the clinical picture and anamnesis.
Pneumonia caused by gram-negative infection, as a rule, develops in middle-aged and elderly people, weakened, suffering from chronic diseases. They are caused by such infectious agents as Klebsiella, Pseudomonas aeruginosa, Proteus.They have a severe clinical course and high mortality.
Here we see an example of Klebsiella pneumonia. With such pneumonia, an extensive lobe darkening is caused, an increase in the volume of the affected lobe. Characterized by the rapid appearance of cavities of destruction in the structure of the infiltrate.
Mycoplasma pneumonia. They have become more frequent lately. They are characterized by infiltration of the alveoli and interstitial tissue. They have a very diverse X-ray picture.They can proceed as interstitial changes such as bronchopneumonia, bronchiolitis, and so on.
I will give you some examples of mycoplasma pneumonia. In this case, we see an increase in the pulmonary pattern in the lower lobe of the right lung, indistinctness and deformation of the bronchovascular bundles.
In this case, pneumonia has a form close to the radiation picture of bronchiolitis: in the form of confluent foci in the center of the lobular foci caused by the expansion and filling of bronchioles.As a rule, with such forms of mycoplasma pneumonia, a pronounced broncho-obstructive syndrome is observed, which persists for a long time after the resolution of this pneumonia.
Severe form of mycoplasma pneumonia in the form of extensive areas of the “ground glass” type with almost subtotal lung involvement.
The X-ray picture of this pneumonia can be different.
As for viral pneumonias, they occur in children and adolescents.As a rule, viral agents, pathogens are adeno- and rhinoviruses, influenza viruses. These pneumonias are characterized by an interstitial type of changes in the lung tissue, and therefore are the most difficult to diagnose.
Let me dwell on influenza pneumonia. The clinical picture is usually dominated by signs of toxicosis, hyperthermia, headache. This pneumonia is characterized mainly by the interstitial type of changes in the initial stages.
In this case, we see strengthening and deformation of the pulmonary pattern (usually in the basal regions).Small focal shadows. Localization in the middle and lower parts of one or both lungs. Root reaction.
In computed tomography, it is possible to reveal a thickening of the pulmonary interstitium, areas of compaction of the lung tissue of the “ground glass” type, located peribronchial or perivascular.
Here we saw an example of a 48-year-old young woman that we observed. Unfortunately, she died from influenza pneumonia. In the terminal stage, we see bilateral focal-confluent pneumonia.Signs of hemorrhagic tracheitis were found at autopsy. In postmortem examination also massive infiltration of lung tissue with hemorrhagic impregnation.
What should be the tactics of radiological examination of patients with community-acquired pneumonia?
The main method of radiation examination of patients with suspected or established pneumonia is, of course, X-ray of the chest cavity organs in two projections.To clarify the X-ray data, either linear, but best of all, of course, computed tomography can be used.
The main radiological sign of pneumonia, as I have already said, is a local compaction of the lung tissue with the presence of an airway in the bronchi. In the absence of a symptom of compaction of lung tissue, an X-ray conclusion about the presence of pneumonia is inappropriate. I mean, especially when it comes to computed tomography. If we do not detect pneumonia with this method, there is no X-ray negative pneumonia in this case.
X-ray examination is carried out, as a rule, at the onset of the disease and not earlier than 14 days after the start of antibiotic therapy. But it can be performed earlier in the event of complications or a significant change in the clinical picture of the disease.
The X-ray picture of community-acquired pneumonia, as I said, has no correlation with the etiology of pneumonia. The degree of its clinical course does not allow determining the outcome of the disease.
When X-ray examination of pneumonia in dynamics, changes in the lung tissue gradually decrease, but persist for a longer time than clinical symptoms. This must be remembered. They have the right to persist for three months, so the most important thing here is to focus on the clinic.
A protracted or recurrent course of pneumonia is an indication for tomographic or bronchological examination to exclude central lung cancer, as well as other inflammatory processes in the lung tissue.
In our experience and according to the literature, computed tomography has significant advantages over the same linear tomography and in assessing the state of the lung tissue and bronchi.
Thank you for the attention.
GBUZ JSC “AOKB” – What traces in the lungs leaves the coronavirus. The opinion of a pulmonologist
Coronavirus infection leaves traces in all systems of the body, but the most severe blow falls on the lungs, which can subsequently form scars
Anna Kokareva, a pulmonologist at the Arkhangelsk Regional Clinical Hospital , told us how to prevent fibrosis after covid pneumonia.
– Anna Anatolyevna, how does coronavirus pneumonia differ from the usual bacterial pneumonia?
– First of all, the nature of the inflammation and the speed of its spread. Bacterial pneumonia always gravitates towards anatomical formations. Each person in the nasopharynx and oropharynx normally has its own flora. If, for some reason, the immune system weakens, this flora can descend into the lungs through the bronchi, settle around this area and inflammation occurs – in one or more adjacent segments of the lungs.If the patient does not seek medical help for a long time, the inflammatory process will spread, but, as a rule, it is always limited to a segment, several adjacent segments or lobes of the lung. With coronavirus pneumonia, the virus enters the lungs through the upper respiratory tract, it spreads diffusely, several segments are affected in different lobes, usually in both lungs at the same time. The virus damages the alveolar-capillary membrane (where oxygen from the lungs enters the bloodstream) and inflammation and edema develop at the site of damage.The process, I repeat, is often diffuse bilateral, symmetrical or asymmetrical. Bacterial pneumonia, as a rule, develops gradually, and with a viral infection, lung damage can be fulminant in nature.
– It happens that in patients with large lung damage, 60 to 80 percent of the tests for covid are negative. How, then, is covid pneumonia distinguished?
– Covid pneumonia on X-ray or computed tomography looks like all viral pneumonia, including influenza (swine flu A, h2N1).Lung tissue should normally be airy – therefore healthy lungs in the “picture” are black. The foci of inflammation are “white spots” on “black lungs”. With bacterial pneumonia in the alveoli, gas exchange occurs in them, purulent fluid accumulates, and in the picture they look like dense foci – white (like a sheet of paper) spots. With the reverse development of pneumonia in patients, this “white zone” of the inflammatory process in the lungs gradually decreases in area, intensity – “dissolves” and then approaches the color of normal lung tissue.With covid pneumonia, CT scans of the lungs, especially at the onset of the disease, show the phenomenon of “ground glass” – this is a focal darkening of the lungs, weak in intensity. This phenomenon is explained by the fact that inflammatory infiltrates in viral pneumonia (COVID-19, influenza A, h2N1) do not affect the alveoli themselves – they remain relatively airy, but nearby interstitial tissue. If the disease progresses, the inflammation affects the alveoli themselves, and instead of “frosted glass” appear denser and more intense darkening in the lungs, as in bacterial pneumonia.As the patient recovers, the “matte glasses” also begin to decrease in intensity and size, approaching in color to healthy lung tissue. Currently, radiologists distinguish bacterial pneumonia from viral pneumonia according to CT scan of the lungs.
– Do patients with 100% lung disease have a chance of surviving?
– It does not always depend on the volume of lung damage. Although patients are always interested in this figure. It is also important how intense and dense the dark areas look – infiltrates: the denser the inflammatory infiltrates, the harder it is for oxygen to enter the blood from the lungs, the worse the gas exchange, the more pronounced the patient’s respiratory failure.Occasionally, a patient is presented with 70% lung disease who, in theory, should have low oxygen levels in the blood and should require oxygen therapy through a mask. But sometimes we see that the patient does without oxygen support and the level of oxygen in the blood with such a volume of damage, oddly enough, is good, because the degree of damage, although large, but the density of infiltrates is low, gas exchange is not impaired. There are also opposite situations, when a patient with lung damage from 25-50% drops oxygen in the blood and oxygen therapy is required.When analyzing CT images of the lungs, we see, although small in area, changes are quite intense in density, which disrupts gas exchange.
Before or after discharge, with repeated CT examination in patients, the volume of lung lesions often does not change or decreases very slowly. It seems like they were treating the patient, but there is no effect. But this is not the case. It is necessary to look at the intensity of inflammatory foci – they should fade and approach in color to healthy lung tissue. Therefore, do not be afraid that the volume of lung damage is very slowly decreasing.In my practice, there were patients with 75-100% lung damage due to coronavirus infection. Yes, some of them were also in the intensive care unit and the terms of hospitalization were from a month or more. But they were discharged home without the need for oxygen therapy, while changes in the lungs were preserved after discharge, according to CT data.
– That is, after discharge from a patient who has had a coronavirus, foci of inflammation in the lungs persist?
– Yes, but these changes are no longer viral or bacterial in nature, but are infiltrates from inflammatory cells (immune).Today, scientists talk about such a condition as “postcoid syndrome.” Patients who have undergone COVID-19 infection often complain of muscle weakness, manifestations on the part of the heart – arrhythmias, myocarditis, and on the part of the lungs – these are long-term absorbable infiltrates. As a rule, long-term regression of changes in the lungs is observed in patients with an initially large volume of damage, a severe course of the disease and also depends on the characteristics of the immune system. If the patient’s immunity overactively reacts to coronavirus infection, that is, it throws all its strength to fight it – it produces a large number of pro-inflammatory factors (cytokines), then such patients develop a so-called “cytokine storm”.That is, instead of an adequate immune response to the infection, an excessive response is formed – the virus itself may not exist in the body, and the immunity continues to fight, depleting the patient’s body. This group of patients is at risk for a protracted course of viral pneumonia and the formation of pulmonary fibrosis.
The so-called “frosted glass” of the coronavirus. Lungs of a patient with coronavirus infection, affected area – more than 70 percent
Today there is a problem: when our patients are discharged for outpatient follow-up treatment, they still have inflammatory infiltrates in the lungs, and the local therapists mistakenly prescribe them several more courses of antibiotics.But these changes in the lungs are no longer viral or bacterial in nature. They are based on the inflammatory cells of the patient himself – immune infiltrates. They do not respond to treatment with antibiotics or antiviral drugs. After the acute process subsides, patients will only need exercise complexes, gymnastics, and dosed loads. Another part is taking anti-inflammatory drugs, such as, for example, high doses of acetylcysteine, pentoxifylline and glucocorticosteroids in tablets in a course, anticoagulants – everything is individual.And someone just needs time.
– Is it true that after coronavirus pneumonia, the lungs do not fully restore their functions and many develop fibrosis?
– Fibrosis is a consequence of a prolonged inflammatory process in the lungs, when healthy, functionally active lung tissue is replaced by connective tissue. In fact, it is a “scar” on the lung. If it is small, then it will not affect the function of the lungs and gas exchange. But the more fibrous tissue in the lungs, the worse the function and gas exchange.In the future, this can lead to irreversible changes in lung function and, as a result, to respiratory failure. The overwhelming majority of those who have undergone coronavirus pneumonia will fully recover their lung function. In the risk group for the formation of fibrosis are patients with a severe course of the disease who were on artificial ventilation of the lungs, as well as those with concomitant chronic diseases: diabetes mellitus, obesity, arterial hypertension, heart failure, oncopathology, various autoimmune diseases, bronchial asthma, COPD.But this does not mean that being in the “risk group” will necessarily lead to irreversible changes in the lung tissue. It is possible to say that a patient who has undergone a coronavirus infection with pneumonia has formed pulmonary fibrosis no earlier than a year after the onset of the disease.
Before the coronavirus, we had flu pandemics. Compared with patients who have had influenza pneumonia (swine flu A, h2N1), the consequences in the lungs went away in some patients within a year, in others after a year, and only a part developed fibrosis.For the prevention of fibrosis in patients who have undergone coronavirus pneumonia, it is necessary to carry out rehabilitation measures.
– When do patients need rehabilitation?
– The earlier it starts, the more chances that inflammatory infiltrates do not transform into pneumofibrosis, which is no longer amenable to reverse development. Rehabilitation doctors begin to work with our patients immediately after the condition has stabilized. First of all, this is gymnastics aimed at the shoulder girdle, the muscles of the chest, breathing exercises.After being discharged home, dosed aerobic exercises are allowed: swimming, walking, light jogging. Massages of the back and chest are useful, which improve blood circulation, and inflammation in the lungs goes away faster. Some physiotherapy procedures are helpful, but only after consulting a doctor.
– Can you inflate air balloons to train your lungs?
– In patients, especially with a large volume of lung lesions, inflammatory infiltrates can come close to the pleura, the membrane covering the lungs from the outside, as a result of prolonged inflammation, the lungs become more fragile, less elastic, there is a threat of tissue rupture and air entering the pleural cavity.This condition is called pneumothorax and requires emergency surgery. Therefore, any sharp fluctuations in pressure in the chest are contraindicated, including forced respiratory movements – a sharp inhalation or exhalation, which often happens when balloons are inflated. We have had cases when patients coughed violently and lung tissue ruptured. Therefore, no balloons – only smooth breathing movements.
– Have there been any cases of re-infection with coronavirus in your practice?
– No soon after the patient is discharged from the hospital, but what happens to the patient’s immune system after COVID-19 still needs to be studied.In my opinion, patients develop a slight immunodeficiency. That is, the body has spent energy fighting the infection, its reserves are being depleted and not everyone has enough reserve for full recovery. Therefore, re-infection is possible even after a short time after the illness, given that the virus mutates – no one is immune from this. Proof that in patients who have had COVID-19, immunity decreases, especially in those who have been ill in a severe form, is the development of a fungal infection of the lungs.Some of our patients develop pneumonia caused by pneumocystis, the same infection is detected, for example, in patients with HIV, that is, with weakened immunity. Therefore, no one knows how your immunity will fight viruses six months after the disease.
– Is this why you need to get vaccinated?
– Necessarily, I would not have pinned high hopes on natural immunity after coronavirus infection. Especially those who have relatives at risk should be vaccinated.After all, they often cannot be vaccinated because of the existing contraindications. For example, these are patients with exacerbated bronchial asthma, cancer patients who have an active process of metastasis, or patients with autoimmune diseases. The more people are vaccinated, the greater the percentage of the population in the community will be immunized to protect those who are in principle at risk. In addition, young age and the absence of chronic diseases do not protect one hundred percent from the severe course of infection and death, although the risk of death in this group of patients is indeed lower.But they pose a threat to loved ones.
– Have you already been vaccinated?
– Yes, back in January 2021. Although I worked in the “red zone”, I was never able to recover from the coronavirus infection naturally. Before the introduction of the first component of the vaccine, the antibody titer was at zero, after the introduction of the second component, three weeks later – more than 14 units.
materials by Lyudmila Zakharova for the newspaper “Pravda Severa”
90,000 CT of lungs | Health Clinic
The essence of the method
What does CT of the lungs show?
CT of the lungs with coronavirus – how effective is the diagnosis
Coronavirus infection in the images
Preparing for CT of the lungs
What should you have with you for diagnosis?
Computed tomography of the lungs
Interpreting the results
How often can CT be done?
Where to get CT of the lungs
Benefits and risks of CT of the lungs
Difference between CT and X-ray
CT of the lungs – price in Moscow
The Moscow Clinical Diagnostic Center “Health Clinic” provides numerous services for the diagnosis and treatment of various diseases.One of the most important areas is computed tomography (CT) of the lungs, which makes it possible to study organ tissues in layers. The enormous possibilities of modern equipment deserve the special attention of patients.
The essence of the method
The principle of operation of CT is based on obtaining multiple images of a person’s lungs using a sensor with an X-ray emitter that makes a multispiral movement around the patient’s body. Any biological tissue has the ability to absorb X-rays, and shooting from different angles provides layer-by-layer separation of the organ.As a result, it is possible to obtain almost 1000 images of different layers of lung tissue with a thickness of 1 mm or more.
All images are transferred to a computer, where images in different planes and a three-dimensional model of the organ are formed. At the same time, there are no “blind” zones. This model allows for a detailed study, assessing the state of all pulmonary regions. It can be transferred to any third-party media or printed on a 3D printer.
IMPORTANT! Unlike traditional X-ray imaging, CT uses low-dose radiation, which is practically harmless to humans.At the same time, it allows for high resolution and image clarity.
What does a CT scan of the lungs show?
With the help of a tomograph, you can distinguish the smallest changes occurring in the lungs. Revealed lesions and foci with a diameter of less than 5 mm. The use of CT in our center allows us to identify the following pathologies:
- Chronic obstructive pulmonary diseases that cause an irreversible deterioration of the airway patency: pneumonia, bronchial asthma, obstructive bronchitis, emphysema, bronchiectasis.
- Foci of infectious lesions in tuberculosis and pneumonia.
- Tumor formations and inflammation of the pleura and pleural adhesions.
- Various types of cysts.
- Malignant formations (cancer) of the lungs and bronchi.
- Pulmonary diseases of the interstitial type: fibrosing alveolitis, vasculitis, granulomatosis.
- Congenital pulmonary anomalies.
CT angiography provides a wealth of information on arterial thromboembolism.It reveals not only the size and location of the lesions, but also creates an opportunity for a full study of the nature of the pathology and assess its distribution.
LUNG CT RECORDING
CT scan of the lungs with coronavirus – how effective is the diagnosis
To date, according to the professor and chief specialist in radiation diagnostics of the Ministry of Health of Russia, coronavirus infection in computed tomography images of the lungs is determined with an accuracy of 98%.
Unlike X-ray, CT immediately visualizes inflammation and the presence of low-density inclusions. CT of the lungs can distinguish viral pneumonia from other types. A distinctive feature is the dullness and opacity of the respiratory system. Together with other signs, frosted-glass lungs confirm the danger of a new infection.
Images with high accuracy confirm viral pneumonia, but additional PCR diagnostics are required to determine the type of virus.
Coronavirus infection in pictures
The diagnostician will see that the coronavirus has affected the lungs according to the following changes:
- partitions are sealed;
- over the entire surface of the lungs there are scatter of thickening in the form of nodes of matte color;
- air gaps of the bronchi are visible on the seals.
In some cases, COVID-19 is diagnosed by multiple focal darkening, cavitation vesicles, pleural effusion, branching linear seals on the pulmonary parenchyma.In some patients, lymph nodes enlarge, solid nodules appear. Fibrous patches occur as the disease progresses.
Indications for CT of the lungs
The direction for CT of the lungs is given by the doctor after the examination. Our center employs highly qualified doctors of various specialties. It is possible to undergo research without a referral from a doctor.
The indications for a CT scan of the lungs are the following symptoms:
- Prolonged coughing and constant temperature within 37-37.5 degrees.This may indicate the presence of inflammation in the lung tissue.
- Suspected lung or bronchial cancer. With the help of CT, it is possible to differentiate between benign and malignant formations.
- Ingress of a foreign body into the bronchi or trachea.
- Painful sensations in the chest, shortness of breath, dry cough, i.e. symptoms characteristic of obstructive pathologies.
- Cough with profuse expectoration for a long time.
- Signs of arterial-pulmonary thromboembolism: heart palpitations, profuse cold sweating, painful syndrome in the chest, pallor of the skin.
- Complications in the form of problems with the respiratory system in other diseases: sarcoidosis, HIV, Crohn’s disease, Wegener’s granulomatosis, hepatitis, cirrhosis, collagenosis.
- Symptoms of pleurisy, chest pain, subfebrile manifestations.
For the study of pulmonary vessels (for example, in pulmonary hypertension), CT angiography is prescribed, which can also be done in our center.It provides a differentiated diagnosis of neoplasms and their spread.
Diagnostics using CT is recognized as safe for the patient, but for its full guarantee in the clinic, it is not carried out in such cases:
- Excessive body weight (over 130 kg). The device is not designed for heavier weight.
- Pregnant women. Any radiation exposure can adversely affect the development of the fetus.
There are limitations in the appointment of CT in renal failure and some pathologies of the thyroid gland.
In these cases, the final decision on the CT scan is made by the doctor. Studies may be ordered if no other alternative is available.
Preparing for CT of the lungs
Before performing a CT scan of the lungs, the patient must fulfill certain conditions:
- Wear loose clothing during the procedure.All jewelry and metal objects must be removed.
- Before the procedure, the doctor should be provided with the following information: the presence of a pacemaker and metal implants, diseases that limit the appointment of CT, about pregnancy.
What should you have with you for diagnostics?
To undergo a CT scan in our center, the patient must have with him:
- Proof of identity (passport or driving license).Citizenship and place of registration does not matter.
- Direction if available.
Conducting computed tomography of the lungs
With CT, the patient is in a supine position on a special table with raised arms. During the examination, immobility must be ensured. The table with the patient enters the working area of the device, where X-ray radiation is directed only at the examined part of the body. Periodically, the patient is asked to hold his breath.
The duration of exposure to radiation on an organ does not exceed 30 s. The total time spent in the tomograph is 5-7 minutes. The whole procedure is completely painless.
If CT is done with contrast, then a special contrast agent is injected into a vein before the start of the study. The duration of this variant of the study is 5-7 minutes longer. With the introduction of contrast, small side effects are possible (taste in the mouth, warmth at the injection site), but this is considered the norm.
At the Health Clinic, CT is performed on a Brilliance CT 16 tomograph by Philips Medical Systems. It provides slices of 16 x 0.75, 16 x 1.5, 8 x 3, 4 x 4.5 and 2 x 0.6 mm. A patented X-ray tube is used. Reinforced table structure allows you to receive patients weighing up to 130 kg. The device belongs to the latest generation, therefore, its radiation exposure is minimal, that is, the patient will receive the minimum radiation dose.
Interpretation of results
The results of studies during CT of the lungs are sent to the computer, where their densitometric analysis is carried out.As it passes through various structures, X-rays are attenuated or amplified, which is reflected in the image in the form of different color intensities. So, normally bones have a pronounced white color, and soft tissues have different shades of gray. Any pathological foci, as well as processes in the tissues, lead to a color change. With the introduction of a contrast agent, the borders of blood vessels and lesions become even more clear and easily distinguishable.
In the “Health Clinic” it takes about an hour and a half to decipher the results.If the patient is in a hurry or simply does not want to wait, he can use the service of sending ready-made descriptions and images to e-mail.
How often can CT scan be done?
The principle of operation of CT is based on X-ray radiation, which means that the patient receives a certain dose of ionizing radiation. At CT of the lungs, it is 3-5 meV. Such exposure roughly corresponds to the annual natural background.
There are no strict prohibitions on the frequency of lung CT scans.Experts consider it completely safe to carry them out 2-3 times a year, recommending taking breaks of about 6 months. In some cases, when it is necessary to diagnose and evaluate the results of treatment, repeated CT scan is performed in 3-4 weeks. In any case, the doctor assesses the need for tomography for health reasons. He can schedule re-examinations at any time.
Where to do CT of lungs?
There are many clinics in Moscow where the procedure is performed.However, the Health Clinic has installed the newest Philips Medical Systems tomograph of the Brilliance CT 16 brand.
Radiation exposure is minimized, so scanning can be carried out for children as well. The procedure is safe, fast and simple.
We have the most affordable price for this type of diagnostics in Moscow! For this amount, you get a high-quality examination on a device of the highest international class, with a description from a doctor with 7 years of experience. The helpful staff will surround you with care and attention.We are located in the very center of Moscow, 1 minute walk from the metro!
How to reach us:
Green color marks the way by car to the parking lot at our Diagnostic Center.
Red dotted dots – marked the pedestrian path from the station. Metro Kitay-Gorod, exit No. 6. Walk to the Health Clinic for 1 minute, the main thing is not to miss the entrance to the arch of the house, it is 20 meters from the exit from the metro. In the courtyard of this house is the entrance to our Diagnostic Center Health Clinic.
Free parking is provided for the patients of the Diagnostic Center. Reservation of a place for a car is made no later than one hour before arrival at the clinic. Call: +7 (495) 628-22-05
Benefits and risks of CT of the lungs
There are such undeniable advantages of CT of the lungs:
- Complex diagnostics. The ability to study all types of biological tissues, including vessels and soft tissues.
- No blind spots.Shooting from different angles.
- Acceleration of diagnostics.
- Sharpness of the image, accuracy of the results.
- Identification of pathologies at an early stage, including malignant tumors. Differentiation of benign and malignant tumors without biopsy.
- Possibility of conducting research in the presence of pacemakers and metal elements in the patient’s body.
- Construction of 3D-models of an organ. Mathematical analysis of the results.
Health Clinic provides additional benefits:
- Possibility of receiving the results of decryption by mail or in electronic form within 24 hours. The patient is given a description and pictures. It is possible to write the results to disk.
- Non-referral patient care. Registration at the place of residence and citizenship does not matter. It is enough to show your passport or driver’s license.
- Description can be translated into English for a fee.
- The cost of CT scan in our center is one of the lowest in Moscow.
Potential patients should also assess the existing risks of CT:
- Accumulation of radiation dose during multiple examinations.
- The presence of contraindications for a number of pathologies, as well as for pregnant women.
Difference between CT and X-ray
Conventional X-ray and CT scan refer to X-ray diagnostic methods, but they have significant differences.When X-ray is used, shooting is done in one plane, and the image is fixed on special photographic plates. It provides an assessment of the overall picture and allows you to examine only sufficiently dense tissues.
Diagnostics with CT allows you to get an image of an organ from different sides and make its layer-by-layer analysis. Such studies provide full detail, which significantly increases the accuracy of the results. It is important to take into account that the ionizing irradiation with CT is higher than with X-ray.The intensity of the radiation may decrease, but the duration of its exposure is longer than with a chest x-ray.
CT of lungs price in Moscow
There are more than 200 centers in Moscow where you can do a CT scan of the lungs, but in the “Health Clinic” the cost of a CT scan of the lungs is much lower than that of competitors. Our main task is to provide high-quality, timely and accessible assistance to everyone.
Special prices are valid for patients who applied to the clinic on their own – not through the portals for finding doctors and diagnostics.
|Service name||Price in rubles||Price until 25.08.|
CT scan of the chest in the morning and evening hours. Share
|4 990||2 900|
CT scan of the lungs in the morning and evening hours. Share
|4 990||2 900|
CT of the chest organs
|4 990||3 190|
CT of lungs
|4 990||3 190|
Description of CT images taken in another healthcare facility / Comparative analysis of the obtained CT data with the data of previous CT studies (dynamics) with the issuance of a conclusion
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90,000 X-ray image of the chest organs of a healthy person | Salamov R.F., Semenova N.A.
The shadow picture of the organs of the chest is a planar image of all organs and tissues that make up its composition.In order to correctly decipher the shadow picture of the roentgenogram, it is necessary, on the basis of knowledge of the topographic anatomy of the chest cavity, to be able to translate anatomical concepts into skialogical ones. The main difficulty lies in the fact that anatomical formations located at different depths of the chest can be depicted in the picture next to or overlapping each other. It should be borne in mind that on the roentgenogram it is not possible to obtain the true dimensions of the anatomical formations due to the divergent path of X-rays.Of great importance in the correct interpretation of the shadow image are the technical parameters that are used when obtaining each specific image. Therefore, in order to fully study the shadow picture of the chest organs and avoid errors in its interpretation, the radiation diagnostician must take into account all these factors and strictly adhere to the algorithm for examining the radiograph:
1) Assessment of the quality of the chest X-ray.
2) Assessment of the shadow pattern of the chest organs:
a) the study of soft tissues;
b) the study of the skeletal system;
c) study of the diaphragm and sinuses;
g) the study of the roots of the lungs;
e) the study of the pulmonary fields;
f) study of the mediastinal organs.
Assessment of the quality of the radiograph
The quality of the technical execution of the chest x-ray includes: the passport part of the x-ray, the completeness of the chest coverage, the position of the patient during the x-ray, the contrast of the x-ray, rigidity and clarity, the presence of artifacts. We present all good quality characteristics for the most commonly used anterior frontal projection, which is performed when the patient is orthopedic, tightly fitting the front surface of the chest wall to the cassette with the film, and the X-ray beam is directed from the back to the front in relation to the subject.
The passport part of the radiograph contains: surname, name, patronymic, patient’s age, date and place of the study. Chest coverage includes an image of the entire chest, from the apex of the lungs to the costophrenic sinuses.
The position of the patient during the image must be correct, which is assessed by the symmetrical arrangement of the sternoclavicular joints relative to the midline, drawn through the spinous processes of the vertebrae.The distance between the sternoclavicular joints and the midline drawn through the spinous processes of the vertebrae should be the same. The assessment of the correctness of the patient’s position also includes the absence of the shadows of the scapula on the pulmonary fields – they should be located outside of the pulmonary fields.
The criterion of the clarity of the radiograph is the single contour of the image of the anterior segments of the ribs visible on the radiograph, since they are the most mobile organs. Their displacements are possible even with shallow breathing of the patient, which leads to an unclear X-ray image.
The contrast of the radiograph is determined by its color gamut – from white to black, that is, when studying the contrast of the image, one should compare the image of the organs that give the maximum density with the organs that almost do not block the X-ray radiation. The most dense shadows are given by the organs of the mediastinum and the liver – they are taken for absolute darkening. Areas of the pulmonary fields projected into the intercostal spaces are shown on the roentgenograms as enlightenments, since they almost do not delay X-ray radiation.The difference in the color image of darkening and enlightenment gives an idea of the contrast of the image.
X-ray hardness depends on the hardness of the X-ray, i.e. from its penetrating power or from the wavelength. It is known that X-rays have less or more penetrating power depending on the wavelength. Depending on the patient’s constitution, the shooting conditions should be selected so that an image of medium hardness is obtained.The criterion for optimal (average) rigidity is the visibility of the bodies of 3-4 upper thoracic vertebrae on the roentgenogram; all other vertebrae can be seen as a single column against the background of the mediastinal organs or merge with it (Fig. 1). With insufficient rigidity, i.e. on a soft image, the spinal column is not differentiated. The X-ray should be considered rigid if the vertebral column is visible consisting of vertebral bodies separated from each other by lumen of the intervertebral discs. Soft and hard X-rays are taken for special indications.The standard images are of medium hardness, which have such an advantage as maximum contrast.
Mandatory absence of artifacts or images of foreign objects in the image is self-explanatory. To achieve this, it is necessary to completely free the study area from clothing and check whether foreign objects have fallen into the X-ray cassettes.
If the roentgenogram meets all the technical requirements for it, then it, as an objective clinical document, is subject to study.
Evaluation of the shadow pattern of the chest organs
Let’s make a reservation right away that “soft tissues” include all formations that cover the outside of the chest and give shadow images on good-quality X-rays that can simulate pathological processes. These include sternocleidomastoid muscles , which create symmetrical darkening with a clear outer contour in the medial parts of both apexes.The outer border of the sternocleidomastoid muscle projectively turns into a clear contour of the skin fold duplication above the clavicle, represented by a low-intensity shadow no more than 0.3 cm wide, located parallel to the clavicle. This stripe is usually absent in persons with a supraclavicular fossa filled with adipose tissue.
Pectoral muscles are displayed as symmetrically or unilaterally arranged shadows of medium density, triangular in shape, with the apex directed to the head of the humerus and an emphasized inferolateral contour, usually extending beyond the bony frame of the chest.They are seen more often in men in the upper-lateral parts of the pulmonary fields (Fig. 2).
Shadows mammary glands occupy the lower parts of the pulmonary fields and, depending on the size, give symmetrically located shadows of varying intensity (Fig. 3). With the sagging type of mammary glands, their lower convex borders are clearly visible due to the duplication of the skin fold. With the bulbous type of mammary glands, when there is no duplicate skin, their shadows do not have a clear lower contour.In men, the mammary glands are visible in old age and on the roentgenogram are similar to the sagging mammary glands of women. Nipples of the mammary glands are displayed on one or both sides symmetrically in the form of large or medium focal shadows of medium density with fairly clear contours. The geometric shape of the nipple is a cylinder, truncated cone or ball segment. The nipples are more visible in men because, unlike women, their small mammary glands do not move during X-rays.
When examining the bone skeleton of the chest, attention should be paid to the symmetry of both its halves, ribs and intercostal spaces, the vertical position of the spinal column, the spinous processes of which serve as an axis of symmetry for the radiologist. The bodies of the first 3-4 vertebrae are most clearly visible, which is facilitated by a light strip representing the trachea, which contains air and weakens the density of the mediastinal shadow in the upper part.At the same level, the shadows of the transverse processes are determined.
The contours of ribs clear, even, except for the lower contours of the posterior sections. The structure of the ribs is small-looped, more pronounced in the anterior regions. The striped shadows of the ribs, projected against a transparent pulmonary background, are clearly defined in the amount of 6-7 pairs; the lateral and posterior segments of most of the lower ribs are also visible. The anterior segments of the ribs are significantly lower than the posterior ones and are directed from the inside from bottom to top.The places of attachment of the ribs to the sternum in adults are not visible, since the medial sections of their anterior sections are represented by cartilage, which is not detected on the roentgenogram. Ossification in the cartilaginous part of the ribs causes the appearance of irregularly shaped conglomerates or focal-like shadows of different sizes in the inner zones of the pulmonary fields. Earlier than all, the anterior segment of the first rib ossifies, which can be observed already from the age of 16-18 years. The posterior, denser ends of the ribs produce intense shadows that extend into the anterior ends from outside to inside and up to the corresponding vertebra.In some cases, due to the summation of the shadows of the inner end of the posterior segment of the rib with the transverse process of the vertebra, large focal-like shadows can form in the paravertebral region and in the projection of the roots of the lungs.
The anatomical features include the presence of fork-shaped (Lyushka’s ribs) and additional cervical ribs , which can be regarded as pathological processes. Lyushka’s ribs can be located unilaterally, symmetrically, asymmetrically (Fig.4). Bifurcation is more often localized in the anterior part of the rib, less often in the posterior and lateral.
Shadow clavicle is projected onto the upper portions of the pulmonary fields. When the patient is correctly positioned, the medial ends of the clavicles are symmetrically spaced from the shadow of the handle of the sternum and the spine and are located at the level of the third intervertebral space. The bone structure of the clavicles is not uniform everywhere. In the region of the medial segment of the clavicle, bone trabeculae can be located more concentrated closer to its compact substance, leaving the inner part of the clavicle transparent and simulating a cavity in the lung.
Shadow of the sternum on a direct radiograph can be partially visible: to the right and left of the median shadow, only the facets of the sternum handle, located slightly below the inner ends of the clavicle, protrude. If misinterpreted, these shadows can be mistaken for enlarged lymph nodes in the mediastinum.
Aperture and sinuses
The diaphragm limits the pulmonary fields from below with a domed shadow. In its central part, it stands most high, to the periphery of the pulmonary fields, the shadow of the diaphragm descends rather steeply downward and forms sharp costo-diaphragmatic angles – sinuses.In the medial parts, the shadow of the diaphragm forms cardiodiaphragmatic sinuses with the shadow of the mediastinal organs, which are less deep than the costophrenic sinuses, and the sharpness of their angles varies considerably, especially on the left – from acute to obtuse. The standing height of the diaphragm varies with age and constitution. In adults, with a deep breath, the dome of the diaphragm is located on the right at the level of the anterior segment of the V-VI ribs, on the left – 1 rib lower. In the position of deep inspiration, the middle part of the dome of the diaphragm flattens.With a significant respiratory excursion, which is usually observed in athletes, the contour of the diaphragm can be serrated, and the teeth are located quite symmetrically and each tooth fits to the upper edges of the anterior ends of the ribs, which reflects the attachment points of individual muscle groups by tendon fibers to the upper edges of the ribs. The right dome of the diaphragm merges with the shadow of the liver, one or two enlightenments are usually visible under the left dome, displaying gas in the fornix of the stomach and in the splenic corner of the colon.
The roots of the lungs from the point of view of anatomy are a set of topographically located anatomical elements in a certain way: pulmonary artery, pulmonary vein, bronchi, lymphatic vessels and nodes, nerves, tissue, pleura. It should be borne in mind that for a large extent, these formations lie extrapulmonally, and therefore on the roentgenogram they are hidden by a dense shadow of the mediastinum. The division of the shadow of the lung root generally accepted in radiology into the upper part (or head), middle (or body) and lower (or tail) does not reproduce the anatomical parts of the root, but for practical reasons it is preserved (Fig.5). The main role in shadow formation of the lung root belongs to the pulmonary artery, to a lesser extent to the pulmonary veins, with the obligatory accompaniment of their bronchi, which introduce an element of contrast into the image of the root, and therefore the “X-ray” root of the lung is a set of vascular-bronchial elements (Fig. 6, 7 ). The rest of the anatomical components of the root take an insignificant part in its shadow formation.
The location of of the roots of the lungs on both sides is not the same, which reflects the lack of their anatomical symmetry.So, the right root is represented by a ribbon-like arcuate curved in the upper section and tapering downwards by a shadow of medium density with the upper border at the level of the II rib – II intercostal space. Between the shadow of the right root and the shadow of the mediastinum, enlightenment is clearly defined, due to the intermediate and lower lobe bronchi. On the left, the shadow of the root is usually more or less hidden by the shadow of the heart, only in 3-5% of patients the left root is fully visible. In accordance with the peculiarities of the anatomical position of the left pulmonary artery, the upper border of the shadow of the left root is located one rib above the right.
The shadow of the lung root of medium density, is never homogeneous: it consists of heavy, oval, rounded shadows, which are a projection overlay on the pulmonary artery of its own branches, as well as the upper and lower zonal and segmental pulmonary veins. In some places, the density of the shadow of the roots is reduced by the longitudinal or transverse projection of the bronchi overlapping them. The visibility of these anatomical structures on the radiograph determines the structure of the lung root.
Outer border the shadow of the root is not a continuous straight line: a large number of vascular shadows, caused by the branching of the pulmonary arteries and veins, diverge from it to the side. The direction of the arteries is more vertical, the veins are predominantly horizontal. In some areas, the contour of the lung root becomes less clear due to the layering of enlightenment from the bronchi. By mentally cutting off the vascular and bronchial branches, it is possible to clearly outline the boundaries of the compact part of the root shadow, which has a somewhat concave or rectilinear direction.The lower part of the root (tail) is formed by the branching point of the pulmonary artery and veins. The shadows of the roots, located on both sides of the mediastinum, stretch almost to the level of the diaphragm. Width of the roots of the lungs is the width of the main arterial trunk and is normally equal to the width of the lumen of the main bronchus, which separates the vascular trunk from the shadow of the mediastinum. This size should not exceed 1.5 cm.
On a direct radiograph, you can see the right and left pulmonary fields, which are the projection of the lungs onto the plane of the X-ray film.The right pulmonary field is short and wide, the left one is narrow and long due to the peculiarities of the location of the mediastinal organs and domes of the diaphragm. Surrounding the mediastinal organs, the lungs seem to envelop them and therefore are partially projected onto the median shadow. These parts of the lung, as well as the areas of the lung covered by the diaphragm, are not visible on a direct radiograph. They are best seen in lateral and oblique projections.
For convenience, the pulmonary fields are usually divided into 3 belts and 3 zones .Drawn at the level of the lower edges of the II and IV ribs, horizontal lines divide the pulmonary field into 3 belts – upper, middle and lower. The supraclavicular region or the tops of the lungs do not belong to any of the belts. Vertical lines drawn through the point of intersection of the clavicle with the outer costal contour and through the middle of the clavicle segment, projected against the background of the pulmonary field, divide the pulmonary field into 3 zones – internal, middle and external.
The main characteristic of the pulmonary fields is their transparency , which is determined by three main factors: air filling, vascular blood filling, the amount of lung parenchyma.The ratio of these factors determines the degree of transparency of the pulmonary fields. Obviously, transparency is directly proportional to the amount of air contained in the lungs, and inversely proportional to the number of blood vessels and lung tissue per unit volume.
In addition to intrapulmonary factors, the condition of the chest wall also affects the transparency of the pulmonary fields. So, the transparency of zones and belts in normal conditions is not the same due to the projection overlay on them of the soft tissues of the chest.Therefore, in men, the lower belts are the most transparent, then the upper and the least transparent middle belts; in women, the lower belts are the least transparent due to the overlap of the shadows of the mammary glands, the upper belts are the most transparent. The transparency of the zones in both men and women decreases from the middle to the lateral and inner zones.
Pulmonary fields have a well-defined and complex pulmonary pattern . The anatomical substrate of the pulmonary pattern in normal conditions is the pulmonary vessels – arteries and veins.The role of the walls of the bronchi and other intrapulmonary elements in the formation of the pulmonary pattern is extremely small. Basically, the pulmonary pattern is represented by heavy intertwining shadows of uneven intensity. In places, these shadows intensify from the intersection with other vascular branches or weaken from the intersection with the bronchi lying in longitudinal and transverse projections. Along with heavy shadows in the pulmonary fields, there are round and oval high-density shadow formations (cross-sections of blood vessels), next to which there are annular darkenings with enlightenments inside (bronchial lumens).
Due to a decrease in the caliber of blood vessels towards the periphery, the nature of the pulmonary pattern in different parts of the pulmonary field is not the same. If you follow its features horizontally in accordance with the division of the pulmonary field into zones, it can be seen that the pulmonary pattern is richest in the medial zones, where the large vascular trunks are located. In the middle zones, it becomes poorer due to a decrease in the caliber of blood vessels. In the lateral zones, only individual vascular branches can be traced.In the marginal border of the pulmonary fields 1-1.5 cm wide, the pulmonary pattern should not be visible. Along the vertical, the patterns of formation of the pulmonary pattern are the same as in the zonal direction. The densest pulmonary pattern is observed in the lower zones, where a large number of terminal branches of the pulmonary arteries and veins are projected. In the upper parts, the pulmonary pattern gradually becomes poorer, and in the region of the apex it is not at all traceable or barely visible.
Lobar and segmental structure of the lungs
Generally the summarized mass of all lung tissue is shown in the overview images.Most of the pulmonary lobes are layered on top of each other, with the exception of the supraclavicular and subclavian regions, the outer costophrenic angles, where the upper and lower lobes are projected, respectively. Therefore, there are no reference points on the basis of which it is possible to accurately delineate the boundaries of individual shares. However, when the pleural layers are compacted or the direction of the X-rays coincides with the course of the interlobar grooves, on the direct radiograph, you can see the image of the additional interlobar fissure in the form of a thin dark line running horizontally at the level of the III intercostal space – IV rib.The visibility on the direct image of the additional interlobar fissure allows you to accurately determine the lower border of the upper and upper border of the middle lobe.
On the lateral radiograph and under the same conditions, thin shadows of the main and additional interlobar sulcus, which are the anatomical boundaries of the upper, middle and lower lobes, are clearly defined (Fig. 8). More often, on direct radiographs of a normal chest, the projections of the pulmonary lobes are tentatively determined. In this case, it is necessary to take into account the known basic topographic and anatomical data on the location of the interlobar boundaries.
The boundaries of the individual lobes on the anterior direct radiograph of the chest are projected as follows: it is known that the border of the right main interlobar sulcus begins behind the level II of the thoracic vertebra. From here, it goes obliquely outside and down in the direction of the anterior ribs and descends to the diaphragm at the level of the IV rib. The upper border of the left main interlobar sulcus is slightly higher than the right one, its descent to the diaphragm is less gentle. An additional interlobar gap in most people is present only in the right lung.Starting from the main interlobar groove at the level of the IV rib, it separates the upper lobe from the lower and has a horizontal direction. Thus, right pulmonary field is divided into the area of projections of the upper, middle and lower lobes. The upper lobe is projected from the apex to the IV rib. Here, its lower boundary can be defined as a very thin horizontal line, below which the middle lobe is located. The middle lobe lies in the anteroposterior part of the lower part of the right thoracic cavity.Its upper plane is bordered by the base of the upper lobe, from the outside, its border projectively coincides with the direction of the anterior end of the VI rib. Thus, the lower-outer portion of the right pulmonary field, located below the anterior end of the VI rib, occupies the lateral sections of only the lower lobe. Taking into account the anatomical features of the level of the location of the anterior ends of the ribs and vertebral bodies, the image of the entire lower lobe on the right is projected onto the area of the pulmonary field, starting from the II rib up to the diaphragm.Thus, from the II to IV ribs, the lower lobe is projected onto the upper one, and above the II rib, only the upper lobe is projected into the supra- and subclavian space.
Left projection of the upper lobe corresponds to the sum of the projections of the upper and middle lobes on the right. The lower lobe on the left occupies the same areas of the pulmonary fields as on the right. Thus, in the left pulmonary field, as well as on the right, in isolation without superpositions, the upper lobe is projected into the supra- and subclavian space, below and lateral to the anterior segment of the VI rib at the edge of the chest wall – only the lower lobe.
The most permanent are the main and right interlobar accessory furrows. However, homologous interlobar grooves may be observed. In this case, the lung may have more lobes. So, if there is a posterior interlobar groove in the lung, as a continuation of the posterior interlobar fissure, then the apex of the lower lobe of the right lung is an independent posterior lobe. On the left, there may be a lingual lobe – a homologue of the middle lobe on the right, separated from the upper, as well as on the right, by an additional interlobar fissure.The pericardial lobe is formed by the medial portion of the lower lobe, usually on the right. The sizes of this lobe can be different depending on the portion of the lower lobe cut off by an obliquely located additional interlobar groove.
According to the mechanism of formation, the additional share of the azygos vein (lobus venae azygos) stands somewhat apart. Her education is linked to a developmental defect. In the process of ontogenesis, v.azygos should be located on the upper contour of the right main bronchus, bypassing the apex of the lung medially.Under normal conditions, this vein is projected in the form of an oval, rather dense shadow at the junction of the right tracheal contour into the upper contour of the right main bronchus. If v.azygos does not go around the apex of the lung, but as if cuts through it, dragging the visceral and parietal pleura with it, then a deep groove is formed, including four pleural sheets, which separates one or another section of the upper lobe of the right lung. On the roentgenogram, the detached inner part of the apex of the lung is bounded outside by a thin smooth linear shadow, which ends downward with a drop-shaped shadow (projection of the azygos vein).The additional lobe of the azygos vein can be of different sizes, its transparency, as a rule, is reduced.
Each lobe of the lung consists of a certain number of independent sections – segments of the lung . The independence of these separate parts is due to the presence of a certain bronchovascular bundle, which branches in a strictly defined section of each lobe. According to the International Scheme, it is customary to distinguish 10 main pulmonary segments on the right and 9 segments on the left (Fig.nine).
Lateral X-ray is made in the orthopedic position of the patient, tightly pressed against the cassette with the examined side, with his hands raised on his head. The picture is taken at the height of inhalation. A good-quality radiograph includes sufficient coverage, contrast, clarity, correct placement, and absence of artifacts. The contrast of the radiograph is established by comparing the dense shadow of the right subphrenic space with the light area of the lung, which is projected into the retrosternal space behind the handle of the sternum.A sufficient difference in the color image of shadows and highlights indicates the contrast of the image. Clarity is determined by the single contour of the bone formations. The correct position of the patient is evidenced by the sternum located strictly in profile.
The shadows of soft tissues in the lateral image are not differentiated separately, but they are more intense in the upper parts of the image, where the massive muscles of the back, shoulder girdle and neck are projected. As a result, a sufficient transparency of the pulmonary field in the lateral projection usually begins only from the level I of the intercostal space, due to which the apex of the lung is poorly visible.
From the shadows of the bone skeleton, the inner end of the adjacent clavicle is determined, which descends obliquely down and anteriorly, forming a clearly visible sternoclavicular articulation. Below the inner end of the clavicle in front in profile is the sternum, differentiating into the handle, body, xiphoid process. The shadow of the spine is not visible throughout – the bodies of the II-XI vertebrae, on which the transparent lung is layered, are determined separately. On the posterior parts of the vertebral bodies, rounded shadows of orthograde transverse processes are layered.The shadows of the shoulder blades are not fully visible – they mostly merge with the soft tissues of the back, and the outer edge of the shoulder blades is projected onto the shadow of the spine or in front of it. The shadows of the ribs of the side adjacent to the film start from the rounded shadows of the axial projection of the transverse processes. Initially, the ribbon-like shadows of the ribs form steep arcs posterior to the vertebrae, reaching the anterior chest wall, without going beyond the image of the sternum in front. The shadow of the 1st rib is not visible, therefore, the ribs are counted from the 2nd rib of the adjacent side, which is easily determined by the place of its connection with the sternum – at the articulation of its handle with the body.Behind, opposite the anterior segment of the II rib, lies the body of the VI vertebra. The shadows of the ribs on the opposite side are wider and projectionally do not coincide with the ribs of the same name on the adjacent side, which are narrower, more structural, their contours are seen more sharply. Bone landmarks are used to determine the boundary between the lobes, when the linear shadows of the interlobar pleura are not visible in lateral images. So, by mentally connecting the body of the IV vertebra with the anterior costodiaphragmatic sinus, you can get a projection of the main interlobar fissure.Drawing a horizontal line along the anterior segment of the IV rib (from the root of the lung perpendicular to the sternum) – the projection of the additional interlobar gap.
The apical segment of the upper lobe is located in the dome of the pulmonary field (Fig. 9). Behind it is the II posterior segment of the upper lobe, anteriorly and outwardly – the III anterior segment of the upper lobe. In the middle lobe, the IV segment is external, located in the angle between the horizontal and lower part of the oblique interlobar fissure. Anterior to the outer is the V inner segment.
The apex of the lower lobe is occupied by a segment, the lower border of which is determined by a line mentally extended posteriorly from the additional interlobar fissure. The rest of the segments are located at the base of the lower lobe in such a way that on the lateral radiograph the VII segment is layered on the VIII, IX and X, occupying different areas in area. So, VII medial-basal adjoins the lower part of the main interlobar fissure and enters the anterior costodiaphragmatic sinus; XI – lateral-basal, located between the VIII and X segments, partially overlaps the posterior basal segment and enters the area of the external sinus.The X posterior basal segment at the top is bordered by the VI segment and occupies a large volume of the posteromedial parts of the lower lobe.
On the left, the localization and the number of segments are somewhat different than on the right. So, I and III segments are more often combined into one posterior apical because of the common bronchus ventilating them. There is no middle lobe on the left. Its homologue is the reed segment, usually not separated from the upper lobe by the interlobar fissure, is divided into IV upper reed and V lower reed segments, so that on the lateral radiograph the IV segment is located above V.In addition, the VII segment is missing on the left.
X-ray examination of the chest organs completes the study of the shadow of the mediastinal organs. Occupying a somewhat asymmetrical position, the heart is mostly located in the left half of the chest, forming on the inner surface of the lungs depressions and grooves. The shade of the heart is homogeneous in structure and has a high density. The position of the heart, depending on the constitution of a person, is oblique, horizontal or vertical.The correspondence of the size of the heart to the size of the chest is determined by the cardiothoracic index, which is normally equal to 0.5, and by the level of the location of the cardiovasal angle.
Thus, the standard projections most often used in practice to study the organs of the chest are the anterior straight line, right and left lateral, I and II oblique projections. The information obtained during their study allows you to get an objective idea of the state of the chest organs. Knowledge of the norm is the basis on which the possibility of distinguishing between health and disease is built.
|Appendices to Article|
|Fig. 1. Chest X-ray A. Medium hardness, visible shadows of the mammary glands.|
|Fig. 1. X-ray of the chest organs B. Low rigidity (soft). B. High rigidity (hard).|
|Fig.2. Shadows of the pectoralis major muscles.|
|Fig. 3. Variant of the norm: on the right, a sagging shadow is visible, on the left – of a bulbous mammary gland.|
|Fig. 4. Fork-shaped rib on the right.|
|Fig. 5. The x-ray shows the roots of the lungs on both sides.|
|Fig. 6. Angiogram of the pulmonary arteries.|
|Fig. 7. Direct bronchogram.|
|Fig. 8. Lateral radiograph of good quality with visible interlobar grooves.|
|Fig.9. Scheme of the segmental structure of the lungs.|
CT of lungs for tuberculosis – DocDoc.ru
Computed tomography (CT) is the most informative way of examining the lungs. With the help of CT, you can detect almost any changes in the bronchopulmonary system, including tuberculosis. Unfortunately, CT cannot be used to screen for disease (like fluorography) due to its high cost, so it is usually prescribed if there are pathological changes on the FLG or X-ray.
CT is a layer-by-layer scan of the lungs using X-rays. Tomograms are much clearer than radiographs, and layer-by-layer slices allow you to obtain a volumetric image and reveal even small changes in the lung tissue. This is very important for early diagnosis of tuberculosis.
Indications for CT of the lungs with suspected tuberculosis:
- infiltrative shadows on a fluorogram or roentgenogram;
- positive results of the Mantoux or Diaskintest test;
- positive sputum culture for tubercle bacillus.
The diagnosis of pulmonary tuberculosis is made only with a positive sputum culture. If it is negative, and characteristic foci are found in the lungs, we are talking about a pathological process of a different etiology. In this case, an additional examination is assigned. If laboratory examination gives positive results, then extrapulmonary forms of tuberculosis should be excluded.
CT is used not only to confirm the diagnosis of tuberculosis of the lungs and intrathoracic lymph nodes, it is used to determine the localization and size of pathological foci, to evaluate the results of treatment.
If you are worried about a health problem, sign up for a diagnosis. The success of treatment depends on the correct diagnosis.
What is visible on a CT scan of the lungs in tuberculosis?
In the acute phase of pulmonary tuberculosis, CT shows foci of lung tissue compaction (infiltrates) near the bronchi and enlarged altered lymph nodes near the root of the affected lung. With disseminated form of tuberculosis, CT of the lungs shows multiple small infiltrates, mainly in the upper lobes.If a conventional tomogram is not informative enough, contrasting is used. CT with contrast “shows” caseous necrosis especially well.
After the course of treatment, the number and size of the lesions should decrease – in order to monitor the effectiveness of therapy, repeated CT is usually prescribed.
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03 June 2015
90,000 Modern diagnostics and treatment of oncological diseases.Moscow City Oncological Hospital No. 62.
An important principle of the surgical treatment of cancer is the performance of minimally traumatic operations in order to preserve the functions of the affected organ as much as possible and shorten the postoperative period. This is achieved by the widespread use of minimally invasive and organ-preserving techniques, the advantages of which are obvious and do not raise doubts either among doctors or patients. Most urological, gynecological and other operations on the abdominal organs have long been performed using laparoscopic techniques, which have become the “gold standard” of modern surgery.
The introduction of endoscopic technologies in thoracic surgery was much slower, and for a long time was limited to small diagnostic operations (pleural biopsy, marginal lung resection, pleural drainage). This is due to the peculiarities of the anatomy of the chest wall (rigid rib frame limiting freedom of manipulation), complex anatomy of the lungs and mediastinum (the presence of closely spaced large vessels, contraction of the heart), as well as the absence of one simple typical operation (cholecystectomy in abdominal surgery), which would allow detailed to work out the endoscopic technique.
Surgical interventions on the lungs and mediastinal organs are complex and require a high concentration of attention from the surgeon, detailed knowledge of the anatomy and accurate performance of all stages of the operation. The accumulation of extensive experience in “open” thoracic surgery, the emergence of new endoscopic instruments and mechanical devices for tissue separation have made it possible to expand the indications for thoracoscopic operations. A kind of intermediate stage in the transition to completely “closed” interventions were video-assisted lung resections from the mini-access, which are still widely performed in a number of clinics, but at the same time they are not devoid of many of the disadvantages of classic “open” operations.
Today in our clinic in the early stages of peripheral lung cancer (tumor no more than 5 cm in diameter, without metastases in the lymph nodes), radical thoracoscopic lobectomy has already become the standard of surgical treatment. It should be noted that during thoracoscopic operations for malignant tumors, the volume of removed tissues fully corresponds to that with an “open” access, which preserves the necessary “oncological radicality” of the intervention.Due to the magnification and high definition of the image, in some cases, with thoracoscopy, it is possible to more thoroughly revise the operation area and remove the affected tissue. A qualitatively different level of thoracoscopic surgery is also provided by the 3D-visualization system we use, the analogs of which are used in the Da Vinci robots.
The thoracoscopic technique of lung resection in our clinic has a number of significant advantages. During the operation, retractors that injure the intercostal nerves are not used.A maximum incision of up to 4 cm is made at the end of the operation to remove a tumor, cyst or part of the lung. To visualize the operating field, special thoracoscopes with a flexible end are used, which makes it possible not to change the position of the camera during the operation. Changing the field of view occurs by controlling the camera using special buttons. Soft anatomical (corresponding to the shape of the intercostal space) trocars are used, and the port insertion sites are sutured with self-absorbable sutures.
The use of ultra-thin instruments (3 and 5 mm in diameter) and the finest flexible optics can significantly reduce tissue trauma during surgery and significantly reduce the intensity of pain in the postoperative period, and in some cases almost completely eliminates it. Accurate isolation of all anatomical structures, the use of modern stapling staplers and hemostasis systems can reduce intraoperative blood loss to 50-100 ml.
The use of all these technologies makes it possible to reduce the patient’s stay in the clinic to 2-4 days, compared to 10-12 days after “open” operations. In this case, the very next day after, in fact, a large abdominal operation, the patient is in the department and is as active as possible. A good cosmetic effect is also undoubtedly important. After thoracoscopic surgery, only small thin scars remain: three 5-7 mm each and one not more than 4 cm (in women it is located under the mammary gland), which become almost invisible within six months.
In our clinic, all thoracoscopic operations are performed on the most modern equipment from leading world manufacturers using the best consumables. Operating surgeons have been trained and trained in leading clinics in France, Belgium and the United States.