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Emphysema of the lungs: diagnosis
Last reviewed: 23.04.2024
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Data of instrumental and laboratory studies
X-ray examination of the lungs and heart. Characteristic features of emphysema are the low position of the dome of the diaphragm and its flattening, markedly reduced diaphragm excursion; increased airiness of pulmonary fields; an increase in the retrosternal space (a sign of Sokolov); impoverishment of pulmonary fields with vascular shadows (the vascular pattern acquires a threadlike character and considerably weakens to the periphery). The cardiac shadow is narrowed, elongated ("drip heart").
CT scan. For pulmonary emphysema, hyper-airyness of the lung tissue is characteristic, depletion of the vascular pattern, in comparison with the usual radiographic examination, bullae are clearly identified.
In the presence of chronic bronchitis high density of the bronchial wall, infiltration along the course of bronchi is revealed.
Examination of the function of external respiration. The most characteristic sign of primary lung emphysema is a decrease in the vital capacity of the lungs (JEL) and an increase in total lung capacity (OEL), residual lung volume (OOL).
The total lung capacity - (OEL) is the entire volume of air in the chest after the maximum inspiration.
The remaining volume of the lungs is the volume of air remaining in the lungs at the end of the maximum expiration.
As the progression of emphysema occurs bronchial obstruction, which is manifested by a decrease in FVC, Tiffon index, MBL, sharply reduced the indicators of peakflowmetry. With secondary emphysema of the lung, the violation of bronchial patency is much more pronounced.
The prognosis in patients with secondary emphysema is determined by the severity of bronchial obstruction, arterial hypoxemia, hypercapnia, pulmonary hypertension. It is recommended to perform tests using bronchodilators to identify the reversible and irreversible nature of bronchial obstruction. In patients with pulmonary emphysema, obstruction has a persistent, irreversible character, and in chronic obstructive bronchitis a partial bronchodilating effect is noted.
General blood test. In patients with emphysema, there is a tendency to increase the number of red blood cells and the level of hemoglobin, especially in the development of respiratory failure.
ECG. With pulmonary emphysema, the deviation of the electric axis of the heart to the right is marked, the rotation of the heart around the longitudinal axis is clockwise (the deep S teeth are marked not only in the right but also in the left thoracic leads).
Changes in the blood pressure of oxygen and carbon dioxide. In patients with primary emphysema in the initial stages of the disease, the partial oxygen tension remains normal; with the development of respiratory insufficiency, PaO2 decreases; in far-reaching stages, RaCO2 is increased. In patients with secondary emphysema, with a pronounced broncho-obstructive syndrome, PaO2 decreases rapidly and PaCO2 increases.
Chronic obstructive bronchitis and emphysema usually always accompany one another, especially in the advanced stage of the disease, when it is extremely difficult to distinguish between these two diseases. Therefore, in such a situation, it is preferable to talk about chronic obstructive pulmonary disease with predominance of emphysema of the lungs or chronic bronchitis. Accordingly, there are two types of COPD: type A - emphysematous (dyspnea, "pink puffing"), type B - bronchitis (coughing, cyanotic).
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