Disseminated pulmonary tuberculosis: diagnosis

X-ray diagnosis of disseminated pulmonary tuberculosis reveals the prevalent syndrome of disseminated pulmonary tuberculosis - focal dissemination. For hematogenous and lymphogematogenic dissemination, multiple focal shadows are characteristic, which are located in both lungs relatively symmetrically. With lymphogenous dissemination, focal shadows are often identified in one lung, mainly in the middle sections. Bilateral lymphogenous dissemination is usually asymmetric.

With acute miliary tuberculosis during the first 7-10 days of the disease, it is not possible to identify focal dissemination in the lungs according to the radiograph. Density and size of fresh foci are not sufficient for their visualization in the survey. Characteristic diffuse decrease in the transparency of the pulmonary fields, blurred (blurred) pulmonary pattern, the appearance of a kind of finely meshed mesh. On the 10-14th day of the disease, radiography can reveal multiple small (no more than 2 mm in diameter) single-type foci, which are symmetrically located from the tips to the basal parts of the lungs. Such total small-focal dissemination is a characteristic x-ray sign of miliary tuberculosis. Focal shadows have a rounded shape, low intensity and fuzzy outlines. They are often arranged in the form of a chain, since they are localized along the course of the vessels. Small vessels against the background of a large number of foci are practically invisible - only large vascular trunks can be clearly visualized.

Diagnosis of disseminated pulmonary tuberculosis with CT helps to identify important signs of miliary lung damage.

In children of an early age, the size of focal shadows is considered to be larger than that of adults in adults with acute disseminated tuberculosis: from 2 to 5 mm.

For subacute disseminated pulmonary tuberculosis that develops with hematogenous dissemination of mycobacteria, subtotal focal dissemination with predominant localization of focal shadows in the upper and middle parts of the lungs is characteristic. Focal shadows are mostly large (5-10 mm), small or medium intensity (subtotal large equiaxial dissemination), usually with fuzzy contours. Some focal shadows merge and form focal shadows with areas of enlightenment, caused by the disintegration of the lung tissue. Sometimes destructive changes are represented by thin-walled ring-shaped shadows.

Subacute dissemination of lymphogenous origin is manifested primarily by unilateral focal shadows in the middle and lower parts of the lung. Focal shadows are located in groups among the strip-shaped and reticular shadows of lymphangitis. When tomographic examination in the root of the lung and mediastinum, the enlarged, compacted, sometimes partially calcified lymph nodes are often found.

With chronic disseminated tuberculosis, lung changes on the radiograph are very diverse. A characteristic feature is a subtotal or total, relatively symmetrical polymorphic focal dissemination. Multiple focal shadows have different values. Form and intensity, which is due to the different prescription of their formation. In the upper and middle parts of the lungs focal shadows are larger, they are much larger than in the lower ones. There are no inclinations to fusion of foci. Symmetry of changes can be disrupted as new rashes appear. In some patients, in both lungs, cavities of decay are seen in the form of thin-walled ring-shaped shadows with clear internal and external contours - this is how the caverns look like stamped, or spectacled.

In the upper parts of both lungs, the pulmonary pattern is strengthened, deformed and has a mesh-cellular character due to pronounced interstitial fibrosis. Two-sided cortico-apical pleural layers (moorings) are clearly visible. In the basal sections, the pulmonary picture is impoverished, the transparency of the pulmonary tissue is increased because of the vicarious emphysema. In connection with fibrosis and a decrease in the volume of the upper lobes, the shadows of the roots of the lungs are symmetrically tucked up (a symptom of a "weeping willow"). The shadow of the heart on the roentgenogram has a medial position ("drip heart"), and its transverse dimension in the region of large vessels is narrowed.

Timely diagnosis of disseminated pulmonary tuberculosis and effective treatment do not leave residual changes on radiographs. After subacute and chronic disseminated tuberculosis, X-ray examination usually reveals small and medium focal shadows of high intensity in both lungs - a symptom of the "starry sky".

Slow progression of chronic disseminated tuberculosis often leads to the formation of a fibrous-cavernous process.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]