Angina

Radiation anatomy of the chest organs. Radiation anatomy of the lungs

Pathology of the respiratory system can only be identified through a comprehensive examination. And the set of diagnostic tools necessarily contains radiation diagnostic methods, without which in the majority of cases it simply cannot be done. They are worth paying attention to.

Radiation diagnostics refers to the use of various radiations to assess the structural and functional characteristics of tissues, organs and systems. This is necessary to identify diseases, monitor their progress during therapy and for prevention purposes. The structure of radiation methods in pulmonology is presented:

X-ray diagnostics.
Computed tomography.
Ultrasound examination.
Radioisotope scanning.
Magnetic resonance imaging.

As we can see, various radiations can be used, which are ionizing and non-ionizing in nature (ultrasonic, electromagnetic). The former cause the excitation of neutral atoms, including those found in organs, and their transformation into charged particles. The number of ions formed in this case depends on the radiation power and energy distribution in the tissues.

The essence of any study comes down to recording scattered or reflected rays that were formed when the beam passed through the chest tissue. And since the density of structural components varies widely, this leads to the formation of images of varying intensity. If the rays are projected onto film, then they talk about an analog representation of the result, and digital recording is carried out on a sensitive matrix, the data from which is analyzed by a computer.

Radiation diagnostics of diseases of the respiratory system includes a number of methods based on various methods of obtaining information about the condition of the chest organs.

X-ray diagnostics

X-ray methods in respiratory medicine are most widespread. They are divided into two types - native and special. The first are performed at the initial stage of the examination and include x-ray and fluorography, fluoroscopy and linear tomography. But to clarify the nature of the pathological process and obtain additional information, it is often necessary to conduct special studies:

Bronchography.
Pleurography.
Angiopulmonography.
Pneumomediastinography.

Each of the presented methods has its own implementation characteristics, advantages and disadvantages, indications and limitations for use. They are prescribed taking into account the expected diagnosis exclusively by the doctor.

Radiography

The initial stage of additional examination of patients with pulmonary pathology is chest x-ray. It is widely available, easy to carry out, and allows for the results to be interpreted by other specialists. Among the disadvantages, it is necessary to note the acquisition of a static image, radiation exposure to the patient (increasing with frequent procedures), and lower information content compared to other techniques (computer and magnetic resonance imaging).

Radiography allows you to diagnose pathological changes in various anatomical formations located in the area under study:

Soft tissues.
Bone structures.
Internal organs and spaces (lungs, pleura, mediastinum).

The technique has a wide range of indications in pulmonology, since it allows you to diagnose any disease accompanied by a change in the normal density of lung tissue. It is prescribed to detect pneumonia, tuberculosis, tumors, pneumoconiosis, emphysema, atelectasis, etc. Radiography can also be used as a screening method, for example, in people exposed to harmful factors.

The study also does not require any specific preparation from the patient, except for the need to remove metal objects and jewelry located in the chest area. Taking into account the side of the lesion, first a survey of the chest is performed in the frontal (anterior or posterior) and lateral (right or left) projections. In the standard technique, the patient is in an upright position while taking a deep breath. In some cases, oblique positioning, horizontal positioning, or targeted shots are also necessary. The resulting image is projected onto x-ray film or paper.

Radiography is a central research method in the diagnosis of lung diseases. It allows you to obtain a summary image of the anatomical structures of the chest cavity.

Fluorography

Typically, fluorography is used as a component of mass preventive medical examinations aimed at early detection of pulmonary pathology, primarily tuberculosis and malignant tumors. The study is performed quickly, resulting in high throughput. Previously, images were obtained on small films, but now the capabilities of fluorography have been significantly expanded thanks to digital recording and data processing.

X-ray

Fluoroscopy allows you to assess the functional state of the chest organs, i.e. their work in real time. In this case, the image is displayed exclusively on the device’s screen, which does not allow it to be documented. The study helps do the following:

Determine the movement of tissues and organs (diaphragm, mediastinum, heart and blood vessels).
Assess the change in lung transparency during inhalation and exhalation.
Monitor the pathological process in the pleural cavity (fluid level, sinus opening).
Monitor the performance of puncture biopsy.

The use of fluoroscopy is currently quite limited, which is due to the higher radiation exposure to the patient and the rather low (compared to modern methods) image resolution.

Linear tomography

X-ray (linear) tomography has not yet lost its importance in clinical practice. It is usually performed in situations where the patient does not have the opportunity to do a CT scan, and the doctor suspects pathological processes in the lungs:

Foci of destruction (cavities).
Changes in the bronchi (tumors, stenoses, foreign bodies).
Enlarged mediastinal lymph nodes.

If structural abnormalities are poorly visible on X-rays, but clinical symptoms indicate their presence, then the patient is also offered to undergo tomography. This study is based on taking a series of slice-by-slice (vertical) images across a region of interest.

Bronchography

By injecting X-ray contrast agents into the bronchial tree, an image of the internal structure of the respiratory tract can be obtained. This is what the method called bronchography is based on. The study is performed if the following pathology is suspected:

Developmental anomalies.
Bronchiectasis.
Cicatricial stenoses.
Foreign bodies.
Neoplasms.
Fistula tracts.

Bronchography is performed under local or general anesthesia. Among the contraindications, it is necessary to note a general severe condition, severe respiratory failure, hypersensitivity to iodine-containing drugs. Due to invasiveness and the availability of more informative diagnostic methods (for example, CT), bronchography is currently used less and less.

With the help of bronchography, it is possible to establish the presence of a pathological process located inside the respiratory tract.

Angiopulmonography

Using a water-soluble contrast agent, you can examine the vessels of the pulmonary circulation. To do this, a catheter is inserted into the pulmonary trunk through the femoral vein, through which the drug is injected. Indications for such a study will be pathological processes in the pulmonary vessels:

Thromboembolism.
Aneurysms and stenoses.
Congenital anomalies.
Tumors of the lung and mediastinum.

The procedure is not performed in case of hypersensitivity to iodine, bronchial asthma, renal and liver failure. The procedure is performed in the operating room under local anesthesia. When contrast is administered, the patient may experience a cough, flushing of the face, and a salty taste in the mouth. During the study, a series of X-rays are taken, which show both the arterial and venous phases of blood flow. Selective angiography can also be performed, in which only the branches of the pulmonary artery (right or left) are contrasted.

Pleurography

By injecting a contrast agent into the pleural cavity, a clearer image is obtained. This makes it possible to clarify the location, shape and size of the encysted inflammatory process or tumor, and to determine the presence and direction of fistula tracts. An X-ray contrast agent is administered during puncture and catheterization of the pleural cavity. After this, a picture is taken in two projections (front and side).

Pneumomediastinography

Contrast enhancement of the mediastinum can be improved by introducing gas (oxygen or nitrous oxide) into it. Spreading throughout the anatomical spaces, it surrounds dense structures, thereby increasing their visualization. The study is mainly carried out to identify and clarify the characteristics of tumors and mediastinal cysts.

The gas is administered under local anesthesia through various approaches. At this moment, the patient feels fullness in the chest, tightness or pain. To reduce discomfort, premedication is given with a narcotic analgesic (promedol). Among the contraindications to the diagnostic procedure, it is worth noting:

Coronary heart disease.
Post-infarction cardiosclerosis.
Severe pulmonary heart failure.
Compression of the superior vena cava.
The only easy one.
Mediastinitis.

Taking into account the invasiveness of the study, the likelihood of complications (bleeding, embolism, pneumothorax), as well as the introduction of CT into practice, pneumomediastinography is currently prescribed very rarely.

Pneumomediastinography makes it possible to better visualize volumetric processes in the mediastinum. But the scope of application of this technique is significantly limited.

Computed tomography

Computed tomography is also classified as a method of radiological diagnosis of the lungs, but it has a number of significant differences from conventional x-rays. The advantage of such a study is the high information content of the result, achieved by obtaining layer-by-layer sections through the area of interest and their computer processing. In this case, the slightest anatomical formations (vessels, subsegmental bronchi, elements of the lobules) and structural changes in the lungs are visible.

To clarify the nature of the pathological process after conventional tomography, several modifications can be used:

High resolution.
Contrasting.
Angiography.
Dynamic.
Polypositional.

Additional information is obtained by analysis with a three-dimensional image. Volumetric conversion technology is most important in the study of the vasculature and bronchial tree.

Ultrasound examination

Traditionally, ultrasound is used to examine soft tissues and parenchymal organs. With its help, you can evaluate the condition of various elements of the respiratory system, pleural sinuses, superficial parts of the lungs, blood vessels, and mediastinum. Almost any pathology that is accompanied by a change in the acoustic density of tissue will become visible on the device’s screen. Therefore, echography is used to identify the following disorders:

Fluid in the pleural cavity.
Neoplasms in the lungs, pleura and mediastinum (liquid, vascular, tissue).
Infiltrative processes (inflammation, abscess, atelectasis, tumor, pneumosclerosis).
Changes in the lymph nodes.
Pulmonary embolism.

The method is simple, harmless to the body (does not provide radiation exposure), and ultrasound machines are available in every medical institution. To study the lungs, you only need special sensors and experience in analyzing the information received by the doctor.

Radioisotope scanning

The method is based on recording radiation from a radioactive substance introduced into the body and distributed in the lungs. In pulmonology, xenon gas and inhaled drugs labeled with technetium are often used. Radioactive particles “get stuck” in small vessels (arterioles and capillaries), providing information about regional blood flow. They emit gamma rays, which are recorded in a special camera.

The results of scintigraphy for pulmonary embolism and malignant tumors have the greatest diagnostic value. But the method will also show disorders that occur with bronchial asthma, obstructive process, emphysema or pneumosclerosis. Radioisotope diagnostics helps assess the function of the respiratory system (ventilation, diffusion and perfusion).

Radioisotope scintigraphy helps to assess the state of ventilation, diffusion processes and blood flow in the lungs, which will indicate various pathological processes in them.

Magnetic resonance imaging

In some situations, magnetic resonance imaging becomes an alternative to computed tomography. It is based on recording waves emitted by hydrogen atoms in a magnetic field. In pulmonology, the technique is considered highly informative in assessing the condition of the roots of the lungs, mediastinum, pleural cavity and chest wall.

Tomography allows you to differentiate between solid and liquid structures, including vascular ones. With contrast enhancement, malignant tumors are better visible; the degree of their activity, vascularization, and the presence of necrosis in the center can be determined. It is possible to reliably recognize pulmonary embolism. Due to the lack of radiation exposure in these situations, magnetic resonance imaging is superior to computer imaging.

Thus, there are quite a lot of radiation diagnostic methods used to detect lung diseases. Some of them may, in some cases, duplicate each other, but differ in other parameters (availability, information content, harmlessness). The feasibility of a particular study is determined by the doctor based on clinical feasibility, the capabilities of the medical institution and the patient.

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MINISTRY OF HEALTH OF UKRAINE

LUBENSOY MEDICAL SCHOOL

DIPLOMA THESIS

BY RADIOLOGY

ON THE TOPIC: RADIATION ANATOMY OF THE CHEST, UPPER RESPIRATORY TRACT AND LUNGS IN ADULTS

Completed: student of group F-31

Mostvichenko Irina

RADIATION ANATOMY OF THE CHEST, UPPER RESPIRATORYABODY TRACTS AND LUNGS IN ADULTS

X-ray image chest formed from bone elements, soft tissues, lungs, mediastinal organs and diaphragm. Of these structures, plain X-rays of the chest in frontal and lateral projections show: clavicles, ribs, sternum, soft tissues, diaphragm, pleura, interlobar fissures, trachea, roots of the lungs, bronchi, lungs.

Clavicles When the patient is positioned correctly, they are located symmetrically in the anterior projection on the plain radiograph, have a horizontal position and do not overlap the apexes of the lungs.

Ribs. On a radiograph in the anterior projection, the anterior segments of the ribs have an inclined position - from top to bottom and medially, the rear segments are located obliquely downward and laterally. The ribs are located parallel and at the same distance from each other. The anterior segments of the ribs are wider, less intense, less clearly defined than the posterior segments, which is explained by their anatomical features and location in relation to the central X-ray beam and film. The cartilaginous sections of the anterior segments of the ribs, if they do not contain calcifications, are not displayed on radiographs. Initial calcification of the costal cartilages begins at the age of 18-19 years, first of all in the 1st rib, then in the 7th, 6th, 5th, 4th, 3rd ribs, and the last to calcify is the costal cartilage of the 2nd rib. Calcification manifests itself in the form of individual small lumps; complete calcification of the costal cartilage of the first rib occurs on average at the age of 30-35 years, of the cartilage of the remaining ribs - at 50 years and later. The rate of calcification of costal cartilage depends on the state of the endocrine system.

Options for the development of ribs: additional cervical ribs, forked bifurcations of the anterior sections of the ribs (Lyushka ribs), fusion of the ribs with the formation of bone bridges between them, which can be located on one or both sides. They can layer on the areas of the apex of the lungs and simulate the presence of a focus or infiltrate.

On plain radiographs in anterior and posterior projections, and on radiographs in lateral projections, the lower cervical and thoracic vertebrae are visualized. A clear image of the four upper thoracic vertebrae is a criterion for the normal exposure of a survey image in the anterior projection.

Soft fabric elements. The skin fold above the clavicle on the radiograph appears as a low-intensity, but clearly defined second contour of the clavicle, sometimes mistaken for periosteal layers.

The sternocleidomastoid muscles are projected onto the internal parts of the apexes of the lungs in the form of structures of low intensity, traced outside the upper parts of the chest, which is not always expressed symmetrically.

At the level of the second to fourth intercostal spaces, the image of the pectoralis major and minor muscles is revealed in the form of a slight decrease in transparency, the intensity of which increases slightly towards the peripheral parts of the lungs. The lower contour of the muscles is defined outside the lung fields. With optimal image rigidity, the intensity of the shadow is low, and the pulmonary pattern is clearly visible through it.

The display of mammary glands on a radiograph in the anterior projection in women and teenage girls can create difficulties in interpreting the resulting image. Sometimes the shadow of the nipple is mistaken for a metastasis, a pulmonary focus or an infiltrative focus, especially with atrophy of the mammary glands, when the pigmented nipple in one pulmonary field is clearly visible, and in the other it is hidden behind the shadow of the rib. Large mammary glands may obscure the image of the lungs behind them. Various changes in the soft tissues of the chest (large pigmented birthmarks, calcifications in the subcutaneous tissue, keloid scars, hematomas, soft tissue abscesses, etc.) can be reflected on a chest x-ray.

Sternum clearly visible only on a radiograph in a lateral projection; its profile image is a criterion for the correct positioning of the patient when taking an image in this projection. On a radiograph in the anterior projection, the manubrium of the sternum can sometimes be identified, the outline of which can imitate pulmonary pathology. Synostosis of the sternum in the lower part of its body occurs at the age of 15-16 years, in the upper part - at 25 years.

Diaphragm It is represented by two domes, right and left, which have convex contours, and is well mobile during the breathing process. On the radiograph in the anterior projection, the right dome is located at the level of the anterior segment of the VI rib, the left one is one rib lower. In the lateral projection, both domes of the diaphragm are simultaneously visualized. Normally, the dome of the diaphragm adjacent to the film is always higher, which is explained by the peculiarities of X-ray skiology.

Pleura divided into parietal and visceral. The parietal pleura lines the inside of the chest cavity, limiting the mediastinum along the lateral surfaces. In the area of the hilum of the lungs, the visceral pleura is formed, covering the lungs on all sides and in the interlobar grooves. Between the layers of the parietal and visceral pleura over the entire area of the lungs, a space is formed, which is called the pleural cavity. Normally, there is a continuous exudation of fluid containing proteins and electrolytes, the amount of which does not exceed 1-2 ml, which ensures the sliding of the visceral pleura along the parietal pleura during the act of breathing.

The duplication of the pleura, going from the root of the lung to the diaphragm, forms the so-called pulmonary ligament, which on radiographs in lateral projections is determined as a triangular-shaped structure above the diaphragm. In this ligament, the inferior vena cava passes from the abdominal cavity to the thoracic cavity. The lobes of the lungs are separated from each other by interlobar fissures, each of which is made of two layers of visceral pleura. The plane of the oblique interlobar fissure is slightly spiral, has a slight convexity directed downward and posteriorly. The convexity of the horizontal slot is directed upward.

Oblique interlobar fissure on radiographs in lateral projections, it is projected on the right starting from the lower edge of Th IV, and on the left - Th |n, goes obliquely down and forward to the diaphragm, where it is visualized at a distance of 3--4 cm (on the right) and 1.5--2 cm (left) from the anterior chest wall. This gap on the right separates the lower lobe from the upper and middle lobes, on the left it separates the upper and lower lobes of the lung. Horizontal interlobar fissure on the radiograph in the anterior projection in the right lung, it is located at the level of the anterior segment of the 4th rib, delimiting the upper lobe from the middle lobe. The normal interlobar pleura corresponds in its location to the anatomical and topographic course of the interlobar fissure, has a uniform thickness of no more than 1 mm, an even and clear contour (Fig. 7.2).

Along with the presence of three lobes in the right and two lobes in the left lung, it is possible to identify additional lobes: the lobe of the azygos vein in the right lung, the lingular lobe in the left, the posterior accessory lobe in both lungs and the pericardial lobe in the right lung, in in accordance with the presence of additional layers of pleura in the lungs (Fig. 7.3).

Rice. 7.2. Spatial arrangement of the main interlobar areaselei

a - anterior projection; b - right lateral projection; c -- left lateral projection. OL -- upper lobe; UL -- lower lobe; ML -- average share; 4 -- fourth thoracic vertebra.

On radiographs in the anterior and lateral projections, sinuses lined with pleura are identified between the diaphragm and the chest wall; on radiographs in lateral projections - anterior and posterior (deeper); on the radiograph in the anterior projection - the lateral pleural sinuses. Between the diaphragm and the heart, there are right and left carcardiodiaphragmatic angles, the parameters of which depend on the condition of the left ventricle and right atrium.

Trachea determined on radiographs in the anterior projection in the median plane against the background of the spinal column in the form of a strip of clearing with clear, even contours, 15-18 mm wide. Normally, tracheal cartilage is not visible, but if calcified, they may appear on the image. The tracheal bifurcation is located at the level of Th v, the bifurcation angle is 90° or less.

Rice. 7.3. Schematic representation of the accessory lobes of the lungs [L.S. Rozenshtraukh, N.I. Rybakova, M.G. Winner].

a - right lateral projection; b - left lateral projection; c -- anterior projection. 1 -- share of the azygos vein; 2 -- posterior lobe; 3 -- pericardial lobe; 4 -- reed lobe.

The right main bronchus is short, wide, looks like a continuation of the trachea, in the right tracheobronchial angle the azygos vein is identified skialologically. The left main bronchus is longer, approximately 1.5 times narrower than the right one, and extends from the trachea at a large angle. On a radiograph in a lateral projection, the trachea is identified as a clearing strip of uniform width; the change in the shape of the trachea in the distal section is where the trachea transitions into the main bronchi.

Plain radiographs can reveal lobar and some segmental bronchi, and with tomography the bronchi can be traced down to the subsegmental ones. The structure of the bronchial tree is shown in Fig. 7.4.

On radiographs, the normally longitudinally located bronchi in the hilar regions and medial-basal parts of the lungs sometimes appear as light stripes bounded by parallel linear shadows of the bronchial walls.

The transverse or oblique section of the bronchi forms ring-shaped or oval clearings.

Roots of the lungs located on the medial surface of the lungs in the area of their hilum. They are a complex formation consisting of various anatomical elements. The concept of “root” includes lobar, zonal and intermediate bronchi, pulmonary arteries and their lobar and zonal branches, veins of the corresponding order, lymph nodes, connective tissue and adipose tissue. On radiographs in the anterior projection, the roots are located between the anterior segments of the II and IV ribs, the upper border of the root of the left lung is located approximately one intercostal space above the upper border of the root of the right lung. This is due to the fact that the edge-forming element of the upper pole of the root of the left lung is the pulmonary artery, and that of the right is the upper lobe bronchus.

The width of the root of the lung in an adult varies within 2-3 cm; in the root of the right lung, half of this value falls on the right pulmonary artery and the intermediate bronchus.

The right and left pulmonary arteries and their lobar branches are detected in the roots of the lungs in the form of linear and focal structures, depending on whether they are located perpendicular to the course of the X-ray rays (linear shadow) or parallel along the course of the rays (focal shadow). A criterion for a normal root, in addition to its structure and size, is also the nature of the external contour of the pulmonary artery. It should be clear, on the right - straight or concave, on the left - variable. The pulmonary veins and their lobar divisions are not clearly visible during fluoroscopy and on plain radiographs in the roots of the lungs. The superior and inferior branches of the pulmonary veins cross the pulmonary arteries in the transverse direction and disappear in the shadow of the mediastinum.

The bronchi are revealed in the form of clearing stripes or rings with clearing in the center, also depending on their location to the direction of the x-rays. Next to the ring-shaped structure of the bronchus, the focal structure of the arterial vessel is usually determined in the same (orthograde) projection. At the root of the right lung one can see part of the lumen of the right main and upper lobe bronchi. Between the right pulmonary artery and the heart is the intermediate bronchus. The criterion for the normal structure of the root of the right lung is a clear visualization of the border between the inner wall of the pulmonary artery and the intermediate bronchus; in the root of the left lung, the vessels and bronchi are partially overlapped by the mediastinum; in the root of this lung, an image of the distal part of the left main bronchus can be traced.

Normally, the connective tissue (stroma) of the lung root is not differentiated on radiographs.

When analyzing a plain radiograph of the lungs, you should always remember that many anatomical structures involved in the formation of a complex summation image can be incorrectly interpreted in this study if the peculiarities of their x-ray semiotics are not taken into account (Fig. 7.5).

Rice. 7.4. Scheme of the structure of the bronchial tree with the designationGmental and subsegmental bronchi

a - right bronchial tree, anterior projection; b - right bronchial tree, right lateral projection; c -- left bronchial tree, anterior projection; d - left bronchial tree, lateral projection; R - right main bronchus; L -- left main bronchus; 1 a-- 1 Os - segmental and subsegmental bronchi.

Rice. 7.5. Anatomical structures that may be a source of diagnostic error

1 -- cervical rib; 2 -- edge of the sternocleidomastoid muscle; 3 -- accompanying stripes of I--II ribs; 4 -- share of the azygos vein; 5 -- bone bridge between the anterior segments of the I--II ribs; 6 -- dense bridge in the posterior segments of the V-VI ribs; 7 - Lyushka's rib; 8 -- small (horizontal) interlobar fissure; 9 -- additional fissure of the lower lobe; 10 -- pericardial lobe; 11 -- nipple; 12 -- shadow of the mammary gland; 13 -- subclavian artery; 14 -- calcified costal cartilages; 15 -- rib groove; 16 -- additional interlobar fissure in the presence of a reed lobe; 17 -- shadow of the pectoralis major muscle; 18 -- shoulder blade.

The structure of the lung is usually compared to the structure of a gland, consisting of parenchyma and interstitial tissue (stroma). The lung parenchyma consists of primary lobules, acini and secondary lobules that form lung segments. Unchanged lobules and stroma are not visualized on radiographs.

The lung segment radiologically has a triangular shape, with its wide base facing the surface and its apex facing the root of the lung. Anatomically, the segments resemble a cone or pyramid. Through the apex of the segment, a segmental bronchus and an artery of the same order enter into it. The collectors of the segmental veins are located along the periphery of the segment, in its stroma.

Normally, the boundaries between segments are not visible on an x-ray, so the position and size of the segments are determined more accurately by tomography, bronchography and angiopulmonography.

Rice. 7.6. Topography of the lung lobes.

a - anterior projection; b - rear projection; c -- right lateral projection; d - left lateral projection; 1-10 --ribs.

Rice. 7.7. Topography of segments of the upper lobes.

a - right oblique projection; b - right lateral projection; c -- anterior projection; d - left lateral projection; d - left oblique projection. 1 -- 10 -- segment numbers; ah - axillary section.

According to the international anatomical nomenclature, 10 segments are distinguished in each lung.

In the right lung:

* Upper lobe:

Apical (C,);

Rear (C p);

Front (N w).

* Average beat:

Lateral (C IV);

Medial (C v).

*Lower lobe:

Medial (cardiac) basal (C V|I);

Anterior basal (C VI]I);

Lateral basal (C 1X);

Posterior basal (C v). In the left lung:

* Upper lobe:

Apical-posterior (C 1+11);

Front (N w);

Superior reedular (C IV);

Lower reed (C v).

*Lower lobe:

Apical (upper) (C VI);

Medial (cardiac) basal (C VI1) -- unstable;

Anterior basal (C V]II);

According to the topography of the bronchi in the roots of the lungs, Linberg and Nelson developed the theory of the four-zone structure of the lungs, according to which 4 zones are distinguished in each lung: upper, lower, anterior and posterior. In the right lung, the upper zone corresponds to the upper lobe, the anterior zone corresponds to the middle lobe, and the posterior zone corresponds to the apical segment of the lower lobe; the inferior zone includes the basal segments of the lower lobe. In the left lung, the upper zone includes the apical-posterior and anterior segments, the anterior zone includes the upper and lower lingular segments of the upper lobe; posterior - apical and lower - basal segments of the lower lobe.

In each lung, three belts are distinguished when two horizontal lines running along the lower edge of the medial ends of the anterior segments of the II and IV ribs divide the lung fields into the upper, middle and lower belts. In the lungs, the root, nuclear and mantle sections are distinguished; in the latter, the parenchyma is represented in the largest volume.

X-ray semiotics of the pulmonary pattern is normal in adults. The term “pulmonary pattern” refers to the set of normal anatomical structures that make up the pulmonary fields on radiographs. In young and middle age, these structures are predominantly the vessels of the arterial and venous systems of the lungs and, partly, the orthograde projections of the bronchi of the 3rd and 4th orders. To a certain extent, the transparency of the lungs is influenced by small branches of arterial and venous vessels. At a later age (on average from 50 to 55 years), and even more so in old age, interstitial connective tissue appears in the structure of the pulmonary pattern, which, as fibrous transformation progresses, causes a cellular rearrangement of the pattern, mainly in the basal parts of the lungs.

The X-ray semiotics of pulmonary patterns in young and middle-aged people are characterized by:

Radial centrifugal direction of arterial vessels heading from the upper and lower sections of the roots to the upper and lower (basal) sections of the lungs, with a quantitative ratio of vascular branches, respectively, 1 2 in these sections of the lungs. In this case, the arteries heading to the apexes of the lungs are located predominantly parallel to the vertical axis of the mediastinum, and the arteries in the basal parts of the lungs, extending from the roots, have a pronounced radial (fan-shaped) centrifugal course;

The predominantly horizontal location of the branches of the venous vessels in the pulmonary fields, which is more observed in the middle and lower belts of the lungs;

Uniform narrowing of linear vascular elements from the roots of the lungs to their periphery for arterial and venous vessels;

Differentiation of linear elements of the pulmonary pattern throughout the entire pulmonary fields, with the exception of the cortical parts of the lungs, where from the edge of the chest wall, in a strip 10-15 mm wide, the branching of the pulmonary vessels is not normally determined;

Clarity of the contours of the elements of a normal pulmonary pattern;

The presence of a peculiar vascular looping (mainly in the middle parts of the lungs), not closed in the peripheral part, which is a reflection of both the true anatomical branching of the vessels in the lungs and the summation effect - a reflection of the vessels located at different depths in the lungs;

The presence of orthograde projections of the pulmonary vessels, which are round and oval structures of uniform and high density, from which 1-2 or more vascular branches extend in the frontal plane.

Among the variety of individual variants of the pulmonary pattern, three types of anatomical structure of the branches of arterial vessels in the mediobasal regions of the lungs should be distinguished.

1st type- main, when there are sufficiently large vessels extending from the root of the lung, from which clearly defined thinner vascular branches sequentially extend (on average 25% of cases);

2nd type-- scattered, when immediately upon leaving the root of the lung the vessels scatter into many small branches (approximately 25% of cases);

3rd type-- mixed, which is a combination of the above types of branching of arterial vessels (on average 50% of cases).

It should be noted that the structural features of the venous vessels in the lungs are subject to the same laws. On radiographs of the lungs taken with the patient in an upright position, there are normally fewer arterial vessels in the upper third than in the lower third. This is physiologically determined by lower pressure in the upper part of the pulmonary arteries. When the patient is in a horizontal position, the severity of the pulmonary pattern in the upper and lower parts of the lungs is approximately the same.

From the age of 55-60 years, a progressive restructuring of the lung structure begins, accompanied by compaction of the connective tissue in the interlobular septa. In this case, a cellular restructuring (fibrous transformation) of the pulmonary pattern is observed, which appears initially in the lower outer parts of the pulmonary fields and, as a person ages, gradually spreads completely to the lower and largely to the middle parts of the lungs, overlapping the linear vascular elements of the pattern.

The airiness of the lungs changes, which, in comparison with the evenly distributed in young and middle age, becomes heterogeneous: reduced in the sections of the transformed pattern (basal and middle sections of the lungs) and increased according to the type of age-related compensatory hyperpneumatosis in the overlying sections. It is clear that the processes of progressive age-related pneumosclerosis and sclerotic changes in blood vessels in the lungs do not bypass the roots of the lungs, which lose their clarity of structure and become heterogeneous in density (age-related fibrous transformation of the roots), which, in combination with the above changes in the parenchyma, makes it possible to more confidently determine age-related restructuring lung structures.

CT ANATOMY OF THE CHEST

Rib cage- This is the musculoskeletal frame that encloses the organs of the thoracic cavity.

With CT it is possible to distinguish (consistently from lung tissue):

Pleura;

A thin layer of extrapleural fat;

Intrathoracic fascia;

sternum;

Thoracic spine;

Shoulder blades;

Internal intercostal muscles;

Intermuscular fat layers and vessels;

External intercostal muscles;

Superficial muscles of the chest;

Subcutaneous fatty tissue;

The ribs (anterior, external, posterior segments) are displayed in fragments, since they run obliquely in relation to the scanning plane, the costal cartilages are visible in the anterior chest between the sternum and the bony part of the rib, their X-ray density is higher than the surrounding muscles. The sternum is depicted in cross section in the anterior part of the chest, centrally located. The shoulder blades are visualized in the posterior upper part of the chest. The thoracic vertebrae are located in the posterior part of the chest. The muscles are separated by fatty layers, in which vessels and small lymph nodes are visualized.

Pleura. With CT, it is impossible to distinguish between the visceral and parietal pleura in the absence of pathology. The pleura can be distinguished from adjacent muscles only in the presence of extrapleural fat. To assess the condition of the pleura, soft tissue and pleural windows are used.

Diaphragm. N It begins posteriorly from the lumbar vertebrae (on the right - L3, on the left - L2) in the form of two legs, from the ligament between the spine and the lower ribs and is attached to the ribs (laterally and posteriorly), the sternum (in front). The right dome of the diaphragm is higher than the left. The legs of the diaphragm are surrounded by fatty tissue and against this background are clearly visible on CT in the form of two arcuate linear structures in front of the lumbar vertebrae. The aorta is located posteriorly and inwardly from the crura of the diaphragm, and the abdominal organs are located anteriorly. The liver is located under the right dome of the diaphragm; on axial sections, the image of the diaphragm and diaphragmatic pleura merge and it is impossible to differentiate them from the liver. To the left of the diaphragm are the left lobe of the liver, the proximal part of the stomach, the spleen, and the left dome of the diaphragm is visible where the fatty tissue adjoins it. The proximal part of the diaphragm is projected onto the middle parts of the pulmonary fields. The outer sections of the diaphragm border on the lung tissue of the basal segments and the middle lobe. Between the diaphragm and the chest wall there are costophrenic sinuses: anterior, posterior (the deepest) and external. Between the pericardium and the diaphragm, the cardiophrenic angle (sinus) is distinguished.

Trachea. The entrance to the chest is located at the border of the neck and chest. Below this level is the intrathoracic trachea, which comes into contact with the right lung at a distance of 1-3 cm from the suprasternal ligament. The location of the large arteries and veins changes dramatically as they enter the chest. The innominate artery is visible on CT on the right side, then in the anterior third of the trachea, where it divides into the right subclavian and carotid arteries. The right internal jugular vein and subclavian veins join the right brachiocephalic vein lateral to the innominate artery. The left carotid artery is located in the middle or lower third of the chest wall on the left. The left subclavian artery is initially located behind the trachea, then goes to the first rib on the left. The esophagus at the entrance to the chest is located behind the trachea or slightly to the left of the midline, at the level of Th, added 11/18/2015

The structure of the chest and its functions. The mechanism of respiratory movements. Congenital deformities of the chest in children. Application of the Gizycka index to determine the degree of deformation. Classification of pectus excavatum deformities and their correction.

test, added 05/28/2009

Complaints of general weakness, feeling hot, cough, shortness of breath, pain in the upper chest on the right. Condition of the upper respiratory tract. The circulatory and digestive system. Endocrine system and sensory organs. Treatment and prognosis for life.

medical history, added 09/24/2014

Various mechanisms of chest injury. Dysfunction of the thoracic cavity. Classification of chest injuries. The main clinical manifestations of post-traumatic pneumothorax. Compression and concussion of the chest, rib fractures.

presentation, added 02/25/2015

Diseases that cause obstruction of the upper respiratory tract. Difficulty breathing and its symptoms. Retraction of the chest wall and flaring of the nostrils during breathing. Cough in infants. Airway management and supportive care.

course work, added 04/15/2009

Increase in the number of chest injuries. Initial resuscitation and ventilation problems. Maintaining airway patency. Intercostal nerve block. Surgical intervention for airway obstruction. Drainage, thoracotomy and shock.

abstract, added 06/30/2009

Consideration of the chest as one of the parts of the torso. Familiarization with the normal structure of the sternum, ribs, spine and muscles of a person. Normosthenic, asthenic and hypersthenic types of chest. Study of the main pathological forms.

presentation, added 04/24/2014

The concept of the chest. Conical, cylindrical, flat shapes of the chest and their characteristics. Pathological forms of the chest. The procedure and methodology for palpation. Determination of the course of the ribs and spine, the width of the intercostal spaces.

presentation, added 05/21/2014

Anatomical and physiological features of the respiratory system in children. Methods for examining the upper respiratory tract (nose, oral cavity), chest. Features of the structure of the bronchial tree in newborns and infants. Functional test Stange-Gench.

presentation, added 10/18/2015

Classification of chest injuries. Factors in the formation of subcutaneous emphysema. Violation of the integrity of the bone structure of the ribs. Damage to the chest bones and soft tissues. Differential diagnosis of lung contusions and intrapulmonary hematomas.

On a survey radiograph in a direct projection (Fig. III. 1), the upper 5-6 pairs of ribs appear almost along the entire length. Each of them can be distinguished body, anterior and posterior ends. The lower ribs are partially or completely hidden behind the shadow of the mediastinum and organs located in the subphrenic space. The image of the anterior ends of the ribs is cut off at a distance of 2-5 cm from the sternum, since the costal cartilages do not provide a visible shadow on the images. In persons 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 islands in the center of the cartilage. They, of course, should not be mistaken for compactions of lung tissue. X-rays of the lungs also contain images of the bones of the shoulder girdle (clavicles and shoulder blades), soft tissues of the chest wall, mammary glands and organs located in the chest cavity (lungs, mediastinal organs).

Both lungs are visible separately on a plain X-ray; they form the so-called pulmonary fields, which are intersected by the shadows of the edges. Between the pulmonary fields there is an intense shadow of the mediastinum. The lungs of a healthy person are filled with air, so they appear very light on an x-ray. Lung fields have a certain structure, which is called pulmonary pattern. It is formed by the shadows of the arteries and veins of the lungs and, to a lesser extent, by the connective tissue surrounding them. In the medial sections of the pulmonary fields, between the anterior ends of the II and IV ribs, a shadow appears roots of the lungs. The main sign of a normal root is heterogeneity

Rve. III. 1. Anterior plain radiograph of the chest organs and a diagram for it.

1 - anterior end of the rib; 2 - trachea and main bronchi; 3 - rib body; 4 - right lower lobe artery; 5 - diaphragm; 6 - posterior end of the rib; 7 - root of the left lung; 8 - contour of the left mammary gland.

the similarity of its image: in it one can distinguish the shadows of individual large arteries and bronchi. The root of the left lung is located slightly higher than the root of the right, its lower (tail) part is hidden behind the shadow of the heart.

The lung fields and their structure are visible only because the alveoli and bronchi contain air. In a fetus and a stillborn child, neither the lung fields nor their pattern are reflected in the image. Only at the first

When you inhale after birth, air enters the lungs, after which an image of the lung fields and the pattern in them appears.

Lung fields are divided into tops- areas located above the key, upper sections - from the apex to the level of the anterior end of the second rib, average- between the II and IV ribs, lower - from the IV rib to the diaphragm. The pulmonary fields are limited below the shadow of the diaphragm. Each half of it, when examined in a direct projection, forms a flat arc running from the lateral part of the chest wall to the mediastinum. The outer section of this arch forms an acute costophrenic angle with the image of the ribs, corresponding to the outer section of the costophrenic sinus of the pleura. The highest point of the right half of the diaphragm is projected at the level of the anterior ends of the V-VI ribs (on the left - 1-2 cm lower).

In a lateral view, images of both halves of the chest and both lungs are superimposed on each other, but the structure of the lung closest to the film is more clearly expressed than the opposite one. The image of the apex of the lung, the shadow of the sternum, the contours of both shoulder blades and the Thin-Thix shadow with their arches and processes are clearly visible (Fig. III.2). The ribs run from the spine to the sternum in an oblique direction down and forward.

In the pulmonary field on the lateral image, two light areas stand out: retrosternal (retrosternal) space- the area between the sternum and the shadow of the heart and ascending aorta, as well as retrocardiac (retrocardial) space- between the heart and the spine. Against the background of the pulmonary field, one can distinguish a pattern formed by arteries and veins, which are directed to the corresponding lobes of the lungs. On a lateral view, both halves of the diaphragm appear as arcuate lines running from the anterior chest wall to the posterior. The highest point of each arch is located approximately on the border of its anterior and middle thirds. Ventral to this point is the short anterior slope of the diaphragm, and dorsal to the long posterior slope. Both slopes form acute angles with the walls of the thoracic cavity, corresponding to the costophrenic sinus.

The interlobar fissures divide the lungs into lobes: the left into two- top and bottom, right into three - top, middle and bottom. The upper lobe is separated from the other part of the lung oblique interlobar fissure. Knowledge of the projection of the interlobar fissures is very important for the radiologist, as it allows one to establish the topography of intrapulmonary foci, but the boundaries of the lobes are not directly visible on the images. Oblique fissures are directed from the level of the spinous process Thin to the junction of the bone and cartilaginous parts of the IV rib. Projection horizontal slot goes from the point of intersection of the right oblique fissure and the midaxillary line to the place of attachment to the sternum of the 4th rib (Fig. III.3).

The smaller structural unit of the lung is bronchopulmonary segment. This is a section of the lung ventilated by a separate (segmental) bronchus and receiving power from a separate branch of the pulmonary artery. According to the accepted nomenclature, 10 segments are distinguished in the lung (in the left lung, the medial basal segment is often absent). The projection of segments onto overview images is shown in Fig. III3.

Rice. Sh.2. Survey X-ray of the thoracic organs in a lateral projection and a diagram for it.

1 - edge of the scapula (in front - right, behind - left); 2 - descending aorta; 3 - bodies of the ribs on the left side; 4 - posterior surface of the right lung; 5 - posterior surface of the left lung; b - vertebral bodies; 7 - bifurcation of the trachea; 8 - vessels in the root of the lung; 9 - sternum in profile.

The elementary morphological unit of the lung is the acinus - a set of branches of one terminal bronchiole with alveolar ducts and alveoli. Several acini make up the pulmonary lobule. The boundaries of normal lobules are not differentiated in the photographs, but their image appears on radiographs and especially on computer tomograms with venous congestion of the lungs and compaction of the interstitial tissue of the lung.

Pec. Sh.Z. Projection of the lobes and segments of the lungs on an x-ray.

a - on radiographs in direct projection; b - on lateral radiographs

projections.

The numbers indicate the numbers of bronchopulmonary segments.

On survey radiographs, a summation image of the entire thickness of the tissues and organs of the chest is obtained - the shadow of some parts is partially or completely superimposed on the shadow of others. For a more in-depth study of the structure of the lungs, X-ray tomography is used.

As already indicated, there are two types of X-ray tomography: linear and computer (CT). Linear tomography can be performed

Rns. Sh.4. Tomogram at the level of the median frontal plane of the chest.

1 - trachea; 2 - right main bronchus; 3 - left main bronchus; 4 - right upper lobe bronchus; 5 - intermediate bronchus; 6 - middle lobe bronchus; 7 - left upper lobe bronchus.

not available in many x-ray rooms. Due to its availability and low cost, it is still widespread.

On linear tomograms a sharp image of those formations that are located in the layer under study is obtained. The shadows of structures lying at a different depth are blurred (“smeared”) in the image (Fig. II 1.4). The main indications for linear tomography are the following: studying the condition of large bronchi, identifying areas of decay or lime deposits in pulmonary infiltrates and tumor formations, analyzing the structure of the lung root, in particular determining the condition of the lymph nodes of the root and mediastinum.

More valuable information about the morphology of the thoracic cavity organs can be obtained computed tomography. Depending on the purpose of the study, the doctor selects the “window width” when analyzing the image. Thus, he places emphasis on studying the structure of either the lungs or the mediastinal organs (Fig. III.5).

Under normal conditions, the density of lung tissue, according to densitometry, ranges from -650 to -850 N. Such a low density is explained by the fact that 92% of the lung parenchyma is air and only 8% is soft tissue and blood in the capillaries. Computed tomograms reveal

for the study of mediastinal organs; b - for pulmonary examination

TSNI G„^/ rtery And B6N “The main ones are clearly differentiated, equity and segmental bronchi, as well as intersegmental and interlobar septa.

background for the mediastinal organs is the fatty tissue of the mediastinum. Her density fluctuates from -70 to -120 HU. Lymph nodes may be visible in it. Normally they are round, oval or triangular in shape. If the size of the node exceeds 1 cm, then it is considered pathologically changed. Using slices at different depth receive an image of pre- and paratracheal lymph nodes, nodes in the aortopulmonary "window" in the roots of the lungs and under the bifurcation of the trachea. CT plays an important role in assessing the condition of the mediastinal organs: it allows us to study the fine details of morphology pulmonary tissue (assessment of the condition of the lobules and perilobular fabrics, detection of bronchiectasis, areas of bronchiolar emphysema, small foci of inflammation and tumors nodules). CT is often necessary to establish the relationship of what is found in lung education to the parietal pleura, pericardium, ribs, large blood vessels.

Magnetic resonance tomography so far, they are less commonly used in lung studies due to the low signal produced by lung tissue. The advantage of MRI is the ability to isolate layers in different planes (axial, sagittal, frontal, etc.).

Ultrasound examination has acquired great importance in the study of the heart and large vessels of the chest cavity, but it also allows one to obtain important information about the condition of the pleura and the surface layer of the lung. With its help, a small amount of pleural cavity exudate is detected earlier than with radiography.

In connection with the development of CT and bronchoscopy, the indications for a special X-ray examination of the bronchi - bronchography - have significantly narrowed. Bronchography consists of artificially contrasting the bronchial tree with radiopaque substances (Fig. III.6). In clinical practice, the indication for its implementation is the suspicion of the presence of a developmental anomaly bronchi, as well as internal bronchial or bronchopleural fistula. Used as a contrast agent propyliodone in the form of an oil suspension or a water-soluble iodide preparation. The study is carried out mainly under local anesthesia of the respiratory tract using 1 % dicaine solution or lido- Cain, but in some cases, mainly when performing bronchography in young children, they resort to intravenous or inhalation anesthesia. The contrast agent is administered through radiopaque catheters, which are clearly visible under fluoroscopy. Some types of catheters have a tip control system, which allows the catheter to be inserted into any part of the bronchial tree.

When analyzing bronchograms, each contrasted bronchus is identified, the position, shape, caliber and outline of all bronchi are determined (see Fig. III.6). A normal bronchus has a cone-shaped shape, departs from a larger trunk at an acute angle and gives off a number of subsequent branches at the same angles. In the initial part of the bronchi of the second and third orders, shallow circular constrictions are often observed, corresponding to the locations of physiological sphincters. The contours of the bronchus shadow are smooth or slightly wavy.

The blood supply to the lungs is carried out pulmonary and bronchial arteries. The former make up the pulmonary circulation; they do

function of gas exchange between air and blood. The bronchial artery system belongs to the systemic circulation and provides nutrition to the lungs. The bronchial arteries do not provide an image on radiographs and tomograms, but the branches of the pulmonary artery and pulmonary veins appear quite well. The shadow of a branch stands out at the root of the lung pulmonary artery(right or left, respectively), and from it their lobar and then segmental branches extend radially into the pulmonary fields. Pulmonary veins do not come from the root, but cross its image, heading towards the left atrium.

Radiation methods make it possible to study the morphology and function of the blood vessels of the lungs. By using spiral x-ray tomography And magnetic resonance imaging you can obtain an image of the initial and proximal parts of the pulmonary trunk, its right and left branches and establish their relationship with the ascending aorta, superior vena cava and main bronchi, trace the branching of the pulmonary artery in the pulmonary tissue down to the smallest units, and also detect defects in the filling of blood vessels during thromboembolism of the branches of the pulmonary artery.

For special indications, X-ray studies are carried out involving the introduction of a contrast agent into the vascular bed, - angiopulmonography, bronchial arteriography, venocavography.

Under angiopulmonography understand the study of the pulmonary artery system (Fig. III.7). After catheterization of the elbow vein or femoral vein, the end of the catheter is passed through the right atrium and right ventricle into the pulmonary trunk. The further course of the procedure depends on the specific tasks: if it is necessary to contrast large branches of the pulmonary artery, then the contrast agent is poured directly into the pulmonary trunk or its main branches, but if small vessels are to be studied, then the catheter is advanced in the distal direction to the desired level.

Bronchial arteriography - This is a contrast of the bronchial arteries. To do this, a thin radiopaque catheter is inserted through the femoral artery into the aorta, and from it into one of the bronchial arteries (as is known, there are several of them on each side).

Indications for angiopulmonography and bronchial arteriography in clinical practice are not very wide. Angiopulmonography is performed if there is a suspicion of an abnormal development of the artery (aneurysm, stenosis, arteriovenous fistula) or pulmonary embolism. Bronchial arteriography is necessary for pulmonary bleeding (hemoptysis), the nature of which could not be determined through other studies, including fiberoptic bronchoscopy.

The term "cavography" indicate artificial contrasting of the superior vena cava. Studying the subclavian, innominate and superior vena cava facilitates the choice of a venous approach to the rational placement of catheters, installation of a filter in the vena cava, and determination of the level and cause of obstruction of venous blood flow.

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On a survey radiograph in direct projection, the upper 5-6 pairs of ribs appear almost along the entire length. Each of them can have 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 subphrenic space. The image of the anterior ends of the ribs is cut off at a distance of 2-5 cm from the fudina, since the costal cartilages do not provide a visible shadow in the photographs. In persons 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 islands in the center of the cartilage. They, of course, should not be mistaken for compactions of lung tissue. X-ray of the lungs also shows an image of the bones of the shoulder girdle (clavicles and shoulder blades), soft tissues of the chest wall, mammary glands and organs located in the chest cavity (lungs, mediastinal organs).

Radiation syndromes of lung damage

Radiation diagnosis of lung injuries and diseases is very difficult. It is no coincidence that the aphorism was even formulated: “Oh, these lungs are not easy!” Hundreds of diseases in different phases of their development create diverse X-ray and radionuclide pictures, and their endless variations sometimes seem unique. Nevertheless, an experienced doctor, based 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 correct conclusion. This happens because he learned to determine the morphological substrate of radiological symptoms using lung x-rays in his practice. Of course, there are many radiological signs of pulmonary pathology, but three main ones stand out among them: darkening of the pulmonary field or part of it, clearing of the pulmonary field or part of it, changes in the pulmonary and root patterns.

Darkening of the pulmonary field or part of it

Most lung diseases are accompanied by compaction of the lung tissue, i.e. reduction or absence of its airiness. Densified tissue absorbs x-rays more strongly. Against the background of the light pulmonary field, a shadow appears or, as they say, darkening. The position, size and shape of the darkening depend, naturally, on the volume of the lesion. There are several typical shading options. If the pathological process has involved the entire lung, then the entire lung field is darkened to one degree or another on the x-ray. This syndrome is referred to as “extensive darkening of the pulmonary field.” It is not difficult to detect it - it catches your eye the first time you look at the photo. However, you need to immediately determine its substrate. Darkening of the entire pulmonary field is most often caused by obstruction of the main bronchus and atelectasis of the corresponding lung.

Clearing of the pulmonary field or part of it

An increase in the transparency of the lung field or part of it can be caused either by the presence of air in the pleural cavity (pneumothorax), or by 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 result from swelling of the lung tissue (emphysema) or decreased flow to the lung (anemia), which occurs primarily in certain congenital heart defects.

Changes in pulmonary and hilar patterns

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

Radiation symptoms of lung damage

Damage to the lungs and diaphragm

In case of acute closed or open injury to the thoracic juchette and lungs, all victims require radiation examination. The question of the urgency of its implementation and volume is 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 location. The importance of radiation methods increases due to the difficulty of clinical examination of patients due to shock, acute respiratory failure, subcutaneous emphysema, hemorrhage, severe pain, etc.

Acute pneumonia

Acute pneumonia is manifested by inflammatory infiltration of 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-ray radiation 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, timely detect complications and monitor the effectiveness of treatment measures.

Thromboembolism of the branches of the pulmonary artery

Thromboembolism of the branches of the pulmonary artery occurs due to the introduction of an embolus from the veins of the lower extremities and pelvis (especially often with thrombophlebitis or phlebothrombosis of the iliofemoral segment of the venous system), thrombosed inferior or superior vena cava, heart (with thromboendocarditis). Clinical diagnosis is not always reliable. The classic triad of symptoms - shortness of breath, hemoptysis, pain in the side - is observed in only 1/4 of patients, so radiation examination is of exceptional value.

Chronic bronchitis and emphysema

Chronic bronchitis is a group of common diseases in which there is diffuse inflammatory damage to the bronchial tree. There are simple (uncomplicated) and complicated bronchitis. The latter manifests itself in three forms: obstructive, mucopurulent and mixed bronchitis.

Chronic pneumonia and limited nonspecific pneumosclerosis

X-ray examination makes it possible to recognize all forms and stages of chronic pneumonia. The images show infiltration of the lung tissue. It causes heterogeneous darkening due to a combination of areas of infiltration and sclerosis, coarse fibrous strands, bronchial lumens bordered by a strip of peribronchial sclerosis. The process may involve part of a segment, part of a lobe, an entire lobe, or even the entire lung. In the shadow of the infiltrate, separate cavities containing liquid and gas may be visible. The picture is complemented by fibrous deformation of the root of the lung and pleural deposits around the affected part of the lung.

Pneumoconiosis

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

Pulmonary tuberculosis

All measures to combat tuberculosis are based on the principle of preventing infection and early recognition of the disease. The purposes 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, clinics and hospitals of the general medical network. In accordance with this classification, the following forms of respiratory tuberculosis are distinguished.

Radiation diagnostics of lung diseases

The lungs are one of the most common objects of radiation research. The important role of the radiologist in the study of the morphology of the respiratory organs and the recognition of pathological processes is evidenced by the fact that the accepted classifications of many diseases, for example pneumonia, tuberculosis, sarcoidosis, pneumoconiosis, and malignant tumors, are largely based on radiological data. It is also known that latent lung lesions are detected during screening fluorographic examinations of the population.

With the development of computed tomography, the importance of the x-ray method in the diagnosis of 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 occupied an important place in assessing the functional pathology of the lungs, in particular disorders of capillary blood flow in them.

Indications for X-ray examination of the lungs are very wide: fever, cough, sputum production, shortness of breath, chest pain, hemoptysis and many other pathological conditions.

On a survey radiograph in direct projection (Fig. 1), the upper 5-6 pairs of ribs appear almost along the entire length. Each of them can be distinguished body, anterior and posterior ends. The lower ribs are partially or completely hidden behind the shadow of the mediastinum and organs located in the subphrenic space. The image of the anterior ends of the ribs is cut off at a distance of 2-5 cm from the sternum, since the costal cartilages do not provide a visible shadow on the images. In persons 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 islands in the center of the cartilage. They, of course, should not be mistaken for compactions of lung tissue. X-rays of the lungs also contain images of the bones of the shoulder girdle (clavicles and shoulder blades), soft tissues of the chest wall, mammary glands and organs located in the chest cavity (lungs, mediastinal organs).

Fig. 1 Anterior plain radiograph of the chest organs and a diagram for it.

When you inhale after birth, air enters the lungs, after which an image of the lung fields and a pattern in them appears.

Lung fields are divided into tops - areas located above the collarbones, upper sections- from the apex to the level of the anterior end of the second rib, average - between the II and IV ribs, lower - from the IV rib to the diaphragm. The pulmonary fields are limited below the shadow of the diaphragm. Each half of it, when examined in a direct projection, forms a flat arc running from the lateral part of the chest wall to the mediastinum. The outer section of this arch forms an acute costophrenic angle with the image of the ribs, corresponding to the outer section of the costophrenic sinus of the pleura. The highest point of the right half of the diaphragm is projected at the level of the anterior ends of the V-VI ribs (on the left - 1-2 cm lower).

In a lateral view, images of both halves of the chest and both lungs are superimposed on each other, but the structure of the lung closest to the film is more clearly expressed than the opposite one. The image of the apex of the lung, the shadow of the sternum, the contours of both shoulder blades and the shadow of the thoracic vertebrae with their arches and processes are clearly visible (Fig. 2). The ribs run from the spine to the sternum in an oblique direction down and forward.

Fig. 2. Overview x-ray of the thoracic cavity organs in the lateral projection and a diagram for it. 1 - edge of the scapula (front - right, back - left); 2 - descending aorta; 3 - bodies of the ribs on the left side 4 - posterior surface of the right lung; 5 - posterior surface of the left lung; 6 - vertebral bodies; 7 - bifurcation of the trachea; 8 - vessels in the root of the lung; 9 - sternum in profile.

In the pulmonary field on the lateral image, two light areas stand out: retrosternal (retrosternal) space - the area between the sternum and the shadow of the heart and ascending aorta, as well as retrocardiac (retrocardial) space- between the heart and the spine. Against the background of the pulmonary field, one can distinguish a pattern formed by arteries and veins, which are directed to the corresponding lobes of the lungs. On a lateral view, both halves of the diaphragm appear as arcuate lines running from the anterior chest wall to the posterior. The highest point of each arch is located approximately on the border of its anterior and middle thirds. Ventral to this point is the short anterior slope of the diaphragm, and dorsal to the long posterior slope. Both slopes form acute angles with the walls of the thoracic cavity, corresponding to the costophrenic sinus.

The interlobar fissures divide the lungs into lobes: the left into two- top and bottom, right into three - top, middle and bottom. The upper lobe is separated from the other part of the lung oblique interlobar fissure. Knowledge of the projection of the interlobar fissures is very important for the radiologist, as it allows one to establish the topography of intrapulmonary foci, but the boundaries of the lobes are not directly visible on the images. Oblique fissures are directed from the level of the spinous process Thnr to the junction of the bone and cartilaginous parts of the fourth rib. Projection horizontal slot goes from the point of intersection of the right oblique fissure and the midaxillary line to the place of attachment to the sternum of the fourth rib.

Rice. 3. Projection of the lobes and segments of the lungs on an x-ray.

The elementary morphological unit of the lung is the acinus - a set of branches of one terminal bronchiole with alveolar ducts - alveoli. Several acini make up the pulmonary lobule. The boundaries of normal lobules are not differentiated on photographs, but their image appears on radiographs and especially on computed tomograms; with venous congestion of the lungs and compaction of the interstitial tissue of the lung.

On survey radiographs, a summation image of the thickness of the tissues and organs of the chest is obtained - the shadow of some parts is partially or completely superimposed on the shadow of others. For a more in-depth study of the structure of the lungs, X-ray tomography is used

As already indicated, there are two types of X-ray tomography - linear and computer (CT). Linear tomography can be performed in many x-ray rooms. Due to its availability and low cost, it is still widespread.

Fig.4. Tomogram at the level of the median frontal plane of the chest.