Lung X-ray

The lungs are one of the most frequent objects of radiation examination. The important role of the radiologist in studying the morphology of the respiratory organs and recognizing pathological processes is evidenced by the fact that the accepted classifications of many diseases, such as pneumonia, tuberculosis, sarcoidosis, pneumoconiosis, malignant tumors, are largely based on radiological data. It is also known that latent lung lesions are detected using screening fluorographic examinations of the population and chest X-rays.

With the development of computer tomography, the importance of X-rays in diagnosing lung diseases has increased even more. With its help, it is possible to identify the earliest changes in the organs of the chest cavity. The radionuclide method has taken an important place in assessing the functional pathology of the lungs, in particular, violations of capillary blood flow in them.

Indications for chest x-ray are very broad: increased body temperature, cough, sputum production, shortness of breath, chest pain, hemoptysis and many other pathological conditions.

Radiological examination of lung function

The functional respiratory system consists of many links, among which the pulmonary (external) respiration and circulatory systems are of particular importance. The efforts of the respiratory muscles cause changes in the volume of the chest and lungs, ensuring their ventilation. Due to this, the inhaled air spreads along the bronchial tree, reaching the alveoli. Naturally, violations of bronchial patency lead to a disorder of the external respiration mechanism. In the alveoli, diffusion of gases occurs through the alveolar-capillary membrane. The diffusion process is disrupted both when the alveolar walls are damaged and when capillary blood flow in the lungs is disrupted.

X-ray examination of lung function

Radiation anatomy of the lungs

On a survey radiograph in a direct projection, the upper 5-6 pairs of ribs are visible almost along their entire length. Each of them can be distinguished by a body, anterior and posterior ends. The lower ribs are partially or completely hidden behind the shadow of the mediastinum and organs located in the subdiaphragmatic space. The image of the anterior ends of the ribs breaks off at a distance of 2-5 cm from the ribcage, since the costal cartilages do not give a distinguishable shadow on the images. In people over 17-20 years of age, lime deposits appear in these cartilages in the form of narrow stripes along the edge of the rib and islets in the center of the cartilage. They, of course, should not be mistaken for compaction of lung tissue. Chest X-ray also shows an image of the bones of the shoulder girdle (clavicles and scapulae), soft tissues of the thoracic wall, mammary glands and organs located in the thoracic cavity ( lungs, mediastinal organs).

Normal X-ray anatomy of the lungs

Radiation syndromes of lung damage

Radiological diagnostics of lung injuries and diseases is very difficult. It is not by chance that the aphorism was formulated: "Oh, these lungs are not easy!" Hundreds of diseases in different phases of their development create a variety of X-ray and radionuclide pictures, and their endless variations sometimes seem unique. Nevertheless, an experienced doctor, relying on the results of studying the anamnesis and clinical picture, knowledge of normal and pathological anatomy, understands typical situations with enviable ease and comes to the right conclusion. This happens because he has learned to determine the morphological substrate of X-ray symptoms, using X-rays of the lungs in his practice. Of course, there are many X-ray signs of pulmonary pathology, but among them, three main ones stand out: darkening of the pulmonary field or part of it, enlightenment of the pulmonary field or part of it, changes in the pulmonary and root pattern.

Darkening of the lung field or part of it

Most lung diseases are accompanied by compaction of the lung tissue, i.e. a decrease or absence of its airiness. Compacted tissue absorbs X-ray radiation more strongly. A shadow or, as they say, darkening appears against the background of a light lung field. The position, size and shape of the darkening depend, naturally, on the extent of the lesion. There are several typical types of darkening. If the pathological process has affected the entire lung, then the entire lung field is darkened to one degree or another on the radiograph. This syndrome is called "extensive darkening of the lung field." It is not difficult to detect - it is striking at first glance at the image. However, its substrate must be immediately determined. Darkening of the entire lung field is most often caused by blockage of the main bronchus and atelectasis of the corresponding lung.

Darkening of the lung field or part of it

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Enlightenment of the lung field or part of it

Increased transparency of the lung field or part of it may be due to either the presence of air in the pleural cavity (pneumothorax) or a decrease in the amount of soft tissue and, accordingly, an increase in the amount of air in the lung or part of it. This condition may be a consequence of swelling of the lung tissue (emphysema) or reduced blood flow to the lung (pulmonary anemia), which is observed mainly in some congenital heart defects.

Enlightenment of the lung field or part of it

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Changes in the pulmonary and root pattern

Changes in the pulmonary pattern are a syndrome often observed in lung diseases. It is often combined with a disruption of the structure of the lung root. This is understandable: after all, the pulmonary pattern is formed primarily by arteries originating from the root, so many pathological processes affect both the lung parenchyma and its root.

Changes in the pulmonary and root pattern

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Radiation symptoms of lung damage

Lung and diaphragm damage

In acute closed or open chest and lung trauma, all victims require radiological examination. The urgency of its implementation and scope are decided on the basis of clinical data. The main task is to exclude damage to internal organs, assess the condition of the ribs, sternum and spine, as well as detect possible foreign bodies and establish their localization. The importance of radiological methods increases due to the difficulty of clinical examination of patients due to shock, acute respiratory failure, subcutaneous emphysema, hemorrhage, severe pain, etc.

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Acute pneumonia

Acute pneumonia is manifested by inflammatory infiltration of the lung tissue. In the infiltrate zone, the alveoli are filled with exudate, due to which the airiness of the lung tissue decreases and it absorbs X-rays more strongly than normal. In this regard, X-ray examination is the leading method for recognizing pneumonia. X-ray of the lungs allows you to determine the prevalence of the process, reactive changes in the roots of the lungs, pleura, diaphragm, promptly detect complications and monitor the effectiveness of treatment.

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Pulmonary artery branch thromboembolism

Pulmonary artery branch thromboembolism occurs as a result of an embolus carried in from the veins of the lower extremities and pelvis (especially common in thrombophlebitis or phlebothrombosis of the iliac-femoral segment of the venous system), thrombosed inferior or superior vena cava, or heart (in thromboendocarditis). Clinical diagnostics are far from always reliable. The classic triad of symptoms - dyspnea, hemoptysis, flank pain - is observed in only 1/4 of patients, so radiological examination is of exceptional value.

Chronic bronchitis and pulmonary emphysema

Chronic bronchitis is a group of common diseases in which there is a diffuse inflammatory lesion of the bronchial tree. A distinction is made between simple (uncomplicated) and complicated bronchitis. The latter manifests itself in three forms: obstructive, mucopurulent and mixed bronchitis.

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Chronic pneumonia and limited non-specific pneumosclerosis

X-ray examination allows to recognize all forms and stages of chronic pneumonia. The images show infiltration of lung tissue. It causes non-uniform darkening due to a combination of infiltration and sclerosis areas, coarse fibrous strands, bronchial lumens bordered by a strip of peribronchial sclerosis. The process can capture part of a segment, part of a lobe, an entire lobe or even the entire lung. In the shadow of the infiltrate, individual cavities containing liquid and gas can be seen. The picture is complemented by fibrous deformation of the root of the lung and pleural layers around the affected part of the lung.

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Pneumoconiosis

With the modern development of industrial and agricultural production, the problem of prevention and early recognition of dust-induced lung diseases - pneumoconiosis - has acquired exceptional importance.

Pulmonary tuberculosis

All measures to combat tuberculosis are based on the principle of preventing infection and early detection of the disease. The goals of early detection are screening fluorographic examinations of various contingents of the healthy population, as well as correct and timely diagnosis of tuberculosis in outpatient clinics, polyclinics and hospitals of the general medical network. In accordance with this classification, the following forms of tuberculosis of the respiratory organs are distinguished.

Primary lung cancer

Primary lung cancer in the early stages of development does not give distinct subjective symptoms and a clear clinical picture. The discrepancy between the clinical manifestations of the disease and the anatomical changes is the reason why the patient does not consult a doctor. There should be an obstacle on the path of the disease - a mass examination of the population using fluorography or radiography. The contingents that most often develop lung cancer are subject to annual examination: male smokers over 45 years old and people suffering from chronic lung diseases. In all patients in whom the X-ray of the lungs revealed changes, it is necessary to first exclude cancer.

Diffuse (disseminated) lung lesions

Diffuse (disseminated) lung lesions are understood as widespread changes in both lungs in the form of scattered lesions, an increase in the volume of interstitial tissue, or a combination of these conditions.

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Pleurisy

The pleural cavity of a healthy person contains 3-5 ml of "lubricating" fluid. This amount is not detected by radiation methods. When the volume of fluid increases to 15-20 ml, it can be detected using ultrasound. In this case, the patient should be in a lying position on the sore side: then the fluid will accumulate in the lowest (outer) section of the pleural cavity, where it is determined.

X-ray symptoms of lung damage