Differential radiological diagnosis of damage to the joints of the hand in rheumatic diseases. Technique for reading radiographs

• To confirm the diagnosis of bronchitis
• To distinguish between bronchitis and pneumonia
• To detect signs of obstruction (“blockage” of the airways - bronchi), a condition manifested by a violation of normal ventilation of the lungs and normal blood gas composition.

Indications for a chest x-ray for suspected bronchitis

Blood changes (appearance in the blood large quantity leukocytes, mainly “young forms”, acceleration of ESR - all these are signs of an inflammatory process);

Ineffectiveness of previous treatment (if the picture was not taken initially);

Monitoring the effectiveness of treatment and recovery.

Contraindications for examination

Relative contraindications are the patient’s serious condition and pregnancy. However, in cases requiring careful diagnosis, when the health risk is too great, the study is carried out in any case - the patient’s abdomen and pelvis are shielded from x-rays.

How often can an x-ray be taken?

Signs of bronchitis on x-ray

• decreased structure of the lung root;
• some increase, vagueness;
• blurred contours;
• enhanced and greatly altered pulmonary pattern;
• thickening of the walls of the bronchi (so-called “tram rails”)

Signs of bronchial obstruction:

1. increasing the transparency of the pulmonary background (the amount of air in the alveoli increases, and air is a medium transparent to x-rays.

2. low position of the diaphragm (it seems to be pushed downwards by the pressure of the inflated lungs)

• the appearance of tissue areas completely devoid of blood vessels (avascularized);
• intense disruption of the pulmonary pattern (due to the vascular component);
• identification of the walls of air bubbles (bullae).

Signs of chronic bronchitis on computed tomography:

• increase in the lumen of the bronchi;
• thickening of the walls of the bronchi (mainly due to inflammation);
• narrowing of the lumen of the arteries;
• the appearance of local foci of compaction of lung tissue.

Standard X-ray Description for Chronic Bronchitis

CT scan for chronic obstructive bronchitis

We observe thickening of the walls of the bronchi, a clear predominance of the width of their lumen over the width of the lumen of nearby arteries, mucus plugs and fluid levels in some of them.

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Pathology of the lungs on an x-ray: roots, cysts and shadows

Lung pathology on X-ray is determined not only by abnormal clearing and darkening. Before starting to formulate an x-ray examination protocol, the radiologist examines other tissues so that not a single smallest detail is missed on the x-ray.

What does lung pathology look like on an x-ray?

The pathology of the lungs on an x-ray is described by the following x-ray syndromes:

1. Total blackout.
2. Limited dimming.
3. Round shadow.
4. Single shadow.
5. Ring shadow.
6. Subsegmental darkening.
7. Enlightenment.

There are other radiological syndromes, but they are less frequently seen on chest films.

In addition to the formations described above, the doctor also pays attention to the roots of the lungs, the pulmonary pattern, and the condition of the mediastinum.

X-ray signs of pulmonary embolism (M. Hofer diagram)

What does the root of the lung look like on x-ray?

On a chest x-ray, the roots of the lungs can be traced on either side of the median shadow in the medial parts of the lung fields. They are formed by a combination of arterial and venous vessels, a group of lymph nodes and nerve trunks. The main role in forming their image in the image is played by veins and arteries.

When reading an x-ray, the doctor classifies the roots into 3 component sections:

• head – formed by shadows large vessels, branches of the pulmonary artery;
• body - formed by branches of the pulmonary artery and other vessels;
• tail - formed by veins that have a horizontal direction.

Based on their structure, roots are divided into:

In the main type, the root head is represented by a massive formation, which is mostly represented by the pulmonary artery. The crumbly structure is characterized by pronounced heaviness, most of which consists of branches from arteries and veins.

On an X-ray, with a scopic examination (transillumination), you can see a cluster of enlarged lymph nodes against the background of the roots in case of viral or bacterial infections. These formations do not belong to functional structures normally, but appear during inflammation of the lymphatic vessels.

Pathological roots in the image appear in several morphological variants:

• little structure;
• increase;
• projection overlay;
• displacement;
• strengthening;
• vascular type deformation;
• fibrous compaction.

If a radiologist indicates in the description protocol that the roots have little structure, this may mean growth in them fibrous tissue(after inflammation or in old age), which makes it difficult to visualize in the image.

Tyazhist roots of the vascular type occur in heart diseases and increased blood pressure when stagnant changes in the small circle of blood supply are observed.

Root deformation of the vascular type occurs when chronic diseases lungs with the formation of bronchiectasis (cavities in the wall of the bronchi).

Displacement of the midline structures is observed with atelectasis of the pulmonary segments, tumors, fluid accumulation in pleural cavity.

What is total blackout

On an x-ray, total darkening on a lateral and direct photograph of the lungs is characterized by a white shadow that occupies most of the lung field. It can be one-sided or two-sided. The causes of the syndrome are toxic pulmonary edema or heart disease, which are accompanied by severe hemothorax.

X-ray limited opacification syndrome is accompanied by a white spot that does not extend beyond the pulmonary lobe or segment. Pathology occurs in cancer, tuberculosis, and lobar pneumonia. If there is a syndrome in the image, the radiologist needs to establish the exact localization of the darkening by segments. Often, simultaneously with this pathology, the roots of the lung are deformed due to inflammatory changes.

Subsegmental darkening occupies some part of the pulmonary segment, but does not completely cover it.

How dangerous is a round and single shadow on a photo of the lungs?

A round shadow on an x-ray has limited localization with round or oval contours more than 1.5 cm in diameter. In the presence of this syndrome, it is necessary to establish the localization of the pathological process. It can be located intra- or extrapulmonary. Causes may include pleural mesothelioma, diaphragm hernia and rib tumors.

What structures of the chest organs give a round shadow:

If several round shadows are noted on an x-ray of the lungs, these are most likely cancer metastases.

How does a lung cyst appear on an x-ray?

A lung cyst appears as a ring-shaped shadow on an x-ray. It was decided to describe this X-ray syndrome separately because the pathology in the image is rarely observed, so radiologists forget its specific manifestations. The disease is missed when deciphering lung images if the doctor does not prescribe a lateral projection. If the cyst has thin walls, it is not clearly visible on direct radiographs. Only when it increases in size or accumulates liquid contents inside it is it possible to see the formation in the image if it is small in size.

X-ray and CT scan of a pericardial cyst

A cyst is a cavity in the lungs that has a fibrous outer lining. Inside, it may be lined with bronchial epithelium. The transparent, straw-colored liquid inside it is caused by glandular secretions.

Obviously, the pathology on an X-ray of the lungs is determined by a combination of many shadows. They form the doctor’s understanding of the state of the human chest organs. Only after studying radiological syndromes can you read radiographs.

Pneumonia on X-ray

Despite the big breakthrough, medicine still cannot make a diagnosis of pneumonia without confirmation clinical symptoms x-ray. It is very difficult to cure the disease in children, due to the characteristics of their body. Sometimes radiological signs are the only thing that speaks in favor of lung disease in children.

In addition, without x-rays it is difficult to talk about recovery. Only if the signs of pneumonia have completely disappeared in the picture can the doctor stop taking the medications.

Efficiency of the method

You need to know that a lung scan will not show all diseases. Asthma, bronchitis - all of them are beyond the scope of the x-ray. This is due to the fact that infectious agents do not affect lung tissue on the same scale as pneumonia.

Even if a person coughs a lot, feels unwell and weak, but blood tests are close to normal, the likelihood that there is pneumonia is minimal. All of these symptoms speak in favor of a common cold.

An x-ray is performed only if there is a serious suspicion of pneumonia, and this is especially true for children.

Indications

X-rays are not prescribed for everyone. The following indications are available for directing the image:

1. A person has been bothered for a long time by a strong cough with sputum, accompanied by high temperature, chills, and clinical tests blood indicate inflammation (acceleration of ESR and leukocytosis).
2. The need to repeat x-rays for pneumonia when its focal or lobar forms are being treated. This is necessary to monitor changes in the lung tissue in order to understand whether the selected drug therapy is benefiting the patient.

The pictures show others serious illnesses which the doctor may suspect.

Contraindications

There are no absolute contraindications for taking pictures of pneumonia. There is only a relative one - for pregnant and breastfeeding women. But if the doctor has a strong suspicion of the disease, then it is better to check than to take antibiotics without reason. The medical personnel responsible for the procedure try to protect the woman as much as possible from unnecessary exposure. To do this, the multiplicity of images is reduced to a minimum, and the irradiation area is reduced, if possible.

Focal pneumonia

This type of pneumonia makes you think about yourself after certain signs. These are wheezing, annoying cough, increased body temperature. The laboratory will show only a slight increase in the number of leukocytes.

Focal pneumonia is not always detected on x-rays. The onset of the disease is characterized by slight infiltration of the lung tissue, which is not clearly visible on the lung image. But based on additional symptoms, the doctor may still suspect pneumonia on an x-ray:

• Darkening of an area of ​​lung tissue.
• Expansion of the roots of the lungs due to their saturation with infiltrate.
• X-ray diagnosis of pneumonia can reveal the appearance of pleural fluid levels.
• A change in the pulmonary pattern with slightly defined boundaries is visible.

X-ray of the lungs for pneumonia is very helpful in making a diagnosis when the disease has already developed. The appearance of foci of darkening indicates a deterioration in the airiness of the lungs.

At first, the infiltration is barely noticeable; only an experienced radiologist can understand that small dark islands indicate a disease. After some time, impregnation with cellular elements and inflammatory mediators in the affected area forms a regular focus of inflammation.

How to recognize focal pneumonia?

There are certain signs by which this form of the disease is diagnosed:

1. A heterogeneous shadow that is clearly visible in a uniform pattern of the lung;
2. “Blurred” edges of the shadow: it is impossible to tell what shape it is and where its boundaries lie.
3. During the addition of pleurisy, the upper level of exudate on the side of inflammation is visualized.
4. During the resorption of the infiltrate, the darkened area becomes more inhomogeneous than it was at the height of the disease. This is explained by the disintegration of the lesion into smaller parts and their resorption.

What does the resolution stage look like?

When the lungs are healing, pneumonia looks a little different on X-ray:

• The darkened area completely disappears; only an experienced clinician can see the residual phenomena (dots and “veins”) in the image.
• Linear stringy lines (bundles of narrow shadows that are located almost parallel to each other or fan-shaped from one point).
• Adhesions leading to adhesion of the pleura.

After the final liberation of the lungs from the pathological flora, the past pneumonia in the picture reminds of itself with a slight change in the pattern.

To monitor remission, patients are given a repeat scan a month after treatment. This rule does not apply to children either.

Lobar pneumonia

If the x-ray shows a large darkening of medium intensity, there is reason to suspect lobar pneumonia. The favorite localization site for microorganisms is one or two pulmonary lobes. Unfortunately, at the moment lobar pneumonia is one of the most dangerous diseases.

Signs

X-ray diagnostics of pneumonia has made great progress. A doctor can confidently diagnose lobar pneumonia if he sees the following symptoms:

1. Shift of the mediastinum to the painful side.
2. Changing the localization of the diaphragm dome.
3. The presence of pleural fluid between the layers of the pleura and in its sinuses.
4. Diffuse change in lung pattern.
5. Presence of cords on the roots of the lungs.
6. One-sided shadows caused by decreased pneumatization of the “main” respiratory organ.

Lobar pneumonia is diagnosed on a plain chest x-ray. But to clarify the size of pathological foci, it is recommended to take a picture not only in a direct, but also in a lateral projection. It is very important, especially in children, to know the size of the infiltrate in order to have an idea of ​​how the condition of the lung tissue has changed during treatment.

Signs in children

If your child is sick for several days without any reason, and he has no other symptoms other than fever, you can suspect that your baby has pneumonia. Clinical signs of pneumonia in children include:

• Small areas of darkening, mainly in the lower lobes of the lungs.
• Small size lesions (in most cases these are small focal shadows of 1–2 mm).
• Visually, the mediastinal lymph nodes are within normal limits.

At the end of the disease, traces of infiltration remain for up to seven days.

Decoding

The images are read by a radiologist. It is he who writes the conclusion and passes it on to the therapist who sent the photo. The radiograph evaluates the number, shape and size of the shadow, as well as its location.

The x-ray is a negative, so what is called a shadow actually appears as a white area. The infiltration of the tissue is a compaction, and when X-rays pass through it, darkened areas are formed.

The following types of shading are distinguished:

• 1–2 mm (finely focal).
• 3–7 mm (medium focal).
• from 8 to 12 mm (large).
• 12 mm and more (focal).

The shape of the shadows can be different: spindle-shaped, ring-shaped, round, regular and irregular. correct form.

According to the degree of intensity, there are 3 groups:

1. Dark relative to bones – low intensity.
2. Transparency, like bone tissue, is medium.
3. Similar to metal intensity - high.

It means that high intensity conceals a very low pneumatization of this area of ​​the lungs, while low indicates the usual airiness of the tissue.

Changes in other organs

When pneumonia occurs, it is not only the lung tissue that is affected. The roots of the lung, the diaphragm and the layers of the pleura - all of them can indicate in favor of the disease.

A change in the roots of the lungs in the image implies an enlargement of the lymph nodes and a disruption of the microcirculation of this area. The bronchi are not visible on an X-ray photo of a healthy person, and their detection indicates an inflammatory process. They look like ring-shaped shadows.

In some cases, with pneumonia, deformation of the diaphragm wall occurs due to the presence of pleural fluid in the sinuses.

Photo of a healthy person

To understand what the radiologist focuses on, you need to know the description of the x-ray image of a healthy person:

• Absence of dark areas in all lung fields.
• Roots are structural.
• The aperture boundaries are not changed.
• The mediastinum is of normal size.
• Costophrenic sinuses without features.

If the X-ray photo matches that of a healthy person, the course of treatment can be stopped.

Many people are interested in whether it is possible to do without “irradiation”? Yes, for pneumonia, radiography is not necessary. But this affects the level of diagnosis of the disease, as well as control over the release of the patient’s lungs from microbial agents. Therefore, after the doctor’s prescriptions, you need to follow all his instructions in order to prevent the infection from harming the body in time.

X-ray of the lungs - norm and pathology (on a digital X-ray)

X-ray of the lungs is a summation image of the soft tissues of the chest. Along the path of X-rays, some structures absorb and others reflect radiation. Such a game is displayed on x-ray film or digital media.

A radiologist reads an x-ray consisting of a complex of white and gray shadows. Their combination forms an image, which a specialist deciphers and makes a description.

Our specialists are ready to interpret readers’ X-ray images for free. We also suggest that you carefully understand on your own the complex of X-ray darkening and clearing.

X-rays of the lungs are normal

X-ray images of the lungs (chest organs) are analyzed according to the “PoChiFora and InRiCoS” scheme. How to decipher these terms:

This algorithm is taught to medical university students preparing to become radiologists.

Consider, for example, an x-ray of a normal lung:

It visualizes a lot of darkening and lightening (white and black), which can intimidate readers. In fact, this radiograph is easy to decipher (see next image)

All anatomical structures are labeled on the radiograph to make it easy for readers to understand. We suggest you remember the intensity of the lung fields. The norm does not imply the presence of pathological darkening (white) and lightening (dark), which are not in the image.

If you get your eye on it, you will learn to clearly distinguish normal from pathology.

X-ray of healthy lungs, how to read

X-rays of healthy lungs should be described according to the classical standard. First, entries are made about pathological X-ray syndromes, then the pulmonary fields, roots, domes of the diaphragm, costophrenic sinuses, cardiac shadow and soft tissues.

Classic algorithm for describing healthy lungs:

• In the pulmonary fields without visible focal and infiltrative shadows;
• The roots are not expanded, structural;
• The contours of the diaphragm and costophrenic sinuses are without features;
• Heart shadow of normal configuration;
• Soft tissues without any features.

The above radiograph fits this description.

X-ray of the chest organs with pneumonia - pathology

An x-ray of the lungs with pneumonia is a classic manifestation of pathology. We give an example of an image of inflammatory changes in lung tissue (pneumonia), so that readers understand how normal differs from pathology.

We suggest that you familiarize yourself with the pictures below for pneumonia and normal conditions. Answer the question: which x-ray is normal and which is pathological? Determine which x-ray shows pneumonia.

Let us tell you that the darkening is small and localized above the diaphragm.

X-ray of healthy lungs is a classic of radiology, since radiology is focused on detecting tuberculosis, cancer and pneumonia.

Reading the X-ray

On the presented radiograph of the lungs, an infiltrative shadow is visualized in the supradiaphragmatic zone on the left. The roots are heavy. The costophrenic sinuses are not veiled. Heart shadow of a classic configuration. No pathology in soft tissues can be traced.

Conclusion: X-ray signs of left-sided segmental pneumonia. An X-ray of the chest organs in the left lateral projection is recommended to establish the localization of the darkening.

Digital X-ray – what is it and how to read it

Digital radiography is a product of modern developments in radiology. In the era of the birth of X-ray diagnostics, in order to obtain an image after X-rays passed through the anatomical structures of the body, it was necessary to use fixatives and developers to create a photo negative. The process is similar to how photographers develop film.

Modern technologies have made it possible to get rid of this labor-intensive procedure. Digital research has replaced film. They involve the use of special sensors that record the intensity of the rays at the exit from the object of study and transmit information to software. It analyzes the signals and displays a digital image on the screen. It is analyzed by a radiologist. When reading the image, the specialist has the ability to enlarge or reduce the image, convert a negative into a positive, and many other functions.

A normal chest x-ray does not differ from digital image from the film analogue. However, the novice radiographer will need to get used to the technology, as the X-ray shadows it produces are somewhat different from those produced by film.

Conclusion or why x-rays are needed

Despite the emergence of other promising diagnostic methods (MRI, CT), lung radiography remains a popular and promising technique. It allows you to identify infiltration of lung tissue and track the patient’s treatment process over time. The method is accessible to everyone and is not expensive, unlike computed tomography and magnetic resonance imaging.

For these reasons, medicine needs x-rays, and modern technologies will not be able to displace it even in the distant future.

Any conclusion from our doctors is not a call to action before consulting with a personal doctor!

When to panic: photos of what should not be on an x-ray of healthy lungs

Radiation diagnostics - medical science about use electromagnetic radiation to obtain images of the internal organs of the human body.

Based on these images, doctors make diagnoses by assessing the condition of organs and their functions,

X-rays can also detect pathological formations.

X-ray of the lungs: what is it done for?

Radiography is a method of studying the internal structure of the body using radiation, in which the resulting image of an object is recorded on a physical medium - x-ray film.

Reference! X-ray is the most widely used method for examining the lungs.

The doctor prescribes a chest x-ray if there is a suspicion of:

• pneumonia;
• pleurisy;
• pulmonary form of tuberculosis;
• neoplasms in the chest area;
• diseases associated with the characteristics of professions - pneumoconiosis (dust diseases: silicosis, carboconiosis, metalloconiosis, silicosis, etc.);
• sarcoidosis;
• presence of a foreign body in the respiratory tract;
• heart disease and other cardiac pathologies;
• chest injury.

What healthy lungs look like on an X-ray

X-rays normally show the following structures:

Pulmonary fields. The lungs are projected on an x-ray as pulmonary fields. The mediastinal organs have their own anatomical features, which determines the difference between these fields: the right one is short and wide, the left one is longer and narrower, this is a normal case.

In a healthy person, these areas are transparent, as they are filled with air, which does not reflect radiation. The pulmonary fields are intersected by smooth and clear stripes - costal shadows, running obliquely.

Important! The places where the ribs are attached to the sternum are not shown, since this joint is represented by cartilage, which weakly reflects X-rays.

Norm for other elements

In the superolateral part, images on both sides can be determined (mainly in men) triangular shape non-intense additional shadows of the pectoral muscles.

In women, the mammary glands are visible in the lower area of ​​the image. Also, shadows of the mammary glands can be visible in older men.

Reference! The root of the lung is a complex of certain anatomical structures that passes through the hilum of the lung and connects the lung with organs located in the mediastinum.

This complex contains the pulmonary artery and vein, bronchi, lymph nodes and vessels, nerves, tissue and pleura. The main element in this shadow formation is the vascular-bronchial component, while other structures are covered by the mediastinum.

The shadows of the roots are organized asymmetrically: the left root is higher than the right one by one edge. They are heterogeneous, their width is no more than 1.5 cm.

Reference! Pulmonary drawing - display of blood vessels of the pulmonary circulation. It looks like intertwining thin strands of shadows.

Towards the peripheral part of the lung, its visibility is weakened, as the number and diameter of the vessels decreases. The pulmonary fields are delimited below by the shadow of the upward-facing dome of the diaphragm.

Under the left dome you can see 1-2 clear spots - this is gas at the bottom of the stomach.

On the inferolateral sides, between the shadow of the diaphragmatic dome and the chest wall there are sharp angles - the cardiophrenic sinuses.

Pathologies

On a chest x-ray of a healthy person you cannot see:

1. Airways. At the level of the VI vertebra, the larynx passes into the trachea, which continues to the IV or V thoracic vertebrae. Here it is divided into the main bronchi: right and left.
2. Trachea and bronchi. In a healthy person, they are not visible on an x-ray because their walls are too thin to reflect radiation. They are visible only when the tracheobronchial tree is displaced to the affected side (with atelectasis - collapse of the lung), pleural effusion, pneumothorax (presence of air in the pleural cavity).
3. The lymph nodes. They can be detected during inflammation in the main bronchi and during cancer metastasis in the form of enlarged round spots with smooth contours.
4. Articulations of ribs and sternum. Calcification of the first rib occurs in flight. Ossification of the cartilaginous part of the remaining ribs appears after 50 years with various pathologies of the endocrine system.

White spots

White spots (focal opacities) in the lungs may be a sign of:

• pneumonia (indistinct, blurry contours, varying intensity);
• tumors;
• atelectasis (triangular in shape; the end is directed towards the root, coincides with the size of the segment);
• tuberculosis (various).

Photo 1. An example of how an X-ray of a healthy person’s lungs should not look like: an image with a tumor.

Cavity

The cavity indicates:

Small lesions

Small scattered foci can be detected when:

A high position of the diaphragm cone is possible with postthromboembolic syndrome.

With emphysema, the diaphragm becomes flattened.

Deformation of the heart shadow indicates disease of cardio-vascular system or pathology of the mediastinal organs.

What determines the quality of an x-ray image?

Chest radiography is one of the most informative methods diagnostics respiratory system, if it is done correctly and correctly deciphered by the doctor. In this case, it is necessary to follow the rules of installation and procedure.

Factors influencing the result of X-ray diagnostics:

1. Symmetrical body position. If the patient does not stand straight during the procedure, the sternoclavicular joints will be located asymmetrically, which can be considered rotation of the thoracic vertebrae.
2. Image hardness. Medium hardness is preferable, since with a soft image some formations may not be visible, but with a hard image, on the contrary, unnecessary shadows (artifacts) will appear, which a specialist may mistake for pathology.
3. Concomitant diseases that may affect the chest.
4. Completeness of coverage (a good image contains the apexes of the lungs above and the costophrenic sinuses below).
5. The shoulder blades should be positioned on the outside of the chest to avoid distortion of the image.
6. Image clarity. The patient is asked not to breathe during the shooting to immobilize the musculoskeletal system of the chest.
7. Contrast. Configured by a doctor on the device; The radiation power is set depending on the patient’s muscle and fat mass.

Photo 2. To receive good result The patient is required to stand straight and hold his breath for a short time.

Useful video

Check out this video that details what a normal lung scan looks like and what a healthy person shouldn't have.

I have never had a sore throat or pneumonia, and I don’t smoke. So for me, fluorography once a year is enough. I hope that the doctors are specialists and if something happens they will see the problem, but so far everything is fine with my lungs.

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An online magazine about tuberculosis, lung diseases, tests, diagnostics, medications and other important information about it.

In radiology, the spot is called a shadow. A spot-like shadow less than 1 centimeter in diameter is a focal shadow. A focal shadow is a lesion whose size ranges from 0.1 cm to 1.0 cm. These pathological lesions are characteristic of various nosological forms. By origin, these lesions can be of inflammatory and tumor origin, and are also caused by hemorrhage, edema, and atelectasis. X-ray experience proves that lesions in the lungs occur in inflammatory diseases that pathologically change the structure of the pulmonary parenchyma. In our country, foci are also characteristic of tuberculosis (focal tuberculosis). In practice, it often occurs when there are 2-3 lesions in one lung, then radiologists talk about a group of lesions in the lung. Inexperienced and young specialists mistake the cross-section of a vessel, the shadow of the nipples of the mammary gland, as well as calcium deposits in the cartilage of the ribs as focal shadows.

A focal shadow has the following characteristics:

1) Localization of focal shadow.
2) Prevalence of focal shadow.
3) Contours of focal shadow.
4) Intensity of focal shadow.

U of this patient a lesion is detected in the middle lobe of the right lung with a decay cavity in the center (indicated by an arrow). According to the clinic, the patient was diagnosed with tuberculosis.

White spot on x-ray of lungs/white spot on x-ray of lungs/white spots on lungs/two spots on lungs/lung disease spot on lung

For each disease there is a characteristic localization of the outbreak. Tuberculosis (focal tuberculosis and tuberculoma) is characterized by localization in the apices of the lungs and under the collarbone. With pneumonia, the localization can be any, but inflammatory lung diseases are characterized by a group of foci (2-3 foci). For peripheral lung cancer or tumor metastasis characteristic feature X-ray shows a single lesion without signs of calcification.

The contours of the lesion can be sharp or blurred. Blurry contours often indicate inflammatory cause origin of the outbreak. If on the radiograph we encounter a single lesion with sharp contours, which is not located in the apex and subclavian region, then the radiologist suspects peripheral cancer. A single focus with sharp contours located at the apex or under the collarbone suggests tuberculosis (focal tuberculosis or tuberculoma).

The following structure of the focus is distinguished: homogeneous or heterogeneous. If we consider the example of pulmonary tuberculosis, then, using these properties, we can tell the phase of the disease, which is taken into account when choosing chemotherapy. A homogeneous focal shadow is characteristic of tuberculosis in the consolidation phase, and a heterogeneous shadow is characteristic of tuberculoma.

This patient showed changes in the roots of the lung, which corresponds to tuberculosis of the intrathoracic lymph nodes in a patient with prolonged fever and cough.

Small spot on the lung/small spot on the lung/spots in the lungs on x-ray/

When talking about the intensity of a focal shadow, radiologists often compare the intensity with nearby anatomical structures, for example, with the blood vessels of the lungs.

The following intensity of the focus is distinguished:

1) low-intensity shadow - if the focus is visualized with intensity, like a longitudinal section of a vessel.
2) medium-intensity shadow - if the focus is visualized with intensity, like a vessel in an axial section.
3) dense focus (high-intensity shadow) - if the focus is visualized with an intensity higher than the intensity of the lung vessel in the axial section.

With a low-intensity shadow on the radiograph, depending on the clinic, it is possible to suspect focal pneumonia or tuberculosis in the infiltration phase (focal tuberculosis). A medium-intensity shadow indicates the attenuation of the tuberculosis process, which is most often observed with adequate treatment.

Also, radiologists separately identify a Ghon lesion or a decayed calcified lesion in the lung, which, together with a calcified lymph node, suggests a primary tuberculosis complex.

Each lesion (spot), if you look closely, is unique, and only an experienced radiologist can compare clinical picture with the picture on the x-ray. To avoid unnecessary diagnostic errors, radiography is done in two projections, and is also performed after a certain time to assess the dynamics of the lesion. Let’s say that if a 70-year-old patient who has been smoking all his life has a single lesion in the lung, then it is more correct to regard this formation as lung cancer.

A 76-year-old patient was diagnosed with a shadow in the right lung. Initially, peripheral lung cancer was suspected, but the diagnosis for this patient was hamartoma of the right lung.

Round spot on the lung/pneumonia of the lungs of the right side spots on the lungs/spots on the lungs causes

The round spot on the radiograph corresponds to radiographic round shadow syndrome. Round shadow syndrome is said to occur when the following shadows are visualized on an x-ray:

1) Single shadows of a round shape.
2) Single shadows of a semicircular shape.
3) Single oval-shaped shadows.
4) Multiple round shadows.
5) Multiple semicircular shadows.
6) Multiple oval-shaped shadows.

Another important criterion for telling when a round shadow is visible on an x-ray is size. The size of a round shadow should be more than 1 centimeter since smaller shadows are focal points.

The round shadow, like the hearth, is caused by different pathological reasons in the lung, for example:

1) Inflammatory process.
2) Tumor process.

Also, a round shadow is visualized when there are cavities in the lung with fluid. There are also reasons not related to lung pathology, but in which a round shadow is visualized - this is pleural pathology. These include pleurisy (inflammation of the pleura), pleural tumor, and cyst.

The patient has a cyst filled with fluid.

Spots on the right lung/spot on the left lung/spot on the lungs during fluorography

In order to guess what disease the round shadow belongs to, the radiologist initially answers the following questions:

1) What shape is the shadow?
2) Is there a relationship with surrounding organs?
3) What are the contours of the shadow?
4) What is the structure of the shadow?

The shape of the rounded shadow delineates the process into a pathological process that is inside and outside the lung. Intrapulmonary pathology is characterized by a round, but also an oval-shaped shadow. An oval-shaped shadow occurs with lung cysts that are filled with fluid. Also, an oval-shaped shadow is a characteristic picture when the cyst has increased in size to such a size that it comes into contact with the diaphragm, pleura, mediastinum, and chest wall.

The contours of a rounded shadow allow the radiologist to establish the cause of the pathology, and therefore are an important sign in the description.

The contours are:

1) Fuzzy or also called unsharp.
2) Clear or sharp.

Fuzzy contours for inflammatory diseases are mild. It is impossible to make a specific diagnosis in this case, but the identified symptom narrows the differential range. If the contours are clear, one should assume a lung tumor, tuberculoma, or a fluid cystic formation that does not contain air inside.

The patient has a darkening in the right lung, which is characteristic of lobar pneumonia.

Spot on the lung image/x-ray of the lungs white spot/x-ray of the lungs light spot

A rounded shadow in its structure is visualized as homogeneous or heterogeneous. The shadow is uniform in tuberculoma, but against the background of the shadow, calcium must be a prerequisite. If a round formation is encountered with a cavity inside, then the first thing radiologists think about is a tumor with decay or infiltrative tuberculosis in the decay phase. Cancer is more characterized by a rounded shadow with a cavity, in which uneven internal contours and uneven wall thickness. Tuberculoma is characterized by small, crescent-shaped cavities. A cavity with liquid contents is visualized when the cyst is opened (exit of liquid contents) into the bronchus, as well as in case of a lung abscess, which is accompanied by a serious condition of the patient.

When interpreting a radiograph with a rounded shadow, it happens that despite taking into account all the above signs, the radiologist did not come to a conclusion. Then a prerequisite for making a diagnosis is the correct assessment of the lung tissue that is adjacent to the pathological focus. If the lung tissue surrounding the lesion with blurred contours is intact, then this is a sign of fresh inflammation (acute and subacute phase). Fibrosis of the tissue surrounding the lesion indicates a chronic inflammatory process, which is more often characteristic of tuberculosis. Chronic inflammation of tuberculous origin is characterized by a path to the pulmonary root, which is visualized as a bronchus draining the cavity with thickened walls.

This patient has left lung cancer.

An X-ray of the lungs does not show a disease, as many patients believe, but only a planar layering of anatomical structures that are in the path of the rays. The image shows the radiological symptoms described by the radiologist. Based on its conclusion, a diagnosis can be assumed, but not always.

In this article we will talk about radiological symptoms, which when “added” form disease syndromes. This is precisely the work of the “all-seeing” radiologist.

What does an x-ray show?

Photo with a diagram of the structural elements of the anatomical structures of the chest organs displayed on an x-ray

An X-ray image of organs in a direct projection is a total planar image of the lungs, heart, mediastinal organs and ribs.

Anatomical structures in the image

What organs does the image show:

• large symmetrical clearings on both sides are caused by air lungs;
• in the central part there is a shadow of the heart;
• aperture domes – visible in the lower part of the image;
• the anterior and posterior segments of the ribs form the lattice structure of the image;
• in the projection of soft tissues in the peripheral part of the radiograph, the shoulder joints can be traced.

We draw the attention of readers that the density of the above-described structures is different, which is due to the different content of calcium, liquid and air in them. It is known that X-rays are strongly reflected from dense structures, but easily pass through airborne ones, without creating a clear structure in the image. So that radiologists can more accurately describe the picture, the concepts of “shadow” and “clearance” were created.

Lightening indicates an area of ​​increased airiness, and shadow indicates a denser focus. In the above image, the lungs represent the lightening, and the heart is the shadow (darkening).

It should be understood that the X-ray picture of diseases depends on various combinations and combinations of the above symptoms. The characteristics of its description by the radiologist are also not affected by the type of image (negative or positive). Below is a positive photo of the lungs, similar to the first one.

Despite the different appearance of both drawings in the article, the radiologist’s description of their lungs is no different, since this is one photograph in negative and positive.

X-ray of the lungs with a doctor's description

When describing an image of the lungs, a radiologist analyzes the following features:

• the image of the heart, which weakly transmits rays, is displayed as a shadow in the central part;
• clearing of the lungs on both sides along with the vascular pattern and roots (heavy lines);
• behind the heart and lungs, a shadow of the spine can be traced, from which one can assess its normal position or the presence of curvature in the lateral plane.

Having analyzed the data, we conclude that the shadow on a classic plain radiograph of the lungs is white, and the clearing is black.

Elements of a radiograph that indicate lung pathology:

1. Calcified shadows (foci with calcium deposits) – with tuberculosis.
2. Multiple darkening – tumors and.
3. Increased pulmonary pattern - with bronchitis.
4. Increased transparency - with emphysema.
5. Pleural opacification with oblique top level– pleurisy (inflammation of the pleura).
6. Enlargement of the heart shadow – cardiomyopathy, heart failure.
7. Enhanced darkening along the contour of the pericardium (the outer lining of the heart) – pericarditis, “shell heart”.

X-rays of the lungs are most often prescribed by doctors to exclude pneumonia. Based on indirect signs, other diseases can be detected in the image:

• hydro- and pneumothorax (accumulation of fluid or air in the pleural cavity);
• Chronical bronchitis;
• bronchiectasis;
• occupational diseases (silicosis, talcosis, asbestosis).

X-rays detect smokers by indirect signs: strengthening and deformation of the pulmonary pattern, accumulation of calcifications in the roots.

Indirect signs Diseases in the picture do not at all mean the presence of pathology. To establish a diagnosis, a comprehensive analysis of the results of clinical diagnostic research methods is necessary.

As a result, a chest x-ray is performed after other examinations. This approach is also used for the purpose of radiation safety of the patient, because sometimes obtaining the results of other research methods eliminates the need for an x-ray examination.

What does the radiologist find in the image?

Professional interpretation of images involves using many specialized terms. As a result, the protocol of a specialist’s conclusion is very difficult for an ordinary person to understand.

Most doctors will say that in the absence medical education It is better not to try to make a diagnosis yourself, but to turn to professionals for this. This is ideal, but in practice the patient faces long queues at public clinics and months of appointments.

For readers who want to understand, here is a brief description and description of the X-ray symptoms that make up the pathological syndromes:

• limited shadowing – intense shadow with clear external borders. Occurs with lung cancer, pneumonia, atelectasis (collapse of a section of the lung), foreign bodies, tuberculosis;
• unlimited darkening - shadows throughout the entire lung tissue on one or both sides. Observed in cases of lobar pneumonia, fungal diseases, cardiovascular disorders, occupational diseases;
• rounded shadows - rounded shadows more than 1 cm in diameter. Observed in lung cancer, echinococcosis;
• focal-like - up to 1 cm in diameter. They are formed by tuberculosis, sarcoidosis, silicosis;
• miliary dissemination - multiple small shadows over large areas characterize tuberculosis;
• heaviness - intense lines in the lungs are observed in cancer, sarcoidosis, tuberculosis;
• ring-shaped shadows with a clear rim and transparent internal part– cysts and cavities in the lung tissue;
• clearings form on the radiograph of diseases with increased airiness of the lungs - emphysema, pneumothorax, atelectasis.

The X-ray symptoms described above do not explain everything pathological changes in the photographs, since there are various combinations of elements that together will indicate a different type of disease, which is indicated by the types of darkening and clearing separately.

Interpretation of a chest x-ray requires an assessment of the properties of various anatomical and pathological elements. According to the standard scheme, a specialist needs to describe the following features of the shadow: size, shape, structure, position, intensity.

For example, in case of focal pneumonia, the description protocol looks approximately as follows: “on a chest x-ray in frontal and lateral projections, an intense focal shadow of a round shape with unclear contours is noted in S8 of the right lung.” Such a conclusion may indicate both focal pneumonia and peripheral cancer.

To establish the correct diagnosis, it is necessary to analyze the results of blood tests, temperature levels, and also monitor the effectiveness of empirical therapy with antibacterial drugs.

To understand the basics of the analysis, we provide examples of images with descriptions.

Digital radiograph with focal intense shadow in S4 of the left lung (tuberculosis)
Limited opacification in the left upper lobe (peripheral cancer)
Unlimited darkening on the right (lobar pneumonia)

In conclusion, I would like to note that patients very often, at the slightest increase in temperature or the appearance of a runny nose, want to have a chest X-ray done to rule out pneumonia. Such an examination is not always rational, since the harm from x-rays will exceed the practical benefits.

We advise you to first consult your doctor, because there are other clinical methods for diagnosing pneumonia. Even if the therapist suspects focal pneumonia without pronounced changes in the body, he will prescribe antibacterial drugs. Only if therapy does not help, an X-ray examination of the chest organs is used. This approach protects a person from radiation exposure and is optimal scheme, but, like everything in life, it is imperfect.

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-1.jpg" alt=">Main radiological syndromes and symptoms of respiratory diseases Department"> Основные рентгенологические синдромы и симптомы заболеваний органов дыхания Кафедра визуальной диагностики Тулеутаева З. К.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-2.jpg" alt="> The main method of X-ray examination of the respiratory organs is radiography in two"> Основным методом рентгенологического исследования органов дыхания является рентгенография в двух проекциях - прямой и боковой, позволяющая получать объективную и документированную информацию о состоянии органов грудной клетки. Рентгенодиагностика любых патологических бронхолегочных синдромов основана на выявлении трех типов изменений легочных полей (Л. Д. Линденбратен и Л. Б. Наумов): 1. распространенного или ограниченного затемнения, свидетельствующего об уплотнении легочной ткани (воспалительная инфильтрация, отек, ателектаз, опухоль и т. п.); 2. ограниченного или диффузного просветления легочной ткани при повышении ее воздушности (полость в легком, киста, распадающаяся опухоль, обструктивный синдром, пневмоторакс и др.); 3. изменений легочного рисунка. В !} clinical practice A combination of two or three types of changes in the X-ray picture is more common.

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-3.jpg" alt="> According to L. D. Lindenbraten, N. R. Paleev and etc."> По мнению Л. Д. Линденбратена, Н. Р. Палеева и др. все многообразие рентгенологических изменений при различных заболеваниях органов дыхания можно представить в виде нескольких патологических рентгенологических синдромов (рис. 2. 49): 1. Патология легочного рисунка. 2. Очаги и ограниченные диссеминации. 3. Округлая тень в легочном поле. 4. Кольцевидная тень в легочном поле. 5. Тотальное или субтотальное затемнение легочного поля. 6. Ограниченное (пристеночное) затемнение легочного поля. 7. Диффузная диссеминация 8. Патология корней легких и внутригрудная аденопатия. 9. Обширное просветление легочного поля.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-4.jpg" alt="> A rounded shadow in infiltrative-pneumonic tuberculosis is characterized by blurred indistinct contours, increased"> Округлая тень при инфильтративно-пневмоническом туберкулезе характеризуется размытыми нечеткими контурами, усилением легочного рисунка вокруг зоны специфического воспаления. При распаде в центре округлого образования появляется просветление. Шаровидная пневмония также характеризуется размытыми контурами и усилением легочного рисунка. При абсцедировании в центре тени появляется просветление с горизонтальным уровнем жидкости.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-5.jpg" alt=">Fig. 2. 49. Schematic representation of the main pathological radiological syndromes ( according to L. D. Lindenbraten"> Рис. 2. 49. Схематическое изображение основных патологических рентгенологических синдромов (по Л. Д. Линденбратену и Л. Б. Наумову в модификации). а - изменение легочного рисунка, б - очаги и ограниченные диссеминации, в - округлая тень в легочном поле, г - кольцевидная тень в легочном поле, д - тотальное и субтотальное затемнение легочного поля, е - ограниченное (пристеночное) затемнение легочного поля, ж - диффузная диссеминация, з - патология корней легких и внутригрудная аденопатия, и - обширное просветвление легочного поля!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-6.jpg" alt="> Changes in pulmonary pattern The main reasons for increased pulmonary pattern are:"> Изменения легочного рисунка Основными причинами усиления легочного рисунка являются: 1. увеличение кровенаполнения сосудов легких, например при некоторых врожденных или приобретенных пороках сердца, ИБС и других заболеваниях сердца; 2. воспалительный отек междольковых перегородок и перибронхиальных пространств (пневмонии, бронхиты, альвеолиты и т. п.), ведущий к усилению интерстициального компонента легочного рисунка; 3. развитие !} connective tissue in the interstitium of the lung (pneumosclerosis). The image of the pulmonary fields in these latter cases is characterized by pronounced reticularity and heaviness; Rice. Strengthening the pulmonary pattern with blood stagnation in the pulmonary circulation in patients with aortic valve insufficiency (a), pneumonia (b) and pneumosclerosis (c).

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-7.jpg" alt="> Depletion of the pulmonary pattern (Fig.) is observed: 1. with a decrease blood flow"> Обеднение легочного рисунка (рис.) наблюдается: 1. при снижении кровотока в легочных сосудах у больных с врожденными пороками сердца со сбросом крови справа налево; 2. при легочной артериальной гипертензии и стенозе легочной артерии; 3. при выраженных нарушениях бронхиальной проходимости (инородное тело, опухоль бронхов, хронический обструктивный бронхит и др.), нередко сопровождающихся развитием микроателектазов. Рис. Обеднение легочного рисунка у больного с обструктивной эмфиземой легких!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-8.jpg" alt="> Foci and limited disseminations Relatively small (from 0.3 to"> Очаги и ограниченные диссеминации Сравнительно небольшие (от 0, 3 до 1, 5 см в диаметре) и разнообразные по форме очаги в легочном поле - наиболее часто встречающийся рентгенологический синдром. Такие очаговые образования в легком чаще всего могут быть обусловлены воспалительной инфильтрацией легочной ткани при острой пневмонии, !} focal tuberculosis and other lung diseases.

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-9.jpg" alt=">Focuses inflammatory infiltration in acute pneumonia, they are characterized by multiplicity, varying size, low intensity of the shadow, blurred"> Foci of inflammatory infiltration in acute pneumonia are characterized by multiplicity, varying size, low intensity of the shadow, blurred outlines and, as a rule, are accompanied by an increase in the pulmonary pattern (Fig.). Fig. X-ray of the lungs in acute focal pneumonia. Foci of inflammatory infiltration are localized in the lower lobe of the right lung and are combined with expansion of the lung root and increased pulmonary pattern

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-10.jpg" alt="> With focal tuberculosis, small areas of inflammation are localized mainly in the apices and subclavian"> При очаговом туберкулезе небольшие участки воспаления локализуются преимущественно в верхушках и подключичных отделах легочных полей (рис. 2. 54). При этом для свежих туберкулезных очагов характерны нерезкие, «размытые» контуры и малоинтенсивная тень, тогда как более старые очаги отличаются более четкими, ровными контурами и более интенсивным затемнением. Со временем нередко происходит обызвествление туберкулезных очагов и они становятся особенно плотным. На рентгенограммах можно обнаружить старый обызвествленный очаг в легком (очаг Гона) и обызвествленные лимфатические узлы в корне легкого (рис. 2. 55). Рис. 2. 54. Рентгенограмма легких при очаговом Рис. 2. 55. Рентгенограмма легких больного, туберкулезе легких. Очаги инфильтрации перенесшего первичный туберкулез легких. расположены в верхушке правого легкого Заметны обызвествленные очаги Гона в верхушке и корне правого легкого!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-11.jpg" alt="> Round formation in the lung Several dozen lung diseases can be accompanied"> Округлое образование в легком Несколько десятков заболеваний легких могут сопровождаться появлением на рентгенограммах одиночных или множественных округлых теней диаметром не менее 1 см. Важнейшими из этих заболеваний являются: 1. острая пневмония; 2. туберкулезный инфильтрат; 3. туберкулома; 4. первичный рак легкого; 5. метастазы опухолей в легкие; 6. ретенционная киста легкого; 7. эхинококк легкого; 8. осумкованный плеврит (костный, медиастинальный, диафрагмальный, междолевой); 9. эозинофильный инфильтрат; 10. киста средостения; 11. опухоль средостения и др.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-12.jpg" alt=">Fig. 2. 56. Multiple metastases to the lungs of bone sarcoma">!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-13.jpg" alt=">Fig. 2. 58. Radiographs of the lungs with a single rounded shadow. a - round (spherical)"> Рис. 2. 58. Рентгенограммы легких с одиночной округлой тенью. а - округлая (шаровидная) пневмония, б - инфильтративный туберкулез, в - туберкулома, г - периферический рак легкого с распадом!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-14.jpg" alt="> Figure 2. 59 schematically shows some important radiological signs of pathological"> На рис. 2. 59 схематически показаны некоторые важные рентгенологические признаки патологических процессов, вызывающих образование на рентгенограммах округлой тени. Метастазы опухолей в легкие характеризуются наличием множественных или (реже) одиночной округлой тени с четкими контурами, без признаков воспаления и усиления рисунка в окружающей легочной ткани. Просветление в центре тени не характерно (рис. 2. 59, а). Периферический рак легкого отличается четкими резкими контурами округлой бугристой тени, которая может быть однородной или иметь просветление в центре (распадающаяся опухоль). Нередко от круглой тени к корню тянется так называемая «сосудистая дорожка» , а в корне легкого имеются увеличенные лимфатические узлы (рис. 2. 59, б).!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-15.jpg" alt="> Fluid containing a lung cyst is characterized by clear sharp (clearly"> Жидкость содержащая киста легкого характеризуется четкими резкими (четко различимыми) контурами тени, которая имеет овальную или грушевидную форму, без просветления в центре и изменения окружающей ткани (рис. 2. 59, в). Туберкулома также отличается резкими контурами, правильной округлой формой и может быть однородной или с просветлением в центре. Вокруг тени туберкуломы могут обнаруживаться крупные или мелкие очаги туберкулезной инфильтрации и так называемая «бронхиальная дорожка» к корню легкого (рис. 2. 59, г).!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-16.jpg" alt="> Syndromic analysis of pulmonary pathology Round shadow in infiltrative pneumonic tuberculosis"> Синдромный анализ легочной патологии Округлая тень при инфильтративно-пневмоническом туберкулезе характеризуется размытыми нечеткими контурами, усилением легочного рисунка вокруг зоны специфического воспаления (рис. 2. 59, д). При распаде в центре округлого образования появляется просветление. Шаровидная пневмония также характеризуется размытыми контурами и усилением легочного рисунка (рис. 2. 59, е). При абсцедировании в центре тени появляется просветление с горизонтальным уровнем жидкости (рис. 2. 59, е).!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-17.jpg" alt=">Fig. 2. 59. Schematic representation of the main radiological signs of pathological processes , accompanied by the appearance"> Рис. 2. 59. Схематическое изображение основных рентгенологических признаков патологических процессов, cопровождающихся появлением округлой тени в легком. а - метастазы опухоли, б - периферический рак легкого, в - жидкостьсодержащая киста, г - туберкулома, д - инфильтративный туберкулез, е - шаровидная пневмония!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-18.jpg" alt="> Ring shadow Most common reasons the appearance of a ring-shaped shadow in the pulmonary field"> Ring-shaped shadow The most common causes of the appearance of a ring-shaped shadow in the pulmonary field are: 1. Lung abscess. 2. Tuberculosis cavity. 3. Peripheral lung cancer in the decay stage. 4. Single air cysts of the lung.

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-19.jpg" alt=">With a lung abscess, a clearly defined cavity is visible on the radiograph,"> При абсцессе легкого на рентгенограмме видна четко очерченная полость, в которой содержатся газ и жидкость (гной). Внутри полости хорошо заметен горизонтальный уровень жидкости. В острой стадии заболевания стенки полости толстые; вокруг нее можно видеть воспалительную инфильтрацию легочной ткани (рис. 2. 60, а). При хроническом течении заболевания стенки полости истончаются, а инфильтрация окружающей легочной ткани уменьшается (рис. 2. 60, б). В клинической практике встречаются также случаи, когда в легком на фоне значительной воспалительной инфильтрации образуется несколько сравнительно небольших по размерам полостей (абсцедирующая пневмония) (рис. 2. 60, в). Рис. 2. 60. Схематическое изображение рентгенологических изменений при абсцессе легкого а - острая б - хроническая стадии) в - при абсцедирующей пневмонии!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-20.jpg" alt="> Tuberculous cavities often have"> Туберкулезные каверны чаще имеют неправильную округлую форму, неровные контуры и толстые стенки. Реже (при гематогенно-диссеминированном туберкулезе) встречаются тонкостенные (так называемые «штампованные») каверны правильной формы. В обоих случаях характерно отсутствие или крайне незначительное количество жидкого секрета в каверне. Рис. 2. 61. Рентгенограмма легких с кольцевидной тенью, обусловленной туберкулезной каверной!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-21.jpg" alt="> Peripheral lung cancer on x-rays often looks like a rounded shadow"> Периферический рак легкого на рентгенограммах чаще выглядит в виде округлой тени (см. выше). Кольцевидная тень в легком образуется при распаде раковой опухоли и отделения некротических масс через бронх (рис. 2. 62). В этих случаях полость имеет, как правило, толстые стенки и неровный внутренний контур. Нередко от опухоли к корню легкого тянется «сосудистая» дорожка, но в окружающей легочной ткани очаговые образования отсутствуют. Рис. 2. 62. Схема типичных рентгенологических изменений при периферическом раке легкого с распадом!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-22.jpg" alt="> air cyst of the lung Enlarged lymph nodes are very typical"> воздушная киста легкого Очень характерно увеличение лимфатических узлов в корне легкого за счет их метастатического поражения. Относительно редко встречается одиночная воздушная киста легкого. Она отличается тонкими ровными стенками и отсутствием в ней жидкого содержимого, а также изменений в корне легкого и в окружающей полость легочной ткани.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-23.jpg" alt="> Total and subtotal darkening of the lung tissue Unilateral total and subtotal darkening"> Тотальное и субтотальное затемнение легочной ткани Одностороннее тотальное и субтотальное затемнение легочного поля может встретиться при двух локализациях патологического процесса - в плевральной полости и в легком. В первом случае причиной затемнения являются: 1. Жидкость в плевральной полости (!} exudative pleurisy or hydrothorax). 2. Massive pleural overlays (moorings). 3. Fibrothorax. 4. Diaphragmatic hernia with organ penetration abdominal cavity(intestines and stomach) into the pleural cavity.

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-24.jpg" alt="> Total and subtotal darkening of lung tissue With intrapulmonary localization"> Тотальное и субтотальное затемнение легочной ткани При внутрилегочной локализации процесса тотальное и субтотальное затемнение легочного поля может быть вызвано: 1. Ателектазом легкого (рак легкого с закупоркой главного бронха, инородное тело в главном бронхе или его травматический отрыв). 2. Массивным воспалением легкого (крупозная пневмония, стафилококковая пневмония, творожистая пневмония, гангрена легкого). 3. Циррозом легкого (туберкулезного или нетуберкулезного происхождения).!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-25.jpg" alt="> Differential diagnosis based on the following radiological signs: 1. displacement"> Differential diagnosis is based on the following radiological signs: 1. displacement of the mediastinal organs in one direction or another; 2. increase or decrease in the size of the affected half of the chest; 3. homogeneous or heterogeneous structure of the darkening. 1 With total or subtotal darkening of the pulmonary field, the shadow of the mediastinum shifts towards the lesion with: 1) atelectasis of the lung (cancer, etc.); 2) cirrhosis of the lung; 3) fibrothorax; 4) massive pleural overlays. Displacement of the median shadow in the direction opposite to the darkening , observed with: 1) massive pleural effusion and 2) diaphragmatic hernia with penetration of the intestines and stomach into the pleural cavity.

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-26.jpg" alt="> Character of darkening 2. The dimensions of the affected half of the chest change in"> Характер затемнения 2. Размеры пораженной половины грудной клетки изменяются у всех больных с тотальным и субтотальным затемнением легочного поля (за исключением пациентов с массивным воспалением легочной ткани): при ателектазе, циррозе легкого и фибротораксе они уменьшаются, а при наличии жидкости в полости плевры - увеличиваются. 3. Характер затемнения легочного поля и структура тени также имеют важное диагностическое значение. Тотальное и субтотальное затемнение однородно при 1) плевральном выпоте и 2) ателектазе легкого, вызванном закупоркой главного бронха. В остальных случаях (цирроз легкого, массивные шварты, фиброторакс, тотальная пневмония, !} diaphragmatic hernia) the structure of the shadow is usually heterogeneous.

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-27.jpg" alt=">Fig. 2. 65. X-ray of the lungs with right-sided exudative pleurisy. Noticeably small"> Рис. 2. 65. Рентгенограмма легких при правостороннем экссудативном плеврите. Заметно небольшое увеличение размеров правой половины грудной клетки и смещение средостения влево Рис. 2. 66. Рентгенограмма легких больного с массивной (тотальной) пневмонией. Заметно тотальное затемнение левого легочного поля, имеющее неоднородный характер. Размеры пораженной половины грудной клетки не изменены, смещение средостения отсутствует!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-28.jpg" alt="> Limited opacification of the pulmonary field is one of the most common"> Ограниченное затемнение легочного поля - один из наиболее часто встречающихся рентгенологических симптомов при заболеваниях органов дыхания. Причинами этого рентгенологического синдрома являются следующие патологические процессы: 1. !} Lung inflammation(acute pneumonia, infiltrative tuberculosis). 2. Limited atelectasis of a lobe or segment (bronchogenic lung cancer, foreign body of a lobar, segmental bronchus). 3. Cirrhosis of the lung (tuberculous and non-tuberculous etiology).

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-29.jpg" alt="> Limited darkening of the pulmonary field 4. Fluid (moderate amount) in the pleural cavities (exudative"> Ограниченное затемнение легочного поля 4. Жидкость (умеренное количество) в плевральной полости (экссудативный плеврит, гидроторакс при застойной недостаточности кровообращения, гемоторакс), в том числе осумкованный плеврит. 5. Плевральные шварты, фиброторакс. 6. Опухоль легкого (без развития ателектаза). 7. Инфаркт легкого.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-30.jpg" alt="> Limited atelectasis caused by blockage of the bronchial tube by a tumor or foreign body usually gives"> Ограниченные ателектазы, обусловленные закупоркой бронха опухолью или инородным телом, дают обычно интенсивную гомогенную тень, соответствующую проекции пораженной доли или сегмента. Последние обычно уменьшены в размерах. Нередко при ателектазах можно заметить также смещение корня легкого к участку ограниченного затемнения. Следует, однако, помнить, что обтурация бронха и ателектатическое спадение части легкого может быть неполным, что отражается на интенсивности и структуре тени. Рис. 2. 69. Частичный ателектаз !} upper lobe in a patient with bronchogenic cancer of the left lung (observation by G.R. Rubinstein). Noticeable shift of the mediastinum to the left

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-31.jpg" alt="> Tumor of a large bronchus without the development of atelectasis on radiographs"> Опухоль крупного бронха без развития ателектаза на рентгенограммах представлена обычно интенсивным гомогенным затемнением, имеющим неровные контуры и расположенным чаще в прикорневой зоне. Нередко в корнях легких обнаруживаются увеличенные лимфатические узлы, что связано с метастазами опухоли в бронхопульмональные лимфатические узлы и лимфоузлы средостения Рис. 2. 71. Рентгенограмма легких больного с центральным раком правого легкого. а - прямая проекция, б - правая боковая проекция!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-32.jpg" alt="> With limited pleural effusion, a homogeneous"> При ограниченном плевральном выпоте на рентгенограммах определяется однородное интенсивное затемнение, которое прилежит к наружному краю грудной клетки и к диафрагме. Верхняя граница затемнения чаще располагается косо сверху вниз и снаружи кнутри (рис. 2. 72). При перемене положения тела затемнение и его верхняя граница меняют свою форму и расположение в связи с перемещением жидкости. Рис. 2. 72. Ограниченное затемнение левого легочного поля при умеренном количестве жидкости в плевральной полости. Заметно интенсивное затемнение нижнего легочного поля слева, небольшое увеличение размеров левой половины грудной клетки. Смещение средостения отсутствует!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-33.jpg" alt=">With encysted pleurisy, the border of the fluid shadow becomes sharper and convex upward. With interlobar"> При осумкованных плевритах граница тени жидкости становится более резкой и выпуклой кверху. При междолевых плевритах однородное ограниченное затемнение имеет часто удлиненную форму, четкие, ровные, выпуклые границы и совпадает с ходом междолевой щели. Рис. 2. 73. Ограниченное затемнение легочного поля при осумкованном плеврите справа!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-34.jpg" alt="> Diffuse dissemination Depending on the size of the foci, there are 4"> Диффузные диссеминации В зависимости от размеров очагов различают 4 типа диссеминации: 1. милиарный тип диссеминации (размер очагов 1– 2 мм); 2. мелкоочаговый тип диссеминации (3– 4 мм); 3. среднеочаговый тип диссеминации (5– 8 мм); 4. крупноочаговый тип диссеминации (9– 12 мм).!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-35.jpg" alt="> Diffuse disseminations The most common causes of pulmonary diffuse disseminations are: 1. tuberculosis"> Диффузные диссеминации Наиболее частыми причинами легочных диффузных диссеминаций являются: 1. туберкулез легкого (милиарный, гематогенно- диссеминированный, лимфогематогенный); 2. острые вирусные и бактериальные пневмонии; 3. метастазы злокачественных опухолей (метастатический карциноматоз легких); 4. отек легких (гемодинамический или токсический); 5. пневмокониозы; 6. саркоидоз; 7. вторичные поражения легких при болезнях соединительной ткани.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-36.jpg" alt="> Acute miliary tuberculosis is characterized by dense and uniform seeding of both lungs"> Для острого милиарного туберкулеза характерно густое и равномерное обсеменение обоих легочных полей однотипными и четко очерченными мелкими очагами Рис. 2. 75. Рентгенограмма легких при остром миллиарном туберкулезе (наблюдение Г. Р. Рубинштейна)!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-37.jpg" alt="> In acute and subacute hematogenously disseminated tuberculosis, the most"> При остром и подостром гематогенно- диссеминированном туберкулезе также наиболее характерно очаговое диссеминированное поражение легких (2. 76). При хроническом гематогенно-диссеминированном туберкулезе очаги имеют различную величину и плотность и больше располагаются в верхних отделах легких. Рис. 2. 76. Рентгенограмма легких при остром гематогенно- диссеминированном туберкулезе!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-38.jpg" alt="> Acute pneumonia are characterized by an uneven distribution of foci with blurred contours,"> Acute pneumonia is characterized by an uneven distribution of foci with blurred contours, located mainly in the middle and lower sections lungs. This radiological picture is often accompanied by infiltration of the roots of the lungs (Fig. 2. 77). Rice. 2. 77. Diffuse dissemination of the lungs in acute small-focal bilateral pneumonia

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-39.jpg" alt="> With pneumoconiosis, which usually develops in workers in “dust occupations”, it is characteristic"> При пневмокониозах, развивающихся обычно у работников «пылевых профессий» , характерен преобладающий диффузный сетчатый фиброз, а также множественные диссеминированные очаги. Корни легких увеличены и фиброзно уплотнены (рис. 2. 78). Рис. 2. 78. Рентгенограмма легких при силикозе. Заметна диффузная диссеминация легочных полей и увеличение корней легких!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-40.jpg" alt="> With sarcoidosis, in typical cases, a significant increase in the roots is detected"> При саркоидозе в типичных случаях выявляются значительное увеличение корней легких и крупные резко очерченные лимфатические узлы без перифокальной реакции вокруг них. Метастатическое диффузное поражение легких (карциноматоз) характеризуется появлением в легочных полях однотипных множественных плотных очагов, не имеющих тенденции к распаду с образованием полостей (рис. 2. 79). Рис. 2. 79. Рентгенограмма легких при массивном метастатическом поражении легких у больного с раком желудка. Определяется грубое густое обсеменение обоих легких множественными средними и крупными очагами. В корнях легких увеличенные лимфатические узлы!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-41.jpg" alt="> Changes in the roots of the lungs Secondary (reactive) changes in the roots of the lungs are observed"> Изменение корней легких Вторичные (реактивные) изменения корней легких наблюдаются при многих описанных выше заболеваниях органов дыхания. Однако в некоторых случаях рентгенологические признаки поражения корней выступают на первый план и приобретают особое самостоятельное диагностическое значение. Л. Д. Линденбратен выделяет несколько типов таких изменений: 1. полнокровие легких («застойные корни»); 2. инфильтрация корней; 3. рубцовая деформация корней; 4. увеличение лимфатических узлов; 5. обызвествление лимфатических узлов в корнях.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-42.jpg" alt="> Changes in the roots of the lungs. Enlarged lymph nodes in the lungs are of particular diagnostic importance."> Изменение корней легких Особое диагностическое значение имеет увеличение лимфатических узлов в корнях легких, которое часто сочетается с увеличением медиастинальных лимфатических узлов. Наиболее частыми причинами этих патологических изменений являются: 1. метастазы злокачественных опухолей; 2. туберкулез легких; 3. саркоидоз; 4. нагноительные процессы в легких; 5. лимфогранулематоз; 6. лимфолейкоз; 7. пневмокониозы; 8. инфекционный мононуклеоз; 9. вирусные аденопатии и др.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-43.jpg" alt=">Fig. 2. 80. Infiltration of the roots of the lungs in a patient with an exacerbation chronic obstructive bronchitis and"> Рис. 2. 80. Инфильтрация корней легких у больного с обострением хронического обструктивного бронхита и эмфиземой легких Рис. 2. 81. Рентгенограмма легких при туберкулезном бронхоадените. Определяется массивное увеличение лимфатических узлов в корнях легких!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-44.jpg" alt="> Extensive clearing of the pulmonary field Increased transparency of one or both pulmonary"> Обширное просветление легочного поля Повышение прозрачности одного или обоих легочных полей или их значительной части обусловлено увеличением воздушности легких и, соответственно, уменьшением легочной паренхимы в единице объема легочной ткани. Наиболее частыми причинами обширного одно- или двухстороннего просветления легочного поля являются: 1. эмфизема легких (первичная и вторичная); 2. пневмоторакс; 3. гигантская киста легкого, заполненная воздухом; 4. врожденный порок развития легкого - гипоплазия легкого.!}

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-45.jpg" alt="> With significant accumulation of air in the pleural cavity (pneumothorax)"> При значительном скоплении воздуха в плевральной полости (пневмотораксе) рентгенологическая картина легочных полей весьма характерна. Область легочного поля, соответствующая проекции газа в плевральной полости, отличается значительным повышением прозрачности и отсутствием сосудистого рисунка. По внутреннему контуру просветления в большинстве случаев определяется четкий край спавшегося легкого. !} lung shadow on the affected side there is reduced transparency, the pulmonary pattern is enhanced here (Fig. 2. 84) Fig. 2. 83. X-ray of the lungs in Fig. 2. 84. X-ray of the lungs with secondary emphysema and pneumothorax

Src="https://present5.com/presentation/3/160310850_159712709.pdf-img/160310850_159712709.pdf-46.jpg" alt=">EVERYTHING!!!">!}

The lungs are a very important human organ, providing the body with oxygen, filtering microthrombi, regulating blood coagulation, responsible for breathing, removing harmful toxins and carcinogens, optimal level acid-base balance of blood.

And with any pathological processes, damage, malfunctions in their work, there is a high probability of extremely serious consequences, even lethal.

That is why it is very important to monitor their condition and periodically undergo medical examination. An X-ray of the lungs will allow you to identify existing problems in time and begin the necessary treatment.

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Chest X-ray

Using an x-ray, the lung is examined specifically (in whole, in parts) or the condition of all organs of the chest is assessed:

• its soft tissues and bones;
• anatomical structures: lungs, heart, pleura, bronchi, trachea, mediastinum, ribs, spine, lymph nodes, vessels, respiratory tract (chest x-ray).

Chest X-ray makes it possible to initial stage detect, exclude the development and complications of a number of diseases. Among them:

• cardiovascular;
• lymphatic system;
• pulmonary;
• inflammatory diseases of the pleura.

It helps to identify traumatic injuries to the lungs and rib joints, rib fractures, see foreign bodies in tissues, gastrointestinal tract organs, respiratory tracts, etc.

What does a lung x-ray show?

Up to 90% of cases of all serious pulmonary diseases can be detected by chest x-ray. What this diagnostic method shows:

• Besnier-Beck-Shaiman disease (sarcoidosis);
• emphysema;
• inflammation of the pleura ();
• pneumonia ();
• neoplasms, including malignant tumors;
• (former name - consumption, phthisis);
• pulmonary edema.

It also makes it possible to assess the volume of the lungs, the location of their roots, identify the presence of cavities in the lungs, fluid in the pleural cavity, thickening of the diaphragm, determine the level of airiness of the bronchi, etc. This greatly facilitates and speeds up the correct diagnosis and prescription necessary treatment, as a result of which the sick person has a greater chance of a positive outcome of the disease and recovery.

Why do they do it in two projections?

Today X-ray examination is not a screening method, that is, a referral to it is given if there are indications for it or if additional examination is necessary after an ambiguous interpretation of the fluorographic image.

When do you need an x-ray of the lungs in two projections, what does this type of research show? Indications for this procedure are:

1. Assumption of the presence of tuberculosis. With X-ray in direct projection, it is not always possible to trace the infiltrative darkening of the upper pulmonary lobe. Lateral x-rays provide this opportunity. It also shows better the paths to the roots of the lungs, indicating tuberculosis of the respiratory system.
2. Diagnosis of pneumonia when direct x-rays or clinical data indicate the likelihood of this disease. The lung consists of segments, inflammation affects 1 or more of them. The most accurate way to determine the extent of the lesion and the segments of the lungs affected by inflammation is an x-ray in the lateral projection.
3. Diagnosis of heart diseases. An X-ray in 2 projections allows you to determine its size, control the location of the catheter in it or in the pulmonary artery, and assess the condition of the electrodes in the installed pacemaker.
4. Central and peripheral. Double radiography more thoroughly reveals the presence malignant neoplasms(cancer tumors).
5. Pathological conditions of the pleura. X-rays in frontal and lateral projections are indicated for suspected pleurisy, accumulation of air in the pleural cavity ().
6. Radical edema at the pulmonary roots, enlargement of areas of the bronchi (bronchiectasis), small foci of infiltration, abscesses, cysts. It happens that on an X-ray in a frontal projection they are not very visible, in contrast to lateral photographs, when they are not hidden by the sternum.

How to do an x-ray of the lungs in a direct projection:

1. The subject stands between the X-ray tube and the detector (film): in the anterior projection - facing the detector, in the rear - facing the X-ray tube. In this case, the distance from the chest to the tube is about 2 m.
2. The chin is placed on the holder so that cervical region was in an upright position.
3. You must hold your breath while shooting.
4. Before the procedure, you need to remove jewelry, remove metal objects, and undress to the waist.

In order to take a picture in a lateral projection, the patient stands up, pressing the examined side against the cassette. Keeps arms raised up or crossed above the head (at the crown of the head).

What do healthy lungs look like?

X-rays of the lungs of a healthy person and those with lung diseases make it possible to examine:

• pulmonary fields on both sides of the spine, with linear shadows of the ribs projected onto them;
• in the central area of ​​the image - the sternum and shadow shading from the heart;
• above - collarbone;
• in the lower part of the image, under the pulmonary fields, there is the dome of the diaphragm.

What do healthy lungs look like on an X-ray? They have a bag-like shape, resembling a semi-cone with a rounded, widened apex. The lung fields are symmetrical on both sides, equally intense, without infiltrative or focal shadows, without enhancing the pulmonary pattern. Their peripheral parts transparent (in the pictures this gives a dark, black color), the vascular pattern should not be visible in them.

The number of pulmonary lobes corresponds to the norm - 5 (3 lobes in the right and 2 in the left lungs). The roots of healthy lungs are clearly structured, have standard sizes, and have no expansions. A healthy organ does not block X-rays, looks uniform in the image, and has no spots. In the central part, near the roots, a network of blood vessels and bronchi is visible.

The cardiac shadow should normally protrude no more than 1 cm on the right side, and should not extend beyond the midclavicular line, which runs vertically down from the center of the clavicle, on the left side. The trachea is located in the center. There are clearings under the domes of the diaphragm, the intercostal spaces are uniform.

Transcript: what does the darkening in the picture mean?

The existing clearing (they are also darkening in the lungs on an x-ray, since the image is a negative), their shape, shade, and intensity of the lines allow the radiologist to make an accurate conclusion about the condition of the lungs and draw up a brief description of the x-ray.

The transcript must indicate in which projection the x-ray was performed. Various darkenings indicate the following diseases:

1. Pneumonia. Both on the frontal and lateral projections, pronounced high-intensity shadows, large and small focal darkening are noticeable. Reduced transparency of the lung fields.
2. Tuberculosis. There are many small darkened foci, an intense pulmonary line, and an increased pulmonary pattern.
3. Exudative pleurisy. Due to the accumulation of fluid in the costophrenic sinus, a thin darkened strip appears on the image on the lower edge of the costal arch. The trachea is displaced or pulled forward.
4. Pulmonary edema. Uneven shadows in the form of flakes.
5. Venous stagnation of the pulmonary circulation (pulmonary circle). Extension of the roots, giving them a shape similar to the wings of a butterfly.
6. Malignant neoplasms (lung cancer). The X-ray image shows rounded shadows of different sizes, with clear boundaries.
7. Emphysema. The image shows consolidation of the diaphragm and increased airiness in the lung fields.
8. Peritonitis. Interpretation of an X-ray of the lungs indicates an accumulation of gases in the abdominal cavity in the absence of a cleared area under the domes of the diaphragm.
9. Atelectasis (collapse of the lung lobe). X-ray in the lateral projection shows darkening of the posterior mediastinum.
10. Heart diseases. The enlargement of the ventricle and atria is indicated by the rounded border of the shadow of the heart: the left - on the right, the right - on the left. In addition, the enlarged right ventricle gives rise to shadowing on the left side on the X-ray in the posterior-anterior direct projection.

It is very important to begin interpreting an x-ray by assessing the quality of the image, because incorrect projection and patient’s posture will result in inaccurate images. A correct radiograph shows 2–3 thoracic vertebrae, the spinous processes of the vertebrae are located at an equal distance between the clavicles. The right dome of the diaphragm is higher than the left, projected in the area of ​​the 6th rib.

How many times can an adult take?

X-rays make it possible to detect a number of lung diseases at the very first stage, which significantly increases the patient’s chances of recovery.

But is an X-ray of the lungs harmless, and how often can this procedure be performed on an adult without causing harm to the body? Sanitary rules and regulations establish the permissible safe proportion of preventive ionizing radiation equal to 1 mSv per year. It is unacceptable to exceed a dose of 5 mSv in a year.

For information: when performing radiography on film X-ray machines of older modifications in 1 procedure human body acquires a radiation dose of approximately 0.3 mSv, with modern digital equipment - about 0.03 mSv.

The decision on how often to take an X-ray of the lungs is determined by a number of factors:

• the health status of the person being examined;
• nature and stage of the disease;
• technical equipment of the X-ray room;
• the pursued purpose of the x-ray is preventive or diagnostic;
• patient's age.

A relatively healthy person should undergo preventive x-rays once a year. Diagnostic examination allows for 1-2 x-rays per year.

Citizens, work activity which are associated with catering establishments or work in child care institutions various directions, are required to be examined every six months. For persons suffering from severe forms of disease, when the harm caused to the body is many times greater than the harm from the radiation received, and x-rays cannot be replaced by another, safer procedure, the doctor may prescribe the procedure much more often - even up to 3 times a week.

X-rays aimed at examining the lungs are prescribed to pregnant women only after carefully weighing all the risks, especially in the 1st trimester of pregnancy. If the procedure cannot be avoided, it is better to undergo it using the latest equipment, covering the abdomen and pelvic area with a lead protective apron. X-rays are not contraindicated for nursing mothers because they do not affect lactation and the composition of milk.

How often can a child be treated?

Many mothers and fathers are concerned about how often can an X-ray of a child’s lungs be done? Radiation exposure can harm the growing cells of a child’s body, sometimes causing gene mutations, damage and DNA strand breakage.

In this regard, it is advisable to carry out x-ray examinations of the lungs of children, as well as adults, no more than once a year.

The only exception is the suspicion of severe forms of pulmonary diseases (malignant neoplasms, tuberculosis, acute inflammation, etc.), when there are no other diagnostic methods, and complications from the disease are greater than the damage caused to health by the procedure. How many times can children be x-rayed in these cases? Each episode requires a personal decision, approximately 5-6 x-rays per year. In some cases:

• if tuberculosis is suspected - once every 3 months to monitor the dynamics of the treatment process;
• for pneumonia - 3–4 days after taking antibiotics, to establish the effectiveness of their use;
• during radiation therapy of malignant tumors of the lungs, when the primary goal is the destruction of cancer cells, and not the effect of radiation on healthy cells - daily.

It is advisable for children to have x-rays performed using digital equipment, which will significantly reduce the amount of radiation exposure.

Attention: X-ray to a minor child is done exclusively with the consent of the parents; up to the age of 12, one of the parents is present during the x-ray session in the x-ray room.

Where to do it?

When deciding where to get an X-ray of the lungs, a person is given a choice at his own discretion:

• municipal clinic (hospital);
• private paid clinic.

Many modern medical institutions have at their disposal a staff of experienced specialists and the latest equipment that gives accurate results and minimizes radiation exposure. Reception of citizens is carried out, as a rule, by pre-registration, the examination results are explained in detail to the patient and handed over in 2 forms: printed and/or digital.

In a number of cities in Russia, Belarus, Ukraine, Kazakhstan, Invitro, a Russian medical company, does lung x-rays, as well as a number of other clinics. Their radiographs meet all accepted standards and are accepted in all medical institutions.

Is the procedure possible at home?

It happens that a person is not able to visit the X-ray room for a number of reasons:

• due to old age;
• for health;
• due to any physical disabilities.

In these cases, it is possible to take an x-ray of the lungs at home.

The procedure is performed using a portable, mobile X-ray device. The most modern of them - digital - have microprocessor control and work in parallel with a computer. Based on the results of the x-ray, the radiologist immediately draws up a detailed report. The radiographs are given to the patient.

X-ray or fluorography?

Like X-rays, fluorography is the photographing of images of organ shadows from an optical device (fluorescent screen) onto film, but, unlike X-rays, in a very small size (1 cm x 1 cm), or onto a computer display from a special chip built into the receiver .

Due to the increase in tuberculosis, mandatory preventive fluorography was introduced for the population, which must be completed annually.

Important: children under the age of 18 are prohibited from undergoing preventive fluorography!

Which is more accurate?

So what is more accurate - x-ray or fluorography of the lungs? Let's compare pictures of these two methods:

1. X-rays of the lungs. They have higher resolution and can be enlarged to very large sizes. Clear, allow you to obtain accurate data and make the correct diagnosis. X-rays make it possible to record changes occurring during the course of the disease, the dynamics of the disease, and the development of pathologies.
2. Fluorographic images of the lungs. The image has lower resolution than an x-ray. Small size The images make it possible to show only a general picture of the condition of the lungs and heart. Deviations from the norm of insignificant size (less than 0.5 cm) look like barely visible threads. Foci of infiltration in pneumonia exceeding 0.5 cm are noticeable, but only if they are located in clean areas of the lung fields. If a disease is suspected, the patient is also sent for an x-ray, which may not confirm the presumptive diagnosis. And this adds additional radiation exposure to the body.

Conclusion: X-ray of the lungs is more precise method than fluorography.

Which is more harmful?

What is more harmful - X-ray of the lungs or fluorography? Harm here refers to dose radiation exposure, acquired during the process. The radiation dose on a film X-ray machine ranges from 0.1 to 0.3 mSv per session. Fluorography today is performed using digital equipment. Digital fluorography gives an approximate dose of 0.04 mSv per 1 session.

Conclusion: fluorography gives a lower dose of radiation than x-rays, which means it is less harmful.

Which is better: CT or X-ray?

The CT (computed tomography) method is also based on scanning with X-rays, but passing through the body at different angles.

The resulting images are combined using a computer into an overall picture, which makes it possible to examine the organ from all sides. CT scan or x-ray of the lungs - which is better and more informative, which is less harmful?

CT has great diagnostic capabilities, since thanks to it it is possible to examine not only the structure of the lung, but also the blood vessels, anatomical processes taking place in the lungs, their internal structures, even differing from each other in density by only 0.1%. The use of a contrast agent increases the accuracy of the data obtained to 98%.

But x-rays have their advantages:

• the dose of radioactive radiation is much lower (for CT scans it ranges from 3 to 10 mVz);
• its cost is several times cheaper;
• Almost all, even municipal, medical institutions have X-ray equipment, so it is more accessible.

When deciding where to take an X-ray of the lungs would be more correct, and where you still need to undergo a CT scan, listen to the point of view of professionals: they will compare the share of what you receive radiation exposure, will take into account the nature of the disease being diagnosed and will be able to provide the necessary direction.

Useful video

You can find out from the following video useful information about x-ray:

Conclusion

1. Nowadays, taking an X-ray of the lungs is not difficult. There are a number of medical institutions, both municipal and private, offering this service to the population.
2. The procedure allows you to examine the lungs and identify up to 90% of pulmonary diseases.
3. In case of severe pathologies that threaten the health and life of the patient, it can be performed quite often.