Small focal changes in the parenchyma of both lungs. Tips for identifying a lesion in the lung. Symptoms and signs of pulmonary metastases

Lesions in the lungs attack the respiratory organs, as many diseases are caused by them. Such formations are dangerous to health, especially if no action is taken. We will talk about the causes of subpleural lesions in this article.

What are subpleural lesions in the lungs on CT

Focal formations are tissue compaction that is caused by a variety of diseases. They are identified when x-ray examination. In some cases, diagnosis is not enough and tissue puncture is prescribed.

You can see on CT small spot irregular or round in shape. CT scan determines its shape and size.

The human lungs are covered by a thin film called pleura. The study allows the lesions to be classified: pleural, subpleural. They can also be single or multiple.

Reference! The subpleural lesion is sometimes not visible on fluorography and x-rays. In this case, CT is preferable.

Subpleural lesions are located under the pleura. This localization indicates the presence of tuberculosis or a malignant tumor.

In tuberculosis, foci can be single or multiple, with a homogeneous or polymorphic structure. Merging, they form infiltrative shadows. If there are decay cavities (cavities) in the image, then this is a clear sign diseases.

When a neoplasm is detected, an irregular shape without clear contours will be noted.

An important criterion in this case is dynamics. If growth of foci is observed, then the oncological process progresses.

Tuberculosis and oncology have many symptoms in common, which makes it difficult to make a diagnosis without additional research. The signs are as follows:

• chronic severe cough;
• dyspnea;
• hemoptysis;
• a sharp decrease in body weight.

Differences between diseases x-rays the following:

• at cancerous tumor the shadow is more intense, has blurred outlines, wavy contours and a uniform structure;
• in case of oncology there are metastases in the root of the lung, in case of tuberculosis - lymph nodes;
• tuberculosis does not grow into the adjacent lung, since growth is limited to the pleura;
• multiple metastases mean cancer; this cannot happen with tuberculosis.

After receiving the results, you should consult a doctor for treatment. Tuberculosis in this moment can be treated if all instructions are followed. With oncology, everything is more complicated: radiation and chemotherapy, surgery.

Foci in the lungs on CT are local areas in which the transparency of the lung tissue is reduced. These may be areas of darkening or compaction of various sizes, which are detected during a computed tomography scan. The cause of this pathological phenomenon may be various diseases respiratory organs. Despite the fact that CT is one of the most precise methods diagnostics, it is impossible to make a diagnosis based on its results alone. The patient must undergo a series of tests, which include blood and sputum tests.

Features of computed tomography

If a pathology of the lower respiratory organs is suspected, the doctor will refer the patient for an x-ray, tests and computed tomography. All these methods help to identify changes in the lung tissue and make an accurate diagnosis.

The advantages over other examination methods can be highlighted as follows:

• In a short time and with maximum accuracy, it is possible to determine what caused the disease. Lesions in the lungs are clearly visible on CT, and the doctor is able to determine their location and structure.
• Thanks to this type of examination, it is possible to determine at what stage the disease is.
• Helps give an accurate assessment of the condition of the lung tissue. Its density and condition of the alveoli are determined, in addition, the volume of the respiratory organs is measured.
• Thanks to CT, it is possible to analyze the condition of even the smallest vessels located in the lungs, as well as evaluate the aorta, heart, vena cava, trachea, bronchi and lymph nodes, which are located in chest.

Such a study helps to examine all segments in the lungs, due to which it is possible to reliably determine where exactly the pathological focus is localized.

Tomography is carried out in medical centers and the cost is quite high. However, if it is necessary to clarify the diagnosis, this procedure is simply irreplaceable.

Focal changes

Focal changes in the lungs may be different sizes. Foci of small diameter 1-10 mm are detected in various diffuse pathologies of lung tissue. Outbreaks with high density and fairly clear edges are mainly observed in the interstitium of the lung. Various low-density foci, resembling frosted glass, with unclear contours occur with pathological changes in the respiratory parts of the respiratory organs.

It should be taken into account that the density and size of the lesions has a weak diagnostic value. To make a diagnosis, the distribution of pathological processes in the lung tissue may be more important:

1. Perilymphatic focus - often observed in the bronchi, vessels, interlobular septa and layers of the pleura. In this case, uneven contours of the anatomical structures are visible, while the septa and walls of the bronchi are somewhat thickened, as are the walls of the blood vessels. Similar pathological changes are often found in tuberculosis, silicosis, sarcoidosis and carcinomatosis. With these pathologies, the lesions are small and do not exceed 2-5 mm. Such foci consist of granulomas or metastatic nodules; they are observed along the lymph nodes in the lung tissue and pleura.
2. Polymorphic focus. Such focal formations in lung tissue occur during tuberculosis. In this case, CT allows you to see areas of different densities and sizes. In some cases, such a picture is observed in oncological pathologies.
3. Centrilobular lesions. Observed in the arteries and bronchi or in close proximity to them. They can be quite dense, well defined and uniform. Changes in lung tissue of this type are observed in pneumonia, endobronchial tuberculosis and different types bronchitis, mainly of bacterial origin. There is another type of centrilobular lesions, in which case the lung tissue has small compactions and looks like frosted glass.
4. Perivascular lesions are pathological formations that are located in close proximity to blood vessels. This condition is observed in oncological pathologies and tuberculosis. The lesions can be either single or multiple.
5. Chaotically located foci. Such formations are characteristic of pathological hematogenous processes. This may be a hematogenous infection, tuberculosis or hematogenous metastases. Large multiple lesions, about 10 mm in size, are often observed with septic emboli, granulomatosis, fungal infections and metastases. All these diseases have some differences by which they can be differentiated.
6. Subpleural lesions are pathologically changed areas located under the pleura. Observation of such areas in the image always indicates the development of tuberculosis or cancer.
7. Pleural lesions. Such pathological formations are located on the pleura. Observed in inflammatory and infectious pathologies of the lower respiratory organs.
8. The apical lesion represents an overgrowth fibrous tissue, which over time replaces healthy cells.
9. Lymphogenic carcinomatosis. This concept includes two types pathological changes in the lungs. WITH right side alveolar infiltration is observed, with visible lumens of the bronchi. On the left side, the density of the lung tissue is slightly increased. In the area of ​​compaction, the walls of the bronchi and blood vessels are observed.

In focal diseases, areas of pathologically altered tissue can be different in size. They can be small, no more than 2 mm in size, medium - up to 5 mm in diameter, and large, the latter exceeding 10 mm in size.

Pathological foci can be dense, medium density, or loose. If single compactions are observed in the lungs, then this may be like age-related changes, which does not pose a danger to humans, and dangerous disease. If multiple foci are observed, then we are talking about pneumonia, tuberculosis or rare forms of cancer.

When Mycobacterium tuberculosis enters the lungs, a primary focus develops, which in the picture is very similar to pneumonia. However, the difference is that inflammatory process can last for a very long time, sometimes even years.

Why are focal changes dangerous?

Focal changes in the lung tissue almost always indicate pathological process. In most cases, doctors refer patients for a CT scan if the x-ray does not help make the correct diagnosis. Usually the diagnosis has already been made in advance and is only confirmed by the results of tomography.

Quite often, based on the results of a CT scan, a diagnosis of tuberculosis or lung cancer is made. For these diseases, it is very important to start therapy in a timely manner. At an early stage these dangerous diseases respond well to treatment and the prognosis for patients is very good.

Disadvantages of tomography

Computed tomography also has weak sides. Thus, this method does not always allow us to see focal changes, the size of which is less than 5 mm and the tissue density is low. If the diameter of the lesion does not exceed 0.5 cm, then the chance of detecting it is about 50%. If the size of the changed area is about 10 mm, the chance of seeing it is equal to 95%.

In conclusion, health workers indicate the likelihood of developing a particular disease. The localization of the pathologically altered tissue does not play a role, but close attention is paid to the contours. If they are unclear and the lesions are more than 1 cm, then this always indicates a malignant process. If the edges are clear, we can talk about tuberculosis or benign neoplasms.

If the doctor has doubts when making a diagnosis, he can refer the patient for a computed tomography scan. This research method is quite accurate, but even with CT it is not always possible to see small focal changes in the lungs.

About maximum dose. Regarding radiation risk: the risk is equal to 0.073 times the dose in Sieverts. The full name of this number is: “lifetime risk coefficient of reducing the duration of a full life by an average of 15 years per one stochastic effect (from fatal cancer, serious hereditary defects and non-fatal cancer, reduced in harm to the consequences of fatal cancer).” All this can be found in paragraph 2.8 SP 2.6.1.758-99 “Radiation Safety Standards (NRB-99): http://www.niirg.ru/HyperTexts/NRB/NRB.htm
Calculation example: if the dose received was 5 mSv, then the risk will be 0.073*0.005 Sv=0.0004. It can be interpreted as follows: if 10,000 people receive 5 mSv, then for 4 of them long-term consequences of radiation are possible, and “on average” one effect will be equivalent to the loss of 15 years of life.
In the area of ​​low radiation doses, this calculation will be rather hypothetical, based on extrapolation of risks from the area of ​​​​high doses. See, for example: www. Radsafe. Ru/downloads/radiationrisk. PDF
Perhaps you should not try to calculate the risk, but pay attention to the fact that the study is well justified (really necessary to obtain diagnostic information) and correctly performed (parameters for turning on the device, shielding of non-examined parts of the patient’s body, etc.), and also that the dose received is registered (inscribed in the outpatient card or medical history in accordance with the requirements of regulatory documents http://www.niirg.ru/PDF/Mu_2.6.1.1797_03.pdf).
The dose limit exists only for medical exposure for preventive purposes (fluorography, mammography) and scientific research, it is equal to 1 millisievert per year (this dose is exhausted, for example, by 1-2 film fluorographs or up to several dozen digital ones, depending on the type of device).
A rather interesting "Consent Language Generator" can be found here
http://www.doseinfo-radar.com/RADARDoseRiskCalc.html (you need to enter the types and number of studies, and then read the generated message, as well as the dose gradation under it).
In conclusion, from SanPiN 2.6.1.1192-03, clause 7.10:
(Quote)
Radiation dose limits for patients for diagnostic purposes are not established. To optimize patient protection measures, it is necessary to comply with the requirements of clause 2.2 of these Rules.
When the accumulated dose of medical diagnostic radiation to a patient reaches 500 mSv, measures must be taken to further limit his radiation exposure if radiation procedures are not dictated by vital indications.
When persons from the population receive an effective radiation dose per year of more than 200 mSv or an accumulated dose of more than 500 mSv from one of the main sources of radiation or 1000 mSv from all sources of radiation, a special medical examination, organized by health authorities.

The solitary lesion or "coin-shaped lesion" is a focal point< 3 см в диаметре, различимый на рентгенограмме легкого. Он обычно окружен легочной паренхимой.

2. How can a solitary lesion in the lung be represented?

Most often it is a neoplasm (cancer) or a manifestation of infection (granuloma), although it may represent lung abscess, pulmonary infarction, arteriovenous anomaly, resolving pneumonia, pulmonary sequestration, hamartoma and other pathologies. General rule is that the probability of a malignant tumor corresponds to the age of the patient.

Thus, lung cancer is rare (although it does occur) in 30-year-olds, while 50-year-old smokers may have a 50-60% chance of having a malignant tumor.

3. How is a solitary lesion in the lung detected?

Usually, a solitary lesion is detected accidentally during a routine X-ray examination of the lung. Several large studies have found that more than 75% of lesions were unexpected findings on routine examinations. radiographs of the lung. Symptoms indicating lung disease were observed in less than 25% of patients. Nowadays, solitary lesions are detected using other highly sensitive studies, such as CT.

4. How often is a solitary lesion in the lung a tumor metastasis?

In less than 10% of cases, solitary lesions represent tumor metastases, so there is no need for an extensive tumor search in organs other than the lungs.

5. Is it possible to obtain a tissue sample from the lesion using fluoroscopic or CT-guided needle biopsy?

Yes, but the result will not affect your treatment. If the biopsy reveals cancer cells, the lesion should be removed. If the biopsy is negative, the lesion still needs to be removed.

6. What is the importance of radiological findings?

They are not the most important. The resolution of modern CT machines allows for a better assessment of signs characteristic of cancer:
a) Fuzzy or unevenly jagged edges of the lesion.
b) The larger the lesion, the more likely it is to be malignant.
c) Calcification of the lesion usually indicates a benign formation. Specific central, diffuse or layered calcification is characteristic of granuloma, while denser calcifications in the form of grains irregular shape observed in hamartoma. Eccentric or small speckled calcifications may be present in malignant lesions.
d) CT can examine changes in the relative density of lesions after contrast administration. This information increases the accuracy of diagnosis.

7. What social or clinical evidence suggests that the lesion is more likely to be malignant?

Unfortunately, there is no data that is sensitive or specific enough to influence diagnosis. How elderly age, and long-term smoking are factors that make lung cancer more likely. Winston Churchill had to get sick lung cancer, but did not get sick.

Therefore, information that the patient is the president of a speleological club (histoplasmosis), his sister raises pigeons (cryptococcosis), he grew up in the Ohio River Valley (histoplasmosis), works as a gravedigger in a dog cemetery (blistomycosis), or simply took a tourist trip to the San Valley - Joaquin (coccidioidomycosis), provide interesting accompanying information, but do not affect diagnostic measures for a solitary lesion in the lung.

8. What is the most important part of the medical history?

Old chest x-rays. If the lesion is recent, it is more likely to be malignant, and if it has not changed in the last 2 years, then it is less likely to be malignant. Unfortunately, even this rule is not absolute.

9. If a patient was previously treated for a malignant tumor, and now he has a solitary lesion in the lung, can it be said that this lesion is a metastasis?

No. The probability that the emerging lesion in the lung is a metastasis is less than 50%, even if the patient previously had malignant tumor. Thus, diagnostic measures for such a patient will be the same as for any other patient with a newly appeared solitary lesion in the lung.

10. How should one deal with a solitary lesion in the lung?

Complete information about travel and activities is interesting, but does not affect the progress of the diagnosis. Due to the peripheral location of most lesions, bronchoscopy has a success rate of less than 50%. Cytological examination of sputum is not very informative, even if it is performed by the most good specialists. A CT scan is recommended as it can identify other potentially metastatic lesions and delineate the condition lymph nodes mediastinum.

As stated above, percutaneous needle biopsy is approximately 80% informative, but its result rarely influences subsequent management.

It is important to determine whether the patient can undergo radical surgery. Function of the lungs, liver, kidneys and nervous system must be considered stable. If it is unlikely that the patient will live for several more years, then there is simply no point in removing an asymptomatic lesion in the lung.

The main way for a patient to undergo surgery is resection of the lesion for diagnostic purposes, performed using thoracoscopy, which has the least invasiveness, or a small thoracotomy.

11. What should be the scope of the operation if the lesion is a cancerous tumor?

Although some studies suggest that wedge resection is sufficient, removal of the anatomical lobe of the lung remains the procedure of choice. Cancer that is found as a solitary lesion is early stage with 65% 5-year survival rate (in the absence of visible metastases). Relapses are divided into local and distant.

Educational video of the anatomy of the roots and segments of the lungs

Lesions in the lungs often attack the respiratory organs, since many of their diseases cause the appearance of cavities similar in appearance and purpose to the lesions. Such formation in the respiratory organs is dangerous to health, especially if the patient does not intend to treat the pathology. The causes of the formation of lesions are various ailments that greatly impair the functioning of organs. In most cases, when diagnosing a disease that causes lumps or cavities, it will not be enough for the doctor to examine the patient and take an x-ray. In this case, the patient will have to donate blood for analysis, sputum and puncture of the lung tissue in order to accurately make a diagnosis.

Lesions in the lungs - what could it be? The opinion that a single or multiple lesion causes only pulmonary tuberculosis is considered erroneous. Many diseases of the respiratory organs can lead to the development of lesions, so they are worth paying attention to Special attention when making a diagnosis.

If the doctor notices a formation in the lung cavity (tomography can reveal this), he suspects the following diseases in the patient:

• violation of fluid metabolism in the respiratory organs;
• neoplasms in the lungs, which are not only benign, but also malignant;
• pneumonia;
• cancer in which large-scale organ damage occurs.

Therefore, in order to correctly diagnose a sick person, you need to examine him. Even if the doctor implies that the inflammation was caused by pneumonia, before prescribing a therapeutic course, he needs to conduct a sputum analysis in order to be absolutely sure of the correctness of the diagnosis.

Currently, indurated, calcified and centrilobular lesions in the lungs are often diagnosed in humans. However, their course is too complicated due to the fact that few patients agree to undergo a number of specific tests, on which their health and general state body.

The genesis of pulmonary lesions is not always favorable for a person; this indicates serious disturbances in the functioning of the respiratory system. Based on the type (it can be dense or liquid), it becomes clear what kind of damage the disease will cause to human health.

Focal lung damage - what is it? This pathology is serious illness, during the development of which compactions begin to appear in the lung tissue, resembling lesions in appearance.

Depending on their number, such neoplasms have different names:

1. If only one lesion was noticeable in a patient after tomography, it is called solitary.
2. If the patient after diagnostic procedures Several neoplasms were identified; they are called single. Most often, there are no more than 6 such seals in the cavity.
3. If found in the lungs a large number of formations of different shapes, they are called multiple. Doctors call this condition of the body dissemination syndrome.

Today there is a slight difference in the concept of defining what pulmonary lesions that develop in the cavity of the respiratory organs are. This difference is formed in the opinions of scientists from our country and foreign researchers. Doctors abroad believe that a single or secondary lesion noticed in the respiratory organs is a small round lump. In this case, the diameter of the neoplasm does not exceed 3 cm. In our country, lumps larger than 1 cm are no longer considered foci - they are tuberculomas or infiltration.

It is important to note that examining the affected lung on a computer, called tomography, helps to accurately identify the type, size and shape of tumors that have appeared in the lung tissue. However, we should not forget that this method often has failures.

Polymorphic lesions in the lungs – what is it? Such formation in the respiratory organs is a change in the composition of the lung tissue as a result of stagnation of a certain fluid in them. Often this is blood, phlegm, and so on. In order to correctly prescribe treatment, the patient will need to undergo a number of modern procedures that make it possible to accurately determine the type of focal formation.

A lesion in the lungs, what could it be? As mentioned earlier, various diseases can cause the appearance of a lesion. Why do they need to be treated immediately after detection? The fact is that diseases often repeatedly attack the human respiratory organs. In 70% of cases, the secondary disease is considered malignant, which means that incorrect treatment tactics cause the development of cancer.

Therefore, for the patient to avoid serious problems With your health, you will need to undergo some diagnostic procedures, namely:

• radiography;

It is especially important for the patient to undergo a CT scan, because it will be able to identify the danger of foci, which may be the formation of cancer or a complex form of tuberculosis. However, in order to accurately identify the type of disease that caused the appearance of lesions in the respiratory organs, you will need to undergo additional types of examinations, since hardware methods alone are often not enough. Nowadays, not a single clinic or hospital has a single algorithm of actions according to which diagnostics are carried out.

The classification of lesions in the lungs on CT allows one to understand their type and cause of occurrence, so this procedure must be undergone by the patient. But the rest of the methods are prescribed by the doctor after a complete examination of the patient and familiarization with his medical record.

Why do doctors not always manage to make the correct diagnosis of a patient? To identify the course of tuberculosis, pneumonia or another disease, the desire of doctors alone is not enough. Even if all the tests are carried out and correctly interpreted, imperfect equipment will not allow identifying some foci of the disease. For example, during a trip to x-ray or fluorography, it is impossible to identify lesions whose diameter is less than 1 cm. It is also not always possible to correctly examine large lesions, which aggravates the diagnosis of pathology.

Unlike the above procedures, tomography is able to correctly determine the location and type of lesions, as well as identify the disease that initiated the development of the disease. For example, this is pneumonia, emphysema, or simply an accumulation of fluid in a person’s lungs.

It is important to note that during the first computer procedure, small lesions are missed - this happens in 50% of cases. However, it is possible to judge the course of the disease and prescribe treatment based on large tumors.

Features of the disease

In modern medicine, there is a specific gradation of lung lesions that differ in shape, density, and damage to nearby tissues.

It is important to note that an accurate diagnosis using a single computer procedure is unlikely, although such cases have been seen in modern world. This often depends on anatomical features body.

After going through all the diagnostic procedures prescribed by the doctor, in order to understand what a subpleural lesion of the lung is – what it is, you first need to figure out what the classification of pulmonary lesions is. After all, the accuracy of diagnostic measures depends on it.

For example, often with pulmonary tuberculosis, the seals are located in the upper parts; during the development of pneumonia, the disease uniformly affects the respiratory organs, and during the course of cancer, the foci are localized in the lower parts of the lobe. Also, the classification of pulmonary neoplasms depends on the size and shape of the seals, which are different for each type of disease.

Having discovered one or another symptom of pulmonary diseases, you must definitely consult a doctor, who will prescribe a series of tests and then prescribe correct treatment, which can benefit the patient’s body.

Signs of development of compaction in the lungs include:

• difficulty breathing;
• accumulation of fluid in the lungs, causing moist cough or wheezing when speaking;
• frequent sputum discharge;
• the appearance of shortness of breath;
• coughing up blood;
• inability to breathe deeply;
• chest pain after physical labor.

It is strictly prohibited to independently diagnose yourself and prescribe treatment if the above symptoms are detected, because this will only aggravate the course of the disease, and will also allow it to develop into an advanced form.