Tuberculosis is a disease that, for many, sounds like a sentence. Others believe that this disease occurs only in dysfunctional people. However, pulmonary tuberculosis is a treatable disease that is becoming more common these days among all segments of the population. Therefore, it is important to know how tuberculosis looks in the image and how to distinguish it from other pathologies that affect the lungs.
What can be seen with fluorography
This diagnostic method is very common for the early detection of lung pathology. This is an x-ray method, which is the reflection of x-rays from tissues of internal organs. Tissues of different densities are able to reflect radiation in different ways, which makes it possible to see them in the picture.
What does lung fluorography show? With its help, you can see such changes in the chest organs:
- violation of the structure of lung tissue;
- inflammation of the lung parenchyma;
- the presence of neoplasms;
- heart and vascular disease;
- foci of pulmonary tuberculosis;
- proliferation of connective tissue in the lungs;
- the presence of cavities: cysts, abscess (purulent cavity);
- occupational diseases of the respiratory system associated with the accumulation of dust or other harmful emissions in the lungs (pneumoconiosis, anthracosis, sarcoidosis).
Indications for fluorography
This diagnostic method is used both for preventive purposes (once a year), and for certain ailments:
- finding out the causes of cough, chest pain, shortness of breath;
- suspected pneumonia (pneumonia) ;
- the presence of pathology of the heart and blood vessels (atherosclerosis, aortic aneurysm, pathology of the heart valves);
- contact with a patient with tuberculosis;
- suspected HIV infection;
- search for foreign bodies in the respiratory tract and upper gastrointestinal tract.
Contraindications to fluorography and x-ray
Although identifying foci of tuberculosis on an x-ray is the most informative way to diagnose this disease, an x-ray examination is associated with radiation exposure, and therefore there are a number of contraindications to its conduct:
- the age of the child is up to 15 years;
- severe condition of the patient, in which it cannot be transported to an X-ray room;
- pregnant women, especially during the first trimester, since then the formation of the organs of the child occurs;
- women during lactation;
- severe respiratory failure.
Differences of fluorography and x-ray
If necessary, to examine the organs of the respiratory system, many have the question of what to choose: fluorography or x-ray of the lungs.
Fluorography is a cheaper way, since it requires less film. In addition, for its manifestation it is not necessary to use special devices, the pictures appear immediately on the film. Due to its high availability, fluorography has become widespread in routine examinations.
However, it is not as accurate and informative as x-rays. Therefore, in order to make an accurate diagnosis and control of the disease in dynamics, it is necessary to carry out a chest x-ray. Another plus of X-rays is less radiation exposure, therefore, if necessary, X-ray diagnostics for pregnant women and children is prescribed precisely this method.
How does lung pathology manifest on x-rays
With the development of the pathological process in the lung tissue, the most characteristic radiological symptom is the presence of a shadow in the lung. Therefore, many may have a question about darkening in the lungs on fluorography. What does that mean?
Dimming can be total (cover the entire lung tissue) and local (occupy a small area). Total dimming is a shadow of white light without clear contours, occupying most of the lungs. It can be either single or double-sided.
Radiologists subdivide the limited shadow into the focus and infiltrate. The focus has a diameter of up to 10 mm, and the infiltrate is more than 10 mm. Infiltrate has no clear contours and most often occurs with pneumonia (pneumonia), pleurisy (inflammation of the pleura - the membrane surrounding the lung).
When answering the question that this is a blackout of the lungs on fluorography, it is also worth separately highlighting the symptom of a single rounded shadow. As a rule, it is a lesion with a size of 10-15 mm and can appear with such diseases:
- tuberculoma;
- peripheral tumor;
- abscess;
- cyst;
- arterial aneurysm (bag-shaped protrusion of its wall).
Multiple rounded shadows can be a manifestation of how tuberculosis looks in the picture. They are also characteristic of cancerous lung metastases.
Types of Tuberculosis
The appearance of tuberculosis on x-rays directly determines the type of disease.
The following radiological types of tuberculosis are distinguished:
- infiltrative;
- cavernous;
- fibrocavernous;
- disseminated;
- cirrhotic;
- primary tuberculosis.
Infiltrative form
This is the most common form of tuberculosis, which occurs in more than 60% of cases. It is characterized by widespread necrosis (death) of lung tissue. Depending on what fluorography of the lungs shows, several subtypes of infiltrative tuberculosis are distinguished:
- round infiltrate - darkening of an oval or round shape in the upper parts of the lungs, most often under the collarbone;
- cloud-like infiltrate - a shadow of a homogeneous structure with uneven borders;
- regional infiltrate - the shadow has the shape of a triangle, the apex of which is directed to the root of the lung;
- lobular infiltrate - is a group of fused foci of various densities;
- lobes - a large shadow covering a whole lobe of the lung, has a heterogeneous structure.
Cavernous form
X-ray cavernous tuberculosis is characterized by the presence of cavities, or caverns. They are formed with necrosis and decay of the lung tissue. With a prolonged course of the disease, connective tissue grows around the cavity, then another form of tuberculosis arises - fibrous-cavernous.
All caverns with tuberculosis can be divided into several groups depending on their structure:
- encapsulated - the cavity has a wall of three layers (capsule);
- sanitized - the cavity does not contain pus and remains after recovery;
- elastic - cavities have suppuration inside, and their wall consists of two layers;
- fibrous - the formation of a connective tissue membrane around, which indicates a transition to the next form.
On an x-ray, the cavernous type of tuberculosis is as follows:
- a white rounded shadow (darkening), in the center of which black lung tissue (enlightenment) is determined;
- clear contours of the shadow;
- there may be a so-called path to the root of the lung.
The most frequent localization of caverns is the upper parts of the lungs, under the collarbone.
Fibrous cavernous form
It is evidence of a chronic tuberculosis process. There is a deformation of the lung tissue and upper respiratory tract (trachea, bronchi). With this course of the disease, alternating exacerbations (with coughing, hemoptysis, shortness of breath) and remission, when the patient is not bothered, are characteristic.
Description of images of tuberculosis in the fibrous-cavernous form has the following features:
- a cavity with a thicker and more pronounced wall than with cavernous tuberculosis;
- displacement of the trachea towards the formation of a cavity;
- deformation of the pulmonary pattern;
- placement of cavities in the upper sections.
Disseminated form
This form of tuberculosis can be divided into acute, subacute and chronic. As a rule, it develops acutely with the rapid spread of tubercle bacilli throughout the body.
Another classification is distinguished depending on the method of distribution of mycobacteria:
- hematogenous - on x-rays manifests itself in larger sizes of foci located in the upper parts of the lungs;
- lymphogenous - foci of medium size, located mainly in the lower sections;
- lymphobronchogenic - characterized by a unilateral lesion in the lower parts of the lung.
The way tuberculosis looks in the image depends both on the nature of its spread and on the severity of the process. The most characteristic subtype of disseminated tuberculosis is miliary tuberculosis. It is an acute, most often hematogenous infection.
The following are its main signs on an x-ray:
- a large number of small foci, several millimeters in diameter;
- foci evenly distributed throughout the pulmonary field;
- sometimes foci merge;
- the roots of the lungs are slightly elevated;
- sometimes the volume of lung tissue becomes smaller.
Cirrhotic form
This type of tuberculosis process is characterized by large-scale destruction of the lung tissue and the growth of connective fibers in its place.
On X-ray, the cirrhotic form is manifested as follows:
- massive dimming of high density, looks like a bright white shadow;
- reduction in the volume of the affected lung;
- the porous appearance of the pulmonary pattern in the lower sections;
- displacement of the root of the lung and the shadow of the mediastinal organs to the sick side.
Primary tuberculosis
This form of tuberculosis affects children or the elderly. There are three subtypes:
- tuberculosis of unknown localization;
- tuberculosis of the intrathoracic lymph nodes;
- primary tuberculosis complex.
At the first subtype, despite the presence of symptoms, changes in the lungs on the X-ray can not be detected. Therefore, further examination is necessary to determine the localization of the pathological process.
With the second subtype, the mediastinal lymph nodes are affected: parabronchial, paraaortic, paratracheal. The way tuberculosis looks in the image directly depends on the location of the affected lymph nodes:
- characterized by expansion of the root of the lung with blurry edges;
- possibly inhomogeneous lung fields.
The primary tuberculosis complex is determined on an X-ray in the presence of these three signs:
- "path" that goes to the root of the lung (lymphangitis);
- root expansion associated with inflammation of the lymph node (lymphadenitis);
- a high-density focus in lung tissue that occurs when calcium salts are deposited (Gon's focus).
Differential diagnosis of tuberculosis
As a rule, when making an X-ray diagnosis of tuberculosis, you must be able to distinguish it from lung cancer and pneumonia. Often the differences in the images of pneumonia and tuberculosis, especially with the infiltrative form, are practically nonexistent. However, there are some differences. Pneumonia is usually a one-sided lesion, while tuberculosis in most cases affects the lung tissue from two sides.
In addition, infiltration in pneumonia is localized in the lower sections, and in tuberculosis in the upper sections. Infiltrate is more pronounced in tuberculosis, often there are foci of destruction, dissemination.
It should also be noted whether cancer is different from tuberculosis in the pictures. Sometimes it is quite difficult to do this, especially with focal forms of tuberculosis. A number of the following symptoms will help in this:
- the cancerous shadow is intense, with more blurry contours;
- the shadow in cancer in most cases has a uniform structure;
- the growth of the tuberculosis process, if there is no dissemination, is limited to pleura, and therefore does not grow into neighboring lobes of the lung;
- cancer can grow into neighboring lobes.
Diagnosis of tuberculosis with x-rays is quite complicated, and only a doctor can make a final diagnosis and prescribe an effective treatment. After all, tuberculosis is not a sentence!