Root densification is one of the most common radiological syndromes, which the radiologist determines on a chest x-ray. What does this mean: "roots of the lungs are compressed"? What diseases and pathological conditions are hidden under this phrase?
Lung root: what is it?
The root of the lung is a complex of structures located at the gates of the lung. These include the pulmonary artery, vein, main bronchus, as well as nerves, lymphatic vessels, pleura, fatty tissue. All these structures are arranged in a strictly defined order, but part of them on the left side is not visible on the radiograph, hiding behind the shadow of the heart.
On a survey radiography and fluorography, such a concept as the root of the lung means only large vessels (artery, vein) and bronchus.
The main characteristics of the roots of the lungs
To determine on a X-ray such a symptom as compaction of the roots of the lungs, first of all you need to know the features of these formations in the norm.
The root of both the right and left lungs consists of three parts: the head, body and tail. The tail includes finite small branching vessels.
In radiology, the width of these structures is also determined. It is usually determined by the width of the right root and includes arteries and an intermediate bronchus. Normally, its width is 1.5-2 cm.
It is also worth noting that the arteries in the roots of the lung are located more vertically, and the veins - horizontally. Sometimes their structure can be heterogeneous due to the fact that in some areas air bleeds in the bronchi are visible.
Differences in the location of the roots of the lungs
The placement of the roots of the right and left lungs is slightly different. So, the root of the right lung corresponds normally to level II of the rib and intercostal space and has the shape of an arc curved downward. Starting with an extension at the top, the root narrows at the bottom. The left root, in turn, corresponds to level I of the rib and intercostal space, that is, it is higher than the right.
Differences in the structure of the roots of the lungs
It must be understood that the left root is poorly visible on the radiograph, as it is covered by the heart, therefore it is sometimes difficult to see when the root of the left lung is densified.
It should also be remembered that the root of the left lung is normally of an inhomogeneous structure, since it consists practically of only vessels, branching into small branches and intertwining with the left bronchus. While the right root has a more uniform structure.
The main causes of root compaction
There are many different diseases and syndromes that lead to the fact that the roots of the lung are densified. The main reasons include:
- Chronic obstructive pulmonary disease (chronic obstructive bronchitis).
- Enlarged lymph nodes of the mediastinum (paratracheal, parabronchial) with the development of petrificates (deposits of calcium salts) in them.
- Expansion and protrusion of the vessel wall or vessel aneurysm.
- Change in the structure of the bronchus under the influence of the tumor process.
- Pulmonary edema (penetration of fluid into the lung parenchyma).
- The growth of connective tissue with the development of fibrosis, which takes place after prolonged inflammatory pulmonary diseases, lung injuries, surgical interventions on the organs of the chest cavity.
- Tuberculous defeat of the bronchi (tuberculous bronchoadenitis), tuberculosis of the intrathoracic lymph nodes, primary tuberculosis complex. The last two forms are related to primary tuberculosis, the most common among preschool children.
- Occupational diseases (asbestosis, metalloconiosis).
Chronic obstructive pulmonary disease
This group of diseases is one of the most common reasons why the roots of the lungs are densified and dilated. As a rule, this process is two-way, - it affects both the left and right roots. Most often, the disease develops in smokers with a long history and is characterized by alternating periods of exacerbation with periods of remission.
The main clinical manifestations are coughing, especially disturbing the patient in the morning - with viscous, sometimes purulent sputum. With a prolonged course of the disease, shortness of breath develops, which is first noted during physical exertion, and then in peace.
In addition to conducting a chest x-ray, characterized by the fact that the roots are sealed and heavy in the lungs, sputum culture is also performed to determine the causative agent of the disease (viral or bacterial).
Etiotropic therapy, that is, treatment of the cause, depends on the pathogen that caused the exacerbation. If the cause is a bacterium, then taking antibiotics will be effective, if the virus is taking antiviral agents.
Symptomatic therapy includes the use of mucolytics, sputum thinners, and expectorants for easier discharge. They also take drugs that expand the bronchi - adrenergic receptor agonists, corticosteroids.
Oncological diseases
A dangerous, but, fortunately, infrequently encountered reason that the roots of the lungs are densified and dilated is the oncological process in the bronchi and organs of the mediastinum. Such a process is usually one-sided, so a change in the root of the lung is observed only on one side.
Oncology implies a long chronic process with a gradual deterioration of the patient's condition. A slight cough, heavy breathing are replaced by pain behind the sternum at the site of the projection of the tumor on the chest wall (with compression of the nerves), hemoptysis, severe shortness of breath. In addition to impaired pulmonary function, the whole body suffers. The patient loses weight, is exhausted, fatigue and weakness appear.
After conducting a radiography of the chest cavity in two projections, the radiologist concludes: "The roots of the lungs are densified and unstructured." Further, the attending physician gives a direction for a biopsy of an X-ray-suspicious formation, which will determine not only the type of tumor (benign or malignant), but also its histological structure (from which tissues it was formed).
Therapy depends on both the stage of the tumor process and its type. The main therapeutic methods: surgical, radiation and chemotherapy. Surgery alone is used in the initial stages of tumor development, in the later stages it is combined with other methods of therapy.
Occupational diseases
People of such professions as miners, metal welders, builders, that is, those who constantly interact with harmful environmental substances, are most susceptible to the development of occupational diseases. This leads to the fact that on the roentgenogram, the roots in the lungs are fibrically densified and heavy. This picture develops due to the accumulation in the bronchi and alveoli of harmful particles that settle on the respiratory tract. As a rule, root damage is not isolated, but combined with the presence of focal shadows and heterogeneity of the lung parenchyma.
Symptoms of these diseases are not specific; when making a diagnosis, they primarily pay attention to a professional history (place of work, length of service). And the main treatment method is to change qualifications and change jobs.
Root damage in tuberculosis
The situation when the roots of the lungs are densified usually occurs in children with primary pulmonary tuberculosis. These are forms such as primary tuberculosis complex and tuberculosis of the intrathoracic lymph nodes. However, these forms can also occur in elderly people with reinfection of the old focus.
Tuberculosis is a chronic disease, so symptoms develop for a long time and gradually. Characteristic are a dry cough or with a small amount of sputum, possibly with an admixture of blood, pain behind the sternum, fatigue, lethargy, weight loss.
After radiography is performed in two projections, sputum culture and microscopy are performed to detect mycobacterium tuberculosis, a tomogram of the lungs for more accurate localization of the site of infection. After sowing the tubercle bacillus, its sensitivity to anti-TB drugs is determined, which is necessary to select the most effective treatment.
Drug therapy is based on the principles of continuity and long-term (at least 6 months). It is also necessary to use a combination of at least 4 anti-TB drugs. Only following these principles will treatment be effective.
The roots of the lungs are heavy and compacted: what does this mean?
As noted above, most often this radiological syndrome occurs in chronic bronchitis of the smoker and occupational lung diseases. However, this symptom can also be determined with acute inflammatory diseases of the respiratory tract, cancer.
These cords are connective tissue fibers that extend from the root to the periphery. The severity is usually combined with the expansion and compaction of the root.
Not possessing high specificity, this syndrome allows the doctor to suspect a certain pulmonary pathology and refer the patient to further examinations.
The roots of the lungs are unstructured and densified: what does this mean?
Violation of the structure of the root of the lung, that is, the inability to distinguish a vessel from the bronchus, the appearance of darkening on the root, is usually found in primary tuberculosis, oncological processes.
On the x-ray with extensive tuberculosis or central lung cancer, instead of the root, a shadow of various contours can be visualized, representing a focus (up to 10 mm in diameter) or infiltrate (more than 10 mm). This symptom can also be combined with compaction, which usually happens with the deposition of calcium salts or calcification (petrification). Calcification is a sign of a chronic, long-running process.
Thus, just one radiological symptom (in the lungs, the roots are fibro densified and heavy) can help suspect many diseases: from ordinary bronchitis to lung cancer. Of course, do not forget that radiography should be supplemented by other examination methods: computed tomogram, biopsy, sputum culture, bronchoscopy, and so on. Additional examination methods are performed as prescribed by the doctor, depending on the path of his diagnostic search. It must be remembered that only a comprehensive examination will help to make the correct diagnosis.