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What is the difference between the right lung and the left? Lung segments

good sage, ..and the volume of the heart?

Each lung is divided into lobes through grooves. One groove, oblique, on both lungs, begins relatively high (6-7 cm below the apex) and then descends obliquely down to the diaphragmatic surface, going deep into the substance of the lung. It separates the upper lobe from the lower lobe of each lung. In addition to this groove, the right lung also has a second, horizontal groove, passing at the level of the IV rib. It demarcates from the upper lobe of the right lung a wedge-shaped area that makes up the middle lobe. Thus, the right lung has three lobes

Lung segments: diagram. Lung structure

What do our lungs look like? IN chest 2 pleural sacs contain lung tissue. Inside the alveoli are tiny sacs of air. The apex of each lung is in the area of ​​the supraclavicular fossa, slightly above (2-3 cm) the collarbone.

The lungs are equipped with an extensive network of blood vessels. Without a developed network of vessels, nerves and bronchi, the respiratory organ would not be able to function fully.

The lungs have lobes and segments. The interlobar fissures are filled with visceral pleura. The segments of the lungs are separated from each other by a connective tissue septum, within which vessels pass. Some segments, if they are damaged, can be removed during surgery without causing harm to neighboring ones. Thanks to the partitions, you can see where the “dividing” line of the segments goes.

Lobes and segments of the lung. Scheme

The lungs, as you know, are a paired organ. The right lung consists of two lobes separated by grooves (lat. fissurae), and the left lung consists of three. The left lung is smaller because the heart is located to the left of center. In this area, the lung leaves part of the pericardium uncovered.

The lungs are also divided into bronchopulmonary segments (segmenta bronchopulmonalia). According to international nomenclature, both lungs are divided into 10 segments. There are 3 in the upper right lobe, 2 in the middle lobe, and 5 segments in the lower lobe. The left part is divided differently, but contains the same number of sections. Bronchopulmonary segment- this is a separate section of the pulmonary parenchyma, which is ventilated by 1 bronchus (namely the 3rd order bronchus) and is supplied with blood from one artery.

Each person has an individual number of such areas. The lobes and segments of the lungs develop during the period of intrauterine growth, starting from 2 months (differentiation of lobes into segments begins from 20 weeks), and some changes during development are possible. For example, in 2% of people the analogue of the right middle lobe is another lingular segment. Although most people have lingular segments of the lungs only in the left upper lobe - there are two of them.

Some people's lung segments are simply "built" differently than others, which does not mean that this is a pathological abnormality. This does not change the functioning of the lungs.

The lung segments, the diagram confirms this, look visually like irregular cones and pyramids, with their apex facing the gate of the respiratory organ. The base of the imaginary figures is located at the surface of the lungs.

Upper and middle segments of the right lung

The structural structure of the parenchyma of the left and right lungs is slightly different. The lung segments have their names in Latin and Russian (with a direct relationship to their location). Let's start with a description of the anterior section of the right lung.

1. Apical (Segmentum apicale). It goes all the way to the scapular spine. Has the shape of a cone.
2. Posterior (Segmentum posterius). It runs from the middle of the shoulder blade to its top edge. The segment is adjacent to the thoracic (posterolateral) wall at the level of 2–4 ribs.
3. Anterior (Segmentum anterius). Located at the front. The surface (medial) of this segment is adjacent to the right atrium and the superior vena cava.

The middle share is “divided” into 2 segments:

1. Lateral. Located at the level of 4 to 6 ribs. It has a pyramidal shape.
2. Medial (mediale). The segment faces the chest wall anteriorly. In the middle it is adjacent to the heart, with the diaphragm running below.

These segments of the lung are displayed in a diagram in any modern medical encyclopedia. There may only be slightly different names. For example, the lateral segment is the outer segment, and the medial segment is often called the internal segment.

Lower 5 segments of the right lung

The right lung has 3 sections, and the very last lower section has 5 more segments. These lower segments of the lung are called:

1. Apical (apicale superius).
2. Medial basal, or cardiac, segment (basale mediale cardiacum).
3. Anterior basal (basale anterius).
4. Lateral basal (basale laterale).
5. Posterior basal (basale posterius).

These segments (the last 3 basal) are largely similar in shape and morphology to the left sections. This is how the lung segments are divided on the right side. The anatomy of the left lung is somewhat different. We will also look at the left side.

Upper lobe and lower left lung

The left lung, some believe, should be divided into 9 parts. Due to the fact that the 7th and 8th sectors of the parenchyma of the left lung have a common bronchus, the authors of some publications insist on combining these lobes. But for now, let’s list all 10 segments:

• Apical. This segment is similar to the mirror right one.
• Rear. Sometimes apical and posterior are combined into 1.
• Front. The largest segment. It comes into contact with the left ventricle of the heart on its medial side.
• Upper lingular (Segmentum lingulare superius). Adjacent at the level of 3–5 ribs to the anterior chest wall.
• Lower lingular segment (lingulare interius). It is located directly below the upper lingular segment, and is separated below by a gap from the lower basal segments.

And the lower sectors (which are similar to the right ones) are also given in the order of their sequence:

• Apical. The topography is very similar to the same sector on the right side.
• Medial basal (cardiac). Located in front of the pulmonary ligament on the medial surface.
• Anterior basal.
• Lateral basal segment.
• Posterior basal.

Lung segments are both functional units of parenchyma and morphological ones. Therefore, for any pathology, an x-ray is prescribed. When a person is given an x-ray, an experienced radiologist immediately determines in which segment the source of the disease is located.

Blood supply

The smallest “details” of the respiratory organ are the alveoli. Alveolar sacs are vesicles covered with a thin network of capillaries through which our lungs breathe. It is in these pulmonary “atoms” that all gas exchange occurs. The lung segments contain several alveolar ducts. In total, there are 300 million alveoli in each lung. They are supplied with air by arterial capillaries. Carbon dioxide is taken up by the venous vessels.

The pulmonary arteries operate on a small scale. That is, they nourish the lung tissue and make up the pulmonary circulation. The arteries are divided into lobar and then segmental, and each feeds its own “section” of the lung. But bronchial vessels also pass here, which belong to big circle blood circulation The pulmonary veins of the right and left lung enter the flow of the left atrium. Each segment of the lung has its own grade 3 bronchus.

On the mediastinal surface of the lung there is a “gate” hilum pulmonis - depressions through which the main veins, lymphatic vessels, bronchi and arteries pass to the lungs. This place of “intersection” of the main vessels is called the root of the lungs.

What will the x-ray show?

On an x-ray, healthy lung tissue appears as a monochromatic image. By the way, fluorography is also an x-ray, but of lower quality and the cheapest. But if cancer cannot always be seen on it, then pneumonia or tuberculosis is easy to notice. If spots of a darker shade are visible in the photo, this may indicate pneumonia, since the density of the fabric is increased. But lighter spots mean that the organ tissue has low density, and this also indicates problems.

Lung segments are not visible on the x-ray. Only the overall picture is recognizable. But the radiologist must know all the segments; he must determine in which part of the pulmonary parenchyma there is an anomaly. X-rays sometimes give false positive results. Analysis of the image only provides “blurred” information. More accurate data can be obtained from computed tomography.

Lungs on CT

Computed tomography- the most reliable way to find out what is happening inside the pulmonary parenchyma. CT allows you to see not only lobes and segments, but also intersegmental septa, bronchi, vessels and lymph nodes. Whereas lung segments on an x-ray can only be determined topographically.

For such a study, you do not need to fast in the morning and stop taking medications. The whole procedure takes place quickly - in just 15 minutes.

Normally, a person examined using CT should not have:

• enlarged lymph nodes;
• fluid in the pleura of the lungs;
• areas of excessive density;
• no education;
• changes in the morphology of soft tissues and bones.

And also the thickness of the bronchi should correspond to the norm. Lung segments are not fully visible on CT scans. But he will create a three-dimensional picture and write it down in medical card The attending physician will view the entire series of images taken on his computer.

The patient himself will not be able to recognize the disease. All images after the study are recorded on disk or printed. And with these pictures you need to contact a pulmonologist - a doctor specializing in lung diseases.

How to keep your lungs healthy?

The greatest harm to all respiratory system causes an incorrect lifestyle, poor nutrition and smoking.

Even if a person lives in a stuffy city and his lungs are constantly “attacked” by construction dust, this is not the worst thing. You can clear your lungs of dust by traveling to clean forests in the summer. The worst thing is cigarette smoke. It is the toxic mixtures inhaled when smoking, tar and carbon monoxide that are scary. Therefore, you need to quit smoking without regrets.

Lung segments

C1. Apical C2. Posterior C3. Front

S1-2. Apical posterior C3. Anterior C4. Upper reed C5. Lower reed

C4. Lateral C5. Medial

C6. Apical C7. Medial basal C8. Anterior basal C9. Lateral basal C10. Posterior basal

C6. Apical C7. C8 is missing. Anterior basal C9. Lateral basal C10. Posterior basal

Topography of right lung segments

C1 – apical segment – ​​along the anterior surface of the 2nd rib, through the apex of the lung to the spine of the scapula.

C2 – posterior segment – ​​along the posterior surface of the chest paravertebrally from the upper angle of the scapula to its middle.

C3 – anterior segment – ​​from II to IV ribs.

Middle lobe: determined along the anterior surface of the chest from the 4th to 6th ribs.

C4 – lateral segment – ​​anterior axillary region.

C5 – medial segment – ​​closer to the sternum.

Lower lobe: upper border - from the middle of the scapula to the diaphragm.

C6 – in the paravertebral zone from the middle of the scapula to the lower angle.

C7 – medial basal.

C8 - anterior basal - in front - the main interlobar groove, below - the diaphragm, behind - the posterior axillary line.

C9 – lateral basal – from the scapular line 2 cm to the axillary zone.

C10 – posterior basal – from the lower angle of the scapula to the diaphragm. The lateral boundaries are the paravertebral and scapular lines.

Topography of left lung segments.

Upper lobe

C1-2 - apical-posterior segment (represents a combination of C1 and C2 segments of the left lung, due to the presence of a common bronchus) - along the anterior surface of the second rib through the apex to the spine of the scapula.

C3 – anterior segment – ​​from the II to IV ribs.

C4 – upper lingular segment – ​​from the IV rib to the V rib.

C5 – lower lingular segment – ​​from the 5th rib to the diaphragm.

The segments of the lower lobe have the same boundaries as those on the right. In the lower lobe of the left lung there is no C7 segment (in the left lung there are segments C7 and C8 right lobe have a common bronchus).

The figures show the locations of the projection of lung segments on a plain X-ray of the lungs in a direct projection.

Rice. 1. C1 – apical segment of the right lung – along the anterior surface of the 2nd rib, through the apex of the lung to the spine of the scapula. (a - general view; b - lateral projection; c - direct projection.)

Rice. 2. C1 – apical segment and C2 – posterior segment of the left lung. (a - frontal projection; b - lateral projection; c - general view).

Rice. 8. C4 – lateral segment of the middle lobe of the right lung. (a - general view; b - lateral projection; c - direct projection).

Rice. 9. C5 – medial segment of the middle lobe of the right lung. (a - general view; b - lateral projection; c - direct projection).

Rice. 11. C6. Apical segment of the lower lobe of the left lung. (a - frontal projection; b - lateral projection; c - general view).

Rice. 13. C8 – anterior basal segment of the lower lobe of the right lung. (a - general view; b - lateral projection; c - direct projection).

Rice. 15. C9 – lateral basal segment of the lower lobe of the right lung. (a - general view; b - lateral projection; c - direct projection).

Rice. 18. C10 – posterior basal segment of the lower lobe of the left lung. (a - frontal projection; b - lateral projection; c - general view).

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Topography and segments of the lungs on a radiograph

Segments are morphofunctional elements of lung tissue, which include its own bronchus, artery and vein. They are surrounded by acini - the smallest functional unit pulmonary parenchyma (about 1.5 mm in diameter). The alveolar acini are ventilated by the bronchiole, the smallest branch of the bronchus. These structures ensure gas exchange between the surrounding air and blood capillaries.

Acini are not visualized on an x-ray, so it is customary to localize pathological shadows on lung images by segments and lobes.

Segmental structure of lung tissue in an image of the lungs

The right lung contains three lobes:

Each of them has its own segmental structure.

Segments of the upper lobe of the right lung:

There are 2 structural segments in the middle lobe:

There are 5 segments in the lower lobe of the right lung:

The left lung has two lobes, so the structural structure of the pulmonary parenchyma is somewhat different. The middle lobe of the left lung consists of the following segments:

The lower lobe has 4-5 segments (different authors have different opinions):

1. Upper (S6).
2. Inferointernal (S7), which can be combined with inferoanterior (S8).
3. Lower external (S9).
4. Inferoposterior (S10).

It is more correct to distinguish 4 segments in the lower lobe of the left lung, since S7 and S8 have a common bronchus.

To summarize: the left lung consists of 9 segments, and the right lung has 10.

Topographic location of lung segments on a radiograph

X-ray, passing through the pulmonary parenchyma, does not clearly highlight topographical landmarks that allow localizing the segmental structure of the lungs. To learn how to determine the location of pathological dark spots in the lungs in an image, radiologists use markers.

The upper lobe is separated from the lower lobe (or middle lobe on the right) by an oblique interlobar fissure. It is not clearly visible on an x-ray. To highlight it, use the following guidelines:

1. On straight shot begins at the level of the spinous process of Th3 (3rd thoracic vertebra).
2. Runs horizontally along the outer part of the 4th rib.
3. Then heads to highest point diaphragm in the projection of its middle part.
4. In the lateral view, the horizontal pleura starts superiorly from Th3.
5. Passes through the root of the lung.
6. It ends at the highest point of the diaphragm.

The horizontal interlobar fissure separates the upper lobe from the middle lobe in the right lung. She goes through:

1. On a direct radiograph along the outer edge of the 4th rib - towards the root.
2. In the lateral projection, it starts from the root and goes horizontally to the sternum.

Topography of lung segments:

• apical (S1) runs along the 2nd rib to the scapular spine;
• posterior – from the middle of the shoulder blade to its upper edge;
• anterior – in front between the 2nd and 4th ribs;
• lateral (upper lingular) – between the 4th and 6th ribs along the anterior axillary line;
• medial (lower lingual) – between the 4th and 6th ribs closer to the sternum;
• upper basal (S6) – from the middle of the scapula to the lower angle along the paravertebral region;
• medial basal - from the 6th rib to the diaphragm between the midclavicular line and the sternum;
• anterior basal (S8) – between the interlobar fissure in front and the axillary lines in the back;
• lateral basal (S9) projects between the middle of the scapula and the posterior axillary line;
• posterior basal (S10) - from the lower angle of the scapula to the diaphragm between the scapular and paravertebral lines.

On the left, the segmental structure is insignificantly different, which allows the radiologist to quite accurately localize pathological shadows in the pulmonary parenchyma on photographs in frontal and lateral projections.

Rare features of lung topography

In some people, due to the abnormal position of the azygos vein, lobus venae azygos is formed. It should not be considered an abnormal lesion, but should be taken into account when reading chest x-rays.

In most people, the venae azygos flows into the superior vena cava medially from the mediastinal surface of the right lung, and therefore is not visible on radiographs.

When identifying the lobe of the azygos vein, it is obvious that in a person the place of entry of this vessel is shifted somewhat to the right in the projection of the upper lobe.

There are cases when the azygos vein is located below its normal position and compresses the esophagus, making swallowing difficult. In this case, difficulties arise during the passage of food - dysphagialusoria (“nature’s joke”). On an x-ray, the pathology is manifested by a marginal filling defect, which is considered a sign of cancer. In fact, after performing a computed tomography (CT) scan, the diagnosis is excluded.

Other rare lung lobes:

1. The pericardium is formed by the irregular course of the medial part of the interlobar fissure.
2. Lingular - can be seen on photographs when the interlobar fissure is located in the projection of the 4th rib on the left. It is a morphological analogue of the middle lobe on the right in 1-2% of people.
3. Posterior - occurs when there is an additional gap separating the upper part of the lower lobe from its base. Occurs on both sides.

Every radiologist should know the topography and segmental structure of the lungs. Without this, it is impossible to read chest X-rays correctly.

It is possible to detect a tumor in the lungs and determine what it may be with a detailed examination. People are susceptible to this disease different ages. Formations arise due to disruption of the process of cell differentiation, which can be caused by internal and external factors.

Neoplasms in the lungs are a large group various entities in the area of ​​the lungs, which have a characteristic structure, location and nature of origin.

Neoplasms in the lungs can be benign or malignant.

Benign tumors have different genesis, structure, location and various clinical manifestations. Benign tumors are less common than malignant tumors and make up about 10% of the total. They tend to develop slowly and do not destroy tissue, since they are not characterized by infiltrating growth. Some benign tumors tend to transform into malignant ones.

Depending on the location there are:

1. Central - tumors from the main, segmental, lobar bronchi. They can grow inside the bronchus and surrounding lung tissue.
2. Peripheral - tumors from surrounding tissues and walls of small bronchi. They grow superficially or intrapulmonarily.

Types of benign tumors

There are the following benign lung tumors:

Briefly about malignant tumors

Increase.

Lung cancer (bronchogenic carcinoma) is a tumor consisting of epithelial tissue. The disease tends to metastasize to other organs. It can be located in the periphery, the main bronchi, or grow into the lumen of the bronchus or organ tissue.

Malignant neoplasms include:

1. Lung cancer has the following types: epidermoid, adenocarcinoma, small cell tumor.
2. Lymphoma is a tumor that affects the lower sections respiratory tract. It may occur primarily in the lungs or as a result of metastases.
3. Sarcoma is a malignant formation consisting of connective tissue. Symptoms are similar to those of cancer, but develop more quickly.
4. Pleural cancer is a tumor that develops in the epithelial tissue of the pleura. It can occur primarily, and as a result of metastases from other organs.

Risk factors

The causes of malignant and benign tumors are largely similar. Factors that provoke tissue proliferation:

• Smoking active and passive. 90% of men and 70% of women who have been diagnosed with malignant tumors in the lungs are smokers.
• Contact with hazardous chemicals and radioactive substances due to occupational activities and contamination environment areas of residence. Such substances include radon, asbestos, vinyl chloride, formaldehyde, chromium, arsenic, and radioactive dust.
• Chronic respiratory diseases. The development of benign tumors is associated with the following diseases: chronic bronchitis, chronic obstructive pulmonary disease, pneumonia, tuberculosis. The risk of malignant neoplasms increases if there is a history of chronic tuberculosis and fibrosis.

The peculiarity is that benign formations may not be caused by external factors, but gene mutations and genetic predisposition. Malignancy and transformation of the tumor into malignant also often occur.

Any lung formations can be caused by viruses. Cell division can be caused by cytomegalovirus, human papillomavirus, multifocal leukoencephalopathy, simian virus SV-40, and human polyomavirus.

Symptoms of a tumor in the lung

Benign lung formations have various signs, which depend on the location of the tumor, its size, existing complications, hormonal activity, direction of tumor growth, and impaired bronchial obstruction.

Complications include:

• abscess pneumonia;
• malignancy;
• bronchiectasis;
• atelectasis;
• bleeding;
• metastases;
• pneumofibrosis;
• compression syndrome.

Bronchial patency has three degrees of impairment:

• 1st degree – partial narrowing of the bronchus.
• 2nd degree – valvular narrowing of the bronchus.
• 3rd degree – occlusion (impaired patency) of the bronchus.

Symptoms of the tumor may not be observed for a long time. The absence of symptoms is most likely with peripheral tumors. Depending on the severity of the symptoms, several stages of the pathology are distinguished.

Stages of formations

Stage 1. It is asymptomatic. At this stage, partial narrowing of the bronchus occurs. Patients may experience a cough with a small amount sputum. Hemoptysis is rare. During examination x-ray does not detect anomalies. Studies such as bronchography, bronchoscopy, and computed tomography can show the tumor.

Stage 2. Valve narrowing of the bronchus is observed. At this point, the lumen of the bronchial tube is practically closed by the formation, but the elasticity of the walls is not impaired. When you inhale, the lumen partially opens, and when you exhale, it closes with the tumor. In the area of ​​the lung that is ventilated by the bronchus, expiratory emphysema develops. As a result of the presence of bloody impurities in the sputum and swelling of the mucous membrane, complete obstruction (impaired patency) of the lung can occur. Inflammatory processes may develop in the lung tissues. The second stage is characterized by cough with the release of mucous sputum (pus is often present), hemoptysis, shortness of breath, increased fatigue, weakness, chest pain, fever (due to inflammation). The second stage is characterized by alternation of symptoms and their temporary disappearance (with treatment). An X-ray image shows impaired ventilation, the presence of an inflammatory process in a segment, lobe of the lung, or an entire organ.

To be able to make an accurate diagnosis, bronchography, computed tomography, and linear tomography are required.

Stage 3. Complete obstruction of the bronchus occurs, suppuration develops, and irreversible changes lung tissues and their death. At this stage, the disease has such manifestations as impaired breathing (shortness of breath, suffocation), general weakness, excessive sweating, chest pain, elevated body temperature, cough with purulent sputum (often with bloody particles). Sometimes pulmonary hemorrhage may occur. During examination, an x-ray may show atelectasis (partial or complete), inflammatory processes with purulent-destructive changes, bronchiectasis, extensive education in the lungs. To clarify the diagnosis, a more detailed study is necessary.

Symptoms

Symptoms of low-quality tumors also vary depending on the size, location of the tumor, the size of the bronchial lumen, the presence of various complications, and metastases. The most common complications include atelectasis and pneumonia.

At the initial stages of development, malignant cavitary formations that arise in the lungs show few signs. The patient may experience the following symptoms:

• general weakness, which intensifies as the disease progresses;
• increased body temperature;
• fatigue;
• general malaise.

Symptoms initial stage the development of the neoplasm is similar to the signs of pneumonia, acute respiratory viral infections, and bronchitis.

Progression malignant formation accompanied by symptoms such as cough with sputum consisting of mucus and pus, hemoptysis, shortness of breath, suffocation. When the tumor grows into the vessels, pulmonary hemorrhage occurs.

A peripheral lung mass may not show signs until it invades the pleura or chest wall. After this, the main symptom is pain in the lungs that occurs when inhaling.

On late stages malignant tumors appear:

• increased constant weakness;
• weight loss;
• cachexia (depletion of the body);
• the occurrence of hemorrhagic pleurisy.

Diagnostics

To detect tumors, the following examination methods are used:

1. Fluorography. A preventive diagnostic method, x-ray diagnostics, which allows you to identify many pathological formations in the lungs. read this article.
2. Plain radiography of the lungs. Allows you to identify spherical formations in the lungs that have a round outline. X-ray images reveal changes in the parenchyma of the examined lungs on the right, left or both sides.
3. Computed tomography. Using this diagnostic method, the lung parenchyma is examined, pathological changes lungs, each intrathoracic lymph node. This study is prescribed when necessary differential diagnosis rounded formations with metastases, vascular tumors, peripheral cancer. Computed tomography allows us to diagnose more correct diagnosis than an x-ray examination.
4. Bronchoscopy. This method allows you to examine the tumor and perform a biopsy for further cytological examination.
5. Angiopulmonography. Involves invasive radiography of blood vessels using contrast agent to detect vascular lung tumors.
6. Magnetic resonance imaging. This diagnostic method is used in severe cases for additional diagnostics.
7. Pleural puncture. Study in the pleural cavity with a peripheral tumor location.
8. Cytological examination of sputum. Helps determine the presence of a primary tumor, as well as the appearance of metastases in the lungs.
9. Thoracoscopy. It is carried out to determine the operability of a malignant tumor.

Fluorography.

Bronchoscopy.

Angiopulmonography.

Magnetic resonance imaging.

Pleural puncture.

Cytological examination of sputum.

Thoracoscopy.

Believed to be benign focal formations lungs are no more than 4 cm in size; larger focal changes indicate malignancy.

Treatment

All neoplasms are subject to surgical treatment. Benign tumors must be immediately removed after diagnosis in order to avoid an increase in the area of ​​affected tissue, trauma from surgery, the development of complications, metastases and malignancy. For malignant tumors and benign complications, a lobectomy or bilobectomy may be required to remove a lobe of the lung. With the progression of irreversible processes, pneumonectomy is performed - lung removal and surrounding lymph nodes.

Bronchial resection.

Central cavity formations localized in the lungs are removed by resection of the bronchus without affecting the lung tissue. With such localization, removal can be done endoscopically. To remove tumors with a narrow base, a fenestrated resection of the bronchial wall is performed, and for tumors with a wide base, a circular resection of the bronchus is performed.

For peripheral tumors, surgical treatment methods such as enucleation, marginal or segmental resection are used. For large tumors, lobectomy is used.

Lung formations are removed using thoracoscopy, thoracotomy and videothoracoscopy. During the operation, a biopsy is performed, and the resulting material is sent for histological examination.

For malignant tumors surgery is not performed in the following cases:

• when it is not possible complete removal neoplasms;
• metastases are located at a distance;
• impaired functioning of the liver, kidneys, heart, lungs;
• The patient's age is more than 75 years.

After removal of the malignant tumor, the patient undergoes chemotherapy or radiation therapy. In many cases, these methods are combined.

A segment is a cone-shaped section of the lung lobe, which with its base faces the surface of the lung and its apex faces the root, ventilated by a third-order bronchus, and consisting of pulmonary lobules. The segments are separated from each other by connective tissue. In the center of the segment there are a segmental bronchus and an artery, and in the connective tissue septum there is a segmental vein.

According to the International Anatomical Nomenclature, the right and left lungs are distinguished by 10 segments. The names of the segments reflect their topography and correspond to the names of the segmental bronchi.

Right lung.

IN upper lobe the right lung has 3 segments:

– apical segment ,segmentum apicale, occupies the superomedial portion of the upper lobe, enters the upper opening of the chest and fills the dome of the pleura;

– posterior segment , segmentum posterius, its base is directed outward and backward, bordering there with the II-IV ribs; its apex faces the upper lobe bronchus;

– anterior segment , segmentum anterius, its base is adjacent to the anterior wall of the chest between the cartilages of the 1st and 4th ribs, as well as to the right atrium and the superior vena cava.

Average share has 2 segments:

– lateral segment, segmentum laterale, its base is directed forward and outward, and its apex is directed upward and medially;

– medial segment, segmentum mediale, comes into contact with the anterior chest wall near the sternum, between the IV-VI ribs; it is adjacent to the heart and diaphragm.

Rice. 1.37. Lungs.

1 – larynx, larynx; 2 – trachea, trachea; 3 – apex of the lung, apex pulmonis; 4 – costal surface, facies costalis; 5 – bifurcation of the trachea, bifurcatio tracheae; 6 – upper lobe of the lung, lobus pulmonis superior; 7 – horizontal fissure of the right lung, fissura horizontalis pulmonis dextri; 8 – oblique fissure, fissura obliqua; 9 – cardiac notch of the left lung, incisura cardiaca pulmonis sinistri; 10 – middle lobe of the lung, lobus medius pulmonis; 11 – lower lobe of the lung, lobus inferior pulmonis; 12 – diaphragmatic surface, facies diaphragmatica; 13 – base of the lung, basis pulmonis.

IN lower lobe There are 5 segments:

– apical segment, segmentumapicale (superius), occupies the wedge-shaped apex of the lower lobe and is located in the paravertebral region;

– medial basal segment, segmentum basale mediale (cardiacum), The base occupies the mediastinal and partly the diaphragmatic surface of the lower lobe. It is adjacent to the right atrium and the inferior vena cava;

– anterior basal segment , segmentum basale anterius, is located on the diaphragmatic surface of the lower lobe, and the large lateral side is adjacent to the chest wall in the axillary region between the VI-VIII ribs;

– lateral basal segment , segmentum basale laterale, wedged between other segments of the lower lobe so that its base is in contact with the diaphragm, and its side is adjacent to the chest wall in the axillary region, between the VII and IX ribs;

– posterior basal segment , segmentum basale posterius, located paravertebrally; it lies posterior to all other segments of the lower lobe, penetrating deeply into the costophrenic sinus of the pleura. Sometimes it is separated from this segment .

Left lung.

It also distinguishes 10 segments.

The upper lobe of the left lung has 5 segments:

– apical-posterior segment , segmentum apicoposterius, corresponds in shape and position apical segment ,segmentum apicale, and posterior segment , segmentum posterius, upper lobe of the right lung. The base of the segment is in contact with the posterior sections of the III-V ribs. Medially, the segment is adjacent to the aortic arch and subclavian artery; may be in the form of two segments;

– anterior segment , segmentum anterius, is the largest. It occupies a significant part of the costal surface of the upper lobe, between the I-IV ribs, as well as part of the mediastinal surface, where it comes into contact with truncus pulmonalis ;

- upper lingual segment, segmentumlingulare superius, is a section of the upper lobe between ribs III-V in front and ribs IV-VI in the axillary region;

– lower lingual segment, segmentum lingulare inferius, is located below the upper one, but almost does not come into contact with the diaphragm.

Both lingular segments correspond to the middle lobe of the right lung; they come into contact with the left ventricle of the heart, penetrating between the pericardium and the chest wall into the costomediastinal sinus of the pleura.

In the lower lobe of the left lung there are 5 segments, which are symmetrical to the segments of the lower lobe of the right lung:

– apical segment, segmentum apicale (superius), occupies a paravertebral position;

– medial basal segment, segmentum basale mediale, in 83% of cases it has a bronchus that begins with a common trunk with the bronchus of the next segment, segmentum basale anterius. The latter is separated from the lingular segments of the upper lobe, fissura obliqua, and participates in the formation of the costal, diaphragmatic and mediastinal surfaces of the lung;

– lateral basal segment , segmentum basale laterale, occupies the costal surface of the lower lobe in the axillary region at the level of the XII-X ribs;

– posterior basal segment, segmentum basale posterius, is a large area of ​​the lower lobe of the left lung located posterior to other segments; it comes into contact with the VII-X ribs, the diaphragm, the descending aorta and the esophagus;

– segmentum subapicale (subsuperius) this is not always available.

Pulmonary lobules.

The lung segments consist of fromsecondary pulmonary lobules, lobuli pulmones secundarii, in each of which includes a lobular bronchus (4-6 orders). This is a pyramidal-shaped area of ​​pulmonary parenchyma up to 1.0-1.5 cm in diameter. Secondary lobules are located on the periphery of the segment in a layer up to 4 cm thick and are separated from each other by connective tissue septa, which contain veins and lymphocapillaries. Dust (coal) is deposited in these partitions, making them clearly visible. In both lungs there are up to 1 thousand secondary lobes.

5) Histological structure. alveolar tree, arbor alveolaris.

The pulmonary parenchyma, according to its functional and structural features, is divided into two sections: conductive - this is the intrapulmonary part of the bronchial tree (mentioned above) and respiratory, which carries out gas exchange between the venous blood flowing to the lungs through the pulmonary circulation and the air in the alveoli.

The respiratory section of the lung consists of acini, acinus , – structural and functional units of the lung, each of which is a derivative of one terminal bronchiole. The terminal bronchiole divides into two respiratory bronchioles, bronchioli respiratorii , on the walls of which appear alveoli, alveoli pulmones,- cup-shaped structures lined from the inside with flat cells, alveolocytes. Elastic fibers are present in the walls of the alveoli. At the beginning, along the respiratory bronchiole, there are only a few alveoli, but then their number increases. Epithelial cells are located between the alveoli. In total, there are 3-4 generations of dichotomous division of respiratory bronchioles. Respiratory bronchioles, expanding, give rise to alveolar ducts, ductuli alveolares (from 3 to 17), each of which ends blindly alveolar sacs, sacculi alveolares. The walls of the alveolar ducts and sacs consist only of alveoli, intertwined with a dense network of blood capillaries. The inner surface of the alveoli, facing the alveolar air, is covered with a film of surfactant - surfactant, which equalizes surface tension in the alveoli and prevents their walls from gluing - atelectasis. In the lungs of an adult there are about 300 million alveoli, through the walls of which gases diffuse.

Thus, respiratory bronchioles of several orders of branching, extending from one terminal bronchiole, alveolar ducts, alveolar sacs and alveoli form pulmonary acinus, acinus pulmonis . The respiratory parenchyma of the lungs has several hundred thousand acini and is called the alveolar tree.

The terminal respiratory bronchiole and the alveolar ducts and sacs extending from it form primary lobule lobulus pulmonis primarius . There are about 16 of them in each acini.

6) Age characteristics. The lungs of a newborn have an irregular cone shape; the upper lobes are relatively small in size; The middle lobe of the right lung is equal in size to the upper lobe, and the lower lobe is relatively large. In the 2nd year of a child’s life, the size of the lobes of the lung relative to each other becomes the same as in an adult. The weight of the newborn’s lungs is 57 g (from 39 to 70 g), volume 67 cm³. Age-related involution begins after 50 years. The boundaries of the lungs also change with age.

7) Developmental anomalies. Pulmonary agenesis – absence of one or both lungs. If both lungs are missing, the fetus is not viable. Lung hypogenesis – underdevelopment of the lungs, often accompanied by respiratory failure. Anomalies of the terminal parts of the bronchial tree – bronchiectasis – irregular saccular dilatations of terminal bronchioles. Reverse position of the thoracic cavity organs, while the right lung contains only two lobes, and the left lung consists of three lobes. The reverse position can be only thoracic, only abdominal and total.

8) Diagnostics. An x-ray examination of the chest clearly shows two light “pulmonary fields”, which are used to judge the lungs, since due to the presence of air in them, they easily transmit x-rays. Both pulmonary fields are separated from each other by an intense central shadow formed by the sternum, spinal column, heart and large vessels. This shadow constitutes the medial border of the lung fields; the upper and lateral borders are formed by ribs. Below is the diaphragm. The upper part of the pulmonary field is crossed by the clavicle, which separates the supraclavicular region from the subclavian region. Below the clavicle, the anterior and posterior parts of the ribs intersecting each other are layered onto the pulmonary field.

The X-ray method of research allows you to see changes in the relationships of the chest organs that occur during breathing. When you inhale, the diaphragm lowers, its domes flatten, the center moves slightly downwards - the ribs rise, the intercostal spaces become wider. The pulmonary fields become lighter, the pulmonary pattern becomes clearer. The pleural sinuses “clear up” and become noticeable. The position of the heart approaches vertical, and it takes on a shape close to triangular. When you exhale, the opposite relationship occurs. Using X-ray kymography, you can also study the work of the diaphragm during breathing, singing, speech, etc.

With layer-by-layer radiography (tomography), the structure of the lung is revealed better than with ordinary radiography or fluoroscopy. However, even on tomograms it is not possible to differentiate individual structural formations of the lung. This becomes possible thanks to a special method of x-ray examination (electroradiography). The radiographs obtained using the latter show not only the tubular systems of the lung (bronchi and blood vessels), but also the connective tissue frame of the lung. As a result, it is possible to study the structure of the parenchyma of the entire lung in a living person.

Pleura.

In the chest cavity there are three completely separate serous sacs - one for each lung and one, middle, for the heart.

The serous membrane of the lung is called the pleura, p1eura. It consists of two sheets:

visceral pleura pleura visceralis ;

pleura parietal, parietal pleura parietalis .

A beam of X-ray radiation lowers the entire human body at chest level and gives a summation image of all organs and tissues of the chest on a fluoroscopic screen or film. The image of the lungs is obtained with a layering of the shadow of the surrounding organs and tissues.

On an anterior plain radiograph, the lungs form pulmonary fields intersected by the shadows of the ribs. Between the pulmonary fields there is a median shadow - this is a summary image of all the organs of the mediastinum, including the heart and large blood vessels.

In internal departments pulmonary fields, on the sides of the median shadow, at the level of the anterior ends of the 2nd and 4th ribs, an image of the roots of the lungs is projected, and against the background of the pulmonary fields, a peculiar shadow pattern, which is called the pulmonary pattern, is normally visible. It is mainly an image of the blood vessels that branch in the airy lung tissue.

The ribs cross the pulmonary fields in the form of symmetrical stripes. Their posterior ends start from the articulation with the thoracic vertebrae, are directed more horizontally than the anterior ones, and are convexly facing upward. The anterior sections go from top to bottom, from the outer edge of the sternum inwards. Their convexity is directed downwards. The anterior ends of the ribs seem to break off, not reaching 2-5 cm to the shadow of the mediastinum. This occurs because the costal cartilage absorbs X-rays poorly.

The areas of the lung fields located above the collarbones are called the apices of the lungs. The rest of the lung fields are divided into sections by horizontal lines drawn on each side at the level of the lower edges of the anterior ends of the 2nd and 4th ribs. The upper section extends from the apex to 2 ribs, the middle section from 2 to 4 ribs, the lower section from 4 ribs to the diaphragm.

Projection of the lobes of the lungs in a direct projection: the upper border of the lower lobe runs along the posterior part of the body of the 4th rib, and the lower border is projected along the anterior part of the body of the 6th rib. The border between the upper and middle lobes of the right lung goes along anterior section body 4 ribs. In lateral projection: first, the upper point of the diaphragm contour is found in the image. A straight line is drawn from it through the shadow of the middle of the root until it intersects with the image of the spine. This line approximately corresponds to the oblique interlobar fissure and separates the lower lobe from the upper lobe in the left lung and from the upper and middle lobe in the right. A horizontal line from the middle of the root towards the sternum indicates the position of the interlobar fissure in the right lung, separating the upper and middle lobes.

In a direct projection image, each half of the diaphragm forms a clear arc running from the shadow of the mediastinum to the image of the walls of the chest cavity.

U healthy person 1/3 of the heart shadow is located to the right of the midline of the chest, drawn through the spinous processes of the vertebrae, and 2/3 to the left. The air bubble of the stomach is located on the left under the diaphragm.

Three vertical lines serve as guidelines for determining the position of the mediastinal organs. One of them is carried out along the right edge of the shadow of the spine, the second through the spinous processes of the vertebrae, the third - the left midclavicular. Normally, the left edge of the heart shadow is 1.5-2 cm medially from the left midclavicular line. The right edge of the heart shadow protrudes into the right pulmonary field 1-1.5 cm outward from the right edge of the spine

Lung segments

Segment S1 (apical or apical) of the right lung. Refers to the upper lobe of the right lung. Topographically projected onto the chest along the anterior surface of the 2nd rib, through the apex of the lung to the spine of the scapula.

Segment S2 (posterior) of the right lung. Refers to the upper lobe of the right lung. Topographically projected onto the chest along the posterior surface paravertebrally from the upper edge of the scapula to its middle.

Segment S3 (anterior) of the right lung. Refers to the upper lobe of the right lung. Topographically, 2 to 4 ribs are projected onto the chest in front.

S4 segment (lateral) of the right lung. Refers to the middle lobe of the right lung. Topographically projected onto the chest in the anterior axillary region between the 4th and 6th ribs.

Segment S5 (medial) of the right lung. Refers to the middle lobe of the right lung. Topographically projected onto the chest between the 4th and 6th ribs closer to the sternum.

Segment S6 (superior basal) of the right lung. Refers to the lower lobe of the right lung. Topographically projected onto the chest in the paravertebral region from the middle of the scapula to its lower angle.

Segment S7 (medial basal) of the right lung. Refers to the lower lobe of the right lung. Topographically localized on the inner surface of the right lung, located below the root of the right lung. It is projected onto the chest from the 6th rib to the diaphragm between the sternum and midclavicular lines.

S8 segment (anterior basal) of the right lung. Refers to the lower lobe of the right lung. Topographically delimited anteriorly by the main interlobar groove, inferiorly by the diaphragm, and posteriorly by the posterior axillary line.

Segment S9 (lateral basal) of the right lung. Refers to the lower lobe of the right lung. Topographically projected onto the chest between the scapular and posterior axillary lines from the middle of the scapula to the diaphragm.

Segment S10 (posterior basal) of the right lung. Refers to the lower lobe of the right lung. Topographically projected onto the chest from the lower angle of the scapula to the diaphragm, delimited on the sides by the paravertebral and scapular lines.

Segment S1+2 (apical-posterior) of the left lung. It is a combination of C1 and C2 segments, which is due to the presence of a common bronchus. Refers to the upper lobe of the left lung. Topographically projected onto the chest along the anterior surface from the 2nd rib and upward, through the apex to the middle of the scapula.

Segment S3 (anterior) of the left lung. Refers to the upper lobe of the left lung. Topographically, the 2nd to 4th ribs are projected onto the chest in front.

Segment S4 (superior lingular) of the left lung. Refers to the upper lobe of the left lung. Topographically projected onto the chest along the anterior surface of the 4th to 5th ribs.

Segment S5 (lower lingular) of the left lung. Refers to the upper lobe of the left lung. Topographically projected onto the chest along the anterior surface from the 5th rib to the diaphragm.

Segment S6 (superior basal) of the left lung. Refers to the lower lobe of the left lung. Topographically projected onto the chest in the paravertebral region from the middle of the scapula to its lower angle.

S8 segment (anterior basal) of the left lung. Refers to the lower lobe of the left lung. Topographically delimited anteriorly by the main interlobar groove, inferiorly by the diaphragm, and posteriorly by the posterior axillary line.

Segment S9 (lateral basal) of the left lung. Refers to the lower lobe of the left lung. Topographically projected onto the chest between the scapular and posterior axillary lines from the middle of the scapula to the diaphragm.

Segment S10 (posterior basal) of the left lung. Refers to the lower lobe of the left lung. Topographically projected onto the chest from the lower angle of the scapula to the diaphragm, delimited on the sides by the paravertebral and scapular lines.

An X-ray of the right lung is presented in a lateral projection indicating the topography of the interlobar fissures.

The lungs are located in the chest, occupying most of it, and are separated from each other by the mediastinum. The sizes of the lungs are unequal due to the higher position of the right dome of the diaphragm and the position of the heart, shifted to the left.

Each lung has lobes separated by deep fissures. The right lung consists of three lobes, the left - of two. The right upper lobe accounts for 20% of the lung tissue, the middle lobe - 8%, the lower right lobe - 25%, the upper left lobe - 23%, the lower left lobe - 24%.

The main interlobar fissures are projected on the right and left in the same way - from the level of the spinous process of the 3rd thoracic vertebra they are directed obliquely down and forward and cross the 6th rib at the place where its bony part transitions into the cartilaginous part.

An additional interlobar fissure of the right lung is projected onto the chest along the 4th rib from the midaxillary line to the sternum.

The figure shows: Upper Lobe - upper lobe, Middle Lobe - middle lobe, Lower Lobe - lower lobe

Right lung

Upper lobe:

• apical (S1);
• rear (S2);
• anterior (S3).

Average share :

• lateral (S4);
• medial (S5).

Lower lobe :

• upper (S6);
• mediobasal, or cardiac (S7);
• anterobasal (S8);
• posterobasal (S10).

Left lung

Upper lobe:

• apical-posterior (S1+2);
• anterior (S3);
• upper reed (S4);
• lower reed (S5).

Lower lobe :

• upper (S6);
• anterobasal (S8);
• lateralobasal, or laterobasal (S9);
• posterobasal (S10).

4. Basic radiological syndromes lung diseases:

X-ray symptoms are divided into two large groups. The first group occurs when the air tissue is replaced by a pathological substrate (atelectasis, edema, inflammatory exudate, tuberculoma, tumor). The airless area absorbs x-rays more strongly. An area of ​​darkening is identified on the x-ray. The position, size and shape of the darkening depends on which part of the lung is affected. The second group is caused by a decrease in the volume of soft tissues and an increase in the amount of air (bloating, cavity). In the area of ​​rarefaction or absence of lung tissue, X-ray radiation is delayed less. The radiograph reveals an area of ​​clearing. The accumulation of air or fluid in the pleural cavity produces darkening or clearing. If changes form in the interstitial tissue, these are changes in the pulmonary pattern. X-ray examination identifies the following syndromes:

• a) extensive darkening of the pulmonary field. With this syndrome, it is important to determine the presence or absence of mediastinal displacement. If the darkening is on the right, then the left contour of the middle shadow is studied, if on the left, then the right contour.

Shift of the mediastinum to the opposite side: effusion pleurisy (uniform shadow), diaphragmatic hernia(shade is not uniform)

No mediastinal displacement: inflammation in the lung tissue (pneumonia, tuberculosis)

Shift to the healthy side: obstructive atelectasis (uniform shadow), lung cirrhosis(heterogeneous shadow), pneumonectomy.

• b) limited dimming. This syndrome can be caused by disease of the pleura, ribs, mediastinal organs, and intrapulmonary lesions. To clarify the topography, it is necessary to perform a lateral photograph. If the shadow is inside the lung and is not adjacent to the chest wall, diaphragm, or mediastinum, then it is of pulmonary origin.

Size corresponds to lobe, segment (infiltration, edema)

Reduction in the size of a lobe or segment (cirrhosis - heterogeneous shadow with clearing, atelectasis - homogeneous)

The dimensions of the compacted area are not reduced, but there are rounded clearings (cavities) in it. If there is a level of fluid in the cavity, then there is an abscess; if the cavity is without fluid, then there is tuberculosis; multiple cavities can be due to staphylococcal pneumonia.

• c) round shadow.

Shadows with a diameter of more than 1 cm, shadows with a diameter of less than 1 cm are called a focus. To decipher this syndrome, I evaluate following signs: shape of the shadow, relationship of the shadow with surrounding tissues, contours of the shadow, structure of the shadow. The shape of the shadow can determine the intrapulmonary or extrapulmonary location of the lesion. An oval or round shadow, most often with an intrapulmonary location, more often it is a cavity filled with fluid (cyst). If the shadow is surrounded on all sides by lung tissue, then it comes from the lung. If the formation is located near the wall, then it comes from the lung, if the largest diameter is in the pulmonary field and vice versa. Fuzzy contours are usually a symptom of an inflammatory process. Clear contours are characteristic of a tumor, fluid-filled cyst, or tuberculoma. The structure of the shadow can be homogeneous or heterogeneous. Heterogeneity may be due to areas of clearing (more dense areas - lime salts, calcification)

• d) ring-shaped shadow

If the ring-shaped shadow in different projections appears within the pulmonary field, this is an absolute criterion for the intrapulmonary cavity. If the shadow has the shape of a semicircle and its wide base is adjacent to the chest, this is an encysted pneumothorax. Wall thickness is important: thin walls (air cyst, tuberculosis cavity, bronchiectasis), uniformly thick walls (tuberculosis cavity, abscess, if there is a fluid level). Multiple ring-shaped shadows can be various reasons: polycystic lung disease (distributed throughout the lung, diameter more than 2 cm), tuberculosis with several cavities (various in diameter), bronchiectasis (mainly at the bottom, diameter 1-2 cm).

• e) foci and limited disseminations

These are shadows with a diameter of 0.1-1cm. A group of lesions close to each other, spread over two intercostal spaces is limited dissemination, scattered in both lungs is diffuse.

Distribution and location focal shadows: apexes, subclavian zones - tuberculosis, bronchogenic dissemination occurs with focal pneumonia, tuberculosis.

Contours of lesions: sharp contours, if localized at the apex, then tuberculosis, if in other parts, then peripheral cancer in the presence of a single focus in another part of the lung.

Shadow structure. Uniformity indicates focal tuberculosis, heterogeneity about tuberculoma.

The intensity is assessed by comparison with the shadow of the blood vessels of the lungs. Low-intensity shadows, in density close to the longitudinal section of the vessels, medium intensity, like the axial section of the vessel, dense lesion, more intense than the axial section of the vessels

• f) widespread dissemination of foci. A syndrome in which lesions are scattered over a large portion of one or both lungs. A picture of pulmonary dissemination can be given by many diseases (tuberculosis, pneumonia, nodular silicosis, nodular tumors, metastases, etc.). For diagnosis, the following delineation criteria are used:

Sizes of lesions: miliary (1-2mm), small (3-4mm), medium (5-8mm), large (9-12mm).

Clinical manifestations (cough, shortness of breath, fever, hemoptysis), onset of the disease.

Predominant localization of lesions: unilateral, bilateral, in the upper, middle, lower parts of the pulmonary fields.

Dynamics of foci: stability, fusion into infiltrates, subsequent disintegration and cavity formation.

• g) pathological changes in the pulmonary pattern. This syndrome includes all deviations from X-ray picture normal pulmonary pattern, which is characterized by a gradual decrease in the size of the shadows from the root to the periphery. Changes in the pulmonary pattern occur with congenital and acquired disorders of blood and lymph circulation in the lungs, diseases of the bronchi, inflammatory and degenerative-dystrophic lesions of the lungs.

Strengthening the pulmonary pattern (increasing the number of pattern elements per unit area of ​​the pulmonary field) occurs with arterial congestion of the lungs (heart defects), compaction of the interlobular and interalveolar septa (pneumosclerosis).

Deformation of the roots of the lungs (in addition to vascular shadows, the images show the lumen of the bronchi, stripes from fibrous cords in the lung tissue). Associated with proliferation and sclerosis of the interstitial tissue of the lung.

Depletion of the pulmonary pattern (reduction in the number of pattern elements per unit area of ​​the pulmonary field)

• h) pathological changes lung root. The anatomical substrate of root damage can be the following processes: infiltration of the fiber of the hilum of the lung, sclerosis of the hilum fiber, enlargement of the lymph nodes in the root. Unilateral lesion - tuberculous bronchoadenitis, central cancer, which leads to atelectasis, bilateral lesion - lymphocytic leukemia, lymphogranulomatosis, metastases to the lymph nodes from a tumor of any location. If there is pathology of the lung, then changes in the root are secondary. The conclusion is made taking into account the clinical manifestations and the patient’s age.
• i) extensive clearing of the pulmonary field (increased transparency of a significant part or the entire pulmonary field). These changes occur with pneumothorax, chronic emphysema, and a large air cavity. Pneumothorax is characterized by the absence of a pulmonary pattern; emphysema is characterized by an increase in both pulmonary fields, an increase in their transparency, a low position and flattening of the diaphragm.

Bronchoscopy

Bronchoscopy is a method of examining the trachea and bronchi from the inside using flexible and rigid (rigid) devices (endoscopes), used for diagnostic and therapeutic purposes.

There are flexible and rigid bronchoscopy.

Method of performing flexible bronchoscopy.

A flexible bronchoscope resembles a gastroscope, only the endoscope for examining the trachea and bronchi is smaller: the length of the tube inserted into the patient’s body does not exceed 60 cm, and the diameter is 5-6 mm. This diameter of the inserted tube does not lead to breathing problems during the procedure. The doctor sees the image of the respiratory tract in the eyepiece or it is shown on the monitor.

A flexible bronchoscope is inserted into one of the nasal passages and passed through the vocal cords into the trachea and bronchi. If the nasal passages are narrow or the nasal septum is deviated, the endoscope is passed through the mouth (as with gastroscopy).

Before insertion of a flexible bronchoscope, local anesthesia of the nasal mucosa and oral cavity is performed with lidocaine. If lidocaine is intolerant, bronchoscopy is performed in intensive care under general anesthesia (anesthesia) while maintaining spontaneous breathing. During the study, the patient is under continuous supervision of the doctor performing the procedure and a nurse assisting him, who has undergone special training and has experience. Bronchoscopy is a painless procedure, does not lead to breathing problems due to the small diameter of the bronchoscope and is quite well tolerated by patients.

Technique for performing rigid bronchoscopy.

A rigid bronchoscope is a set of hollow tubes of different diameters from 9 mm to 13 mm, which are connected to a light source and a device for forced breathing (artificial ventilation). (slide showing an endoscope) A rigid bronchoscope is inserted into the mouth and then through the vocal cords into the trachea and large bronchi.

Rigid bronchoscopy is performed in the operating room under general anesthesia. During the procedure, monitoring equipment is connected to the patient and the body’s vital signs are reflected on the monitor, which makes it possible to promptly prevent negative reactions of the body and increases the safety of the procedure.

Currently, rigid bronchoscopy is exclusively therapeutic in nature, while flexible bronchoscopy is performed for both therapeutic and diagnostic purposes.

Indications for bronchoscopy

In patients over 45 years of age with a long history of smoking for timely diagnosis of tumor diseases;

To diagnose tumor diseases in the early stages, when there are still no radiological signs of a tumor;

Suspicion of a tumor (malignant or benign) in the trachea, bronchi, lung;

To determine the extent of the tumor process and decide on surgery or chemotherapy, radiation treatment, photodynamic and laser therapy;

The appearance of hemoptysis (the presence of blood in the sputum when coughing);

Suspicion of injury to the respiratory tract (trachea and bronchi);

Protracted pneumonia, lack of dynamics in the treatment of pneumonia, recurring (recurrent) pneumonia;

Prolonged cough, change in cough character;

Suspicion of a foreign body in the respiratory tract or identification of a foreign body during an X-ray examination;

Suspicion of pulmonary and bronchial tuberculosis;

With formations in the mediastinum and enlargement of the mediastinal lymph nodes (lymphadenopathy);

Diffuse (interstitial) lung diseases: fibrosing alveolitis, granulomatosis, vasculitis with collagenosis, diseases with alveolar accumulation (proteinosis), multiple foci of a tumor nature (pulmonary dissemination);

Inflammatory diseases lungs (abscesses, bronchiectasis);

Chronic bronchitis, bronchial asthma, accompanied by difficult discharge of bronchial secretions, outside the exacerbation phase;

Narrowing of the lumen of the respiratory tract (trachea, bronchi) due to tumors (tumor stenosis), scars (cicatricial stenosis) or due to external compression (compression stenosis)

The presence of a defect in the bronchus communicating with the pleural cavity (bronchopleural communication or fistula

Contraindications for bronchoscopic examination:

1) Asthmatic status;

2) Chronic obstructive bronchitis or bronchial asthma in acute period;

3) Acute myocardial infarction and acute disorder cerebral circulation;

4) Acute or new-onset cardiac arrhythmia; unstable angina;

5) Severe degree of heart failure (III degree);

6) Severe degree pulmonary insufficiency(III degree): with the volume of forced expiration in 1 second. less than 1 liter according to the external respiration function; when the carbon dioxide content in the blood is over 50 mm Hg and the oxygen content in the blood is below 70 mm Hg. according to the determination of blood gases;

7) Mental disorders, epilepsy, loss of consciousness after brain injury or visible reasons without preliminary treatment and the opinion of a neurologist and psychiatrist;

8)Aneurysm thoracic aorta;

Changes in the mechanical properties of the lungs associated with intraoperative factors and anesthesia

Instrumental research. X-ray examination of the lungs

Methodological features of therapeutic exercises for nonspecific lung diseases in children

Mechanics of breathing. Mechanism of inhalation and exhalation. Dynamics of pressure in the pleural fissure in the lungs during the respiratory cycle. The concept of ETL.