Currently, every sixth newly diagnosed cancer patient is lung cancer patient, and the share of this nosological form increases annually. The “greatest contribution” to the unsatisfactory mortality statistics for cancer is made by lung cancer. An intensive increase in incidence is observed everywhere, it is significantly higher than the average level in the North and East of Russia (smoking since childhood of the indigenous population). Lung cancer occurs more often pulmonary tuberculosis, in men 3-20 times (depending on the histological structure) more often than in women; the vast majority of patients are heavy smokers; Occupational contact with chemical carcinogens and radiation is important.
Pathomorphology of lung cancer. Based on histological structure, they are divided into squamous cell carcinoma (highly, moderately, poorly differentiated) - more than 40% of all cases lung cancer , adenocarcinoma (highly, moderately, poorly differentiated, bronchioloalveolar) - 30%, small cell carcinoma (oat cell, intermediate cell, combined) - 20%, large cell undifferentiated cancer , poorly differentiated cancer , dimorphic , polymorphic And multidifferentiated cancer - about 10%, carcinoid, tumors of the bronchial glands (adenocystic, mucoepidermoid, mixed) - rare types of lung cancer . Lymphogenic metastases in the intrapulmonary lymph nodes, bronchopulmonary, tracheobronchial, paratracheal, mediastinal and supraclavicular can occur with a violation of phasing. Hematogenous metastases are most often localized in the liver, brain, bones, and less often in organs gastrointestinal tract, kidneys, adrenal glands, skin. The lungs are considered target organs for metastases majority malignant tumors person. Sometimes solitary and single secondary (metastatic) lung tumors long time remain the only manifestation of cancer and can themselves be a source of metastasis.

Clinical picture of lung cancer. Symptoms of lung cancer depend on the caliber of the bronchus in which the tumor arose, its size, characteristics of metastasis, complications and paraneoplastic manifestations. At the core clinical manifestations central cancer obstruction of large bronchi and destruction lie: the triad is characteristic - cough, dyspnea, hemoptysis. At first the cough is dry, then worsens at night and becomes annoying. Mucous sputum is replaced by mucopurulent. Streaks of blood appear in it, then more pronounced signs of pulmonary hemorrhage appear. Dyspnea first occurs when physical activity, and then becomes noticeable during normal activities, for example, when climbing stairs. Fever usually recurrent, when taking antibiotics, a rapid effect can be observed within 2-3 days - normalization of temperature, but patients often note the absence subjective feeling recovery.
Symptoms peripheral cancer associated with the involvement of the pleura in the infiltrative process, tumor disintegration, germination and external compression of large bronchi. Pain and cough occur and intensify. With cancer of the apex, the tumor quickly grows into the dome of the pleura. Pain appears in the shoulder, shoulder blade or chest wall, then it radiates to the area elbow joint, in the forearm and little finger, intensify and interfere with sleep. Hyperesthesia or a feeling of cold may occur. Muscle atrophy increases, primarily the muscles of the hand. On average, 3 months after the onset of pain, symptoms of Horner's syndrome appear - ptosis, miosis, enophthalmos, impaired lacrimation.
Metastases in the lymph nodes of the mediastinum, with predominantly left-sided localization, can manifest as sudden hoarseness and aphonia. With right-sided localization, symptoms of compression of the superior vena cava occur: due to swelling of the face, neck, and upper limbs, patients notice that the shirt collar and watch strap have become tight, puffiness has appeared, then headache(when coughing!), drowsiness, dizziness, fainting, nausea. Dilation may be noticeable jugular veins and subcutaneous vessels chest wall.
Pleurisy in persons over 40 years of age, usually associated with cancer: either lung tumors, either metastases in the pleura, or hemoblastosis.
Metastases in the brain are characterized by acute or subacute onset. Headache paroxysmal, worsens with changes in position, accompanied by vomiting. Join focal, shell, radicular symptoms, mental disorders, sometimes isolated damage to the spinal cord is observed.
Metastases in the bones are accompanied by increasing pain and pathological fractures.
Paraneoplasia with lung cancer can be very diverse. Finger deformation in the form of drumsticks, hypertrophic osteoarthropathy, rheumatoid arthropathy, arthralgia. WITH lung tumor visible changes in the skin and underlying tissues may be associated - dermatomyositis, acanthosis nigricans, hyperpigmentation, psoriatic acrokeratosis, urticarial rash. Gynecomastia is one of many symptoms of endocrine activity lung cancer. When examining blood, anemia, erythrocyte aplasia, leukemoid reactions, eosinophilia, plasmacytosis, thrombopenia, and thrombocytosis are sometimes recorded.

Diagnosis of lung cancer. The group at increased risk of cancer includes: long-term heavy smokers - more than 10 years, more than 20 cigarettes per day; faces with chronic diseases lungs and bronchi chronic bronchitis, bronchiectasis, pulmonary tuberculosis, pneumoconiosis; men over 50 years old; persons who have contact with radiation, occupational hazards: arsenic and its derivatives, asbestos, chromium, nickel, polycyclic aromatic hydrocarbons, vinyl chloride, etc.
Hazardous industries: mining and processing of ores containing radioactive elements, arsenic, chromium, nickel, asbestos, production of fuels and lubricants, paints, glass and plastics.
Latent period For occupational lung cancer ranges from 1.5 years to 60 years.
As part of the medical examination diagnostic measures carried out 2 times a year: survey and physical examination; blood test, sputum analysis for atypical cells, fluorography - 2 images in frontal projection (inhalation and exhalation), 2 - in lateral projections.
When contacting about a persistent cough, changes in voice timbre and aphonia, blood in the sputum, increased body temperature, loss of body weight by 5-6 kg over several months, symptoms stomach ulcers After a thorough physical examination, it is necessary to conduct a blood test and fluorography. Detected changes in the blood count, and on fluorograms - focal and infiltrative shadows, pneumofibrosis, disturbances of bronchial obstruction, deformation of the roots of the lungs, disruption of their structure, the presence of polycyclic shadows in the mediastinum, especially with the upper lobe localization of changes, are the basis for conducting a full-fledged x-ray examination, including tomography and other instrumental studies. The patient should be referred to the next stage of diagnostic and treatment care, at which it is possible to use surgical methods diagnostics and establishment of local and metastatic spread cancer.

To detect metastases, the following is used:
- in the liver - ultrasound or X-ray computerized tomography for liver enlargement, jaundice, increasing the level alkaline phosphatase or other liver tests, LDH;
- in bones - radiography in the presence of local pain, skeletal scanning in case of pain, increased alkaline phosphatase levels, hypercalcemia;
- in the brain - CT scan of the skull with small cell cancer or symptoms of possible brain damage;
- V bone marrow- examination of punctate or biopsy from the sternum or iliac crest for anemia or leukoerythroblastosis, increased alkaline phosphatase levels, inconclusive but suspicious bone scan data.

Lung cancer treatment. Diagnosis lung cancer ” is an indication for surgical treatment. Oncological contraindications to surgery: presence of distant metastases; the inability to technically perform resection for metastases in the mediastinum, involvement of the trachea, diaphragm, chest wall, and mediastinal formations in the tumor infiltrate.

Functional contraindications:
- uncorrectable after therapy with bronchodilators, antibiotics, diaphragm stimulation and postural drainage respiratory failure III degree;
- non-correctable heart failure,
- myocardial infarction, which developed less than 3 months ago;
- uncompensated diabetes mellitus,
- renal And liver failure.

Age is not an obstacle to surgical treatment.
In the event that the patient, for one reason or another, cannot undergo surgical treatment, radiation therapy according to a radical program is indicated.
Chemotherapy is highly effective only for small cell lung cancer: drugs with different mechanisms of action and toxicity are combined and radiation therapy. Polychemotherapy regimens usually include platinum complexes, adriamycin, Vepesid or vinca alkaloids, and fluorouracil. For non-small cell cancers, chemotherapy solves symptomatic problems.

The anatomical structure of the lungs, their ability to be filled with air that freely transmits x-ray radiation, makes it possible to obtain, during fluoroscopy, an image that reflects in detail all the structural elements of the lungs. However, darkening in the lungs on an x-ray does not always reflect changes in the tissues of the lung itself, since there are other organs at the level of the lungs chest and, consequently, a beam of radiation, passing through the body, projects on film a superimposed image of all organs and tissues falling within its range.

In this regard, if any darkened formation is detected in the image, before answering the question of what it could be, it is necessary to clearly differentiate the localization of the pathological focus (in the tissues of the chest, diaphragm, pleural cavity or, directly, in the lungs).

Main syndromes on radiographs

On an x-ray taken in the anterior projection, the contours of the lungs form pulmonary fields over the entire area, intersected by symmetrical shadows of the ribs. A large shadow between the pulmonary fields is formed by the combined overlap of the projection of the heart and main arteries. Within the contour of the lung fields, one can see the roots of the lungs located at the same level with the anterior ends of the 2nd and 4th ribs and a slight darkening of the area caused by the rich vascular network located in the lung tissue.

All pathological changes, reflected on x-rays can be divided into three groups.

Dimming

Appear on the picture in cases where a healthy part of the lung replaced pathological formation or substance, causing the air part to be displaced by denser masses. As a rule, it is observed in the following diseases:

• bronchial obstruction (atelectasis);
• accumulation of inflammatory fluid (pneumonia);
• benign or malignant tissue degeneration (tumor process).

Change in pulmonary pattern

• total (complete) or subtotal (almost complete) blackout;
• limited dimming;
• round (spherical) shadow;
• ring shadow;
• focal darkening.

Enlightenment

The clearing in the image reflects a decrease in the density and volume of soft tissues. As a rule, similar phenomenon takes place during education in light air cavities (pneumothorax). Due to the specific reflection of x-ray results on photographic paper, areas that easily transmit radiation are reflected in a darker color due to the more intense effect of x-rays on the silver ions contained in photographic paper; areas of a denser structure have a light color. The wording “darkening” in the image is actually reflected in the form of a light area or focus.

X-ray showing a pulmonary pattern of healthy lungs

Total blackout syndrome

Total darkening of the lung on an x-ray represents complete or partial darkening (at least 2/3 pulmonary field). In this case, gaps are possible in the upper or lower part of the lung. Main physiological reasons manifestations of this syndrome are the absence of air in the lung cavity, an increase in the density of the entire tissue lung surface, the content of fluid or any pathological content in the pleural cavity.

Diseases that can cause such a syndrome include:

• atelectasis;
• cirrhosis;
• exudative pleurisy;
• pneumonia.

To implement differential diagnosis diseases, it is necessary to rely on two main signs. The first sign is to assess the location of the mediastinal organs. It can be regular or offset, usually in the direction opposite to the darkening focus. The main landmark in identifying the displacement axis is the shadow of the heart, located mostly to the left of the midline of the chest, and less to the right, and the stomach, the most informative part of which is the air bubble, which is always clearly visible on the images.

The second sign that makes it possible to identify a pathological condition is an assessment of the uniformity of darkening. Thus, with uniform darkening, atelectasis can be diagnosed with a high degree of probability, and with heterogeneous darkening, cirrhosis can be diagnosed. Interpretation of the results obtained using the radiographic method consists of a comprehensive assessment of all visually detected pathological elements in comparison with anatomical features each individual patient.

Limited dimming syndrome

To identify the causes of limited darkening of the pulmonary field, it is necessary to take an image in two directions - in direct projection and lateral. Based on the results of the obtained images, it is important to assess the localization of the darkening focus. If the shadow in all photographs is located inside the pulmonary field and is similar in size to its contours or has a smaller volume, it is logical to assume a lung lesion.

When darkening is adjacent to the diaphragm or mediastinal organs with a wide base, extrapulmonary pathologies can be diagnosed ( liquid inclusions in the pleural cavity). Another criterion for evaluating limited shades is size. In this case, two possible options should be considered:

• The size of the darkening clearly follows the contours of the affected part of the lung, which may indicate an inflammatory process;
• The size of the darkening is less than the normal size of the affected lung segment, which indicates cirrhosis of the lung tissue or bronchial blockage.

Particular attention should be paid to cases in which there is a darkening of normal dimensions, in the structure of which light foci (cavities) can be traced. First of all, in this case, it is necessary to clarify whether the cavity contains liquid. To do this, a series of photographs are taken in different positions of the patient (standing, lying down or bending over) and changes in the level of the estimated upper limit of the liquid contents are assessed. If fluid is present, a lung abscess is diagnosed, and if it is not present, then the likely diagnosis is tuberculosis.

Important! The detection of several cavities with limited darkening of the lung is characteristic of pneumonia caused by staphylococcus. Such a lesion has an unfavorable prognosis, and often treatment is only possible through surgery.

X-ray shows limited darkening of the lungs in two projections

Round shadow syndrome

I identify round shadow syndrome when the spot on the lungs has a round or oval shape on two photographs taken perpendicular to each other, that is, from the front and the side. To decipher the results of radiography when a round shadow is detected, they rely on 4 signs:

• form of shading;
• localization of darkening relative to nearby organs;
• clarity and thickness of its contours;
• structure of the internal shadow field.

Since the shadow reflected on the image within the lung field may actually be located outside it, assessing the shape of the darkening can greatly facilitate diagnosis. Thus, a round shape is characteristic of intrapulmonary formations (tumor, cyst, infiltrate filled with inflammatory contents). An oval shadow in most cases is the result of compression of a round formation by the walls of the lung.

The structure of the internal shadow field is also highly informative. If, when analyzing the results, the heterogeneity of the shadow is obvious, for example, lighter foci, then with a high degree of probability, it is possible to diagnose the disintegration of necrotic tissue (with disintegrating cancer or disintegration of tuberculous infiltrate) or the formation of a cavity. Darker areas may indicate partial calcification of tuberculoma.

A clear and dense contour indicates the presence of a fibrous capsule, characteristic of hydatid cyst. Round shadow syndrome includes only those shadows that are more than 1 cm in diameter; shadows with a smaller diameter are considered lesions.

Ring shadow syndrome

A ring-shaped spot on the lung on an x-ray is the easiest syndrome to analyze. As a rule, a ring-shaped shadow appears on an x-ray as a result of the formation of a cavity filled with air. Required condition, in which the detected darkening is referred to as ring-shaped shadow syndrome - this is the preservation of a closed ring when taking pictures in all projections and in various positions of the patient’s body. If in at least one of the series of photographs the ring does not have a closed structure, the shadow can be considered an optical illusion.

If a cavity is detected in the lung, the uniformity and thickness of its walls should be assessed. Thus, with a large and uniform thickness of the contour, one can assume the inflammatory origin of the cavity, for example, a tuberculous cavity. A similar picture is observed with an abscess, when purulent melting of tissue occurs and the contents are removed through the bronchi. However, with an abscess, the remains of pus, most often, continue to be in the cavity and their complete removal a rather rare occurrence, so usually such a cavity is a tuberculous cavity.

The unevenly wide walls of the ring indicate the process of decay of lung cancer. Necrotic processes in tumor tissue can cause the formation of a cavity, but since necrosis develops unevenly, tumor masses remain on the inner walls of the cavity, creating the effect of an “uneven” ring.

Important! The main difficulty in assessing the ring-shaped shadow is determining the localization of the formation, since in most cases a similar syndrome is observed in extrapulmonary processes (deformation of the ribs, gases in the intestines, gases in the pleural cavity).

The image shows a ring-shaped shadow in the lower lobe right lung

Focal opacification syndrome

Spots on the lungs larger than 1 mm and smaller than 1 cm are considered lesions. On an x-ray, you can see from 1 to several lesions located at a considerable distance from each other or in a group. If the area of ​​distribution of foci does not exceed 2 intercostal spaces, the lesion (dissemination) is considered limited, and if the foci are distributed over a larger area, it is considered diffuse.

The main criteria for assessing focal darkening are:

• area of ​​distribution and location of foci;
• shadow contours;
• darkening intensity.

When one or more dark spots are located in the upper parts of the lung- a clear sign of tuberculosis. Many foci with limited spread are a sign of focal pneumonia or the result of the disintegration of a tuberculous cavity, located, as a rule, slightly above the detected foci. In the latter case, a round or ring-shaped shadow may also be observed in the picture.

The reason for the appearance of a single darkening in any part of the lung is, first of all, considered the likelihood of developing cancer or tumor metastasis. This is also evidenced by clear contours shadows. Fuzzy contours indicate the inflammatory origin of the darkening.

To assess the intensity of darkening, they are compared with the image of the vessels visualized in the image. If the severity of the lesion is inferior to the shadow of the vessel, this is a low-intensity darkening characteristic of focal pneumonia or infiltrated tuberculosis. With medium and strong darkening of the focus, when the severity is equal to or darker than the vascular pattern, one can judge the attenuation of the tuberculosis process.

Since extensive dissemination of lesions can indicate more than 100 diseases, to distinguish between causes, the size of the shadows should be assessed. Thus, the smallest foci covering the entire area of ​​the lung may indicate pneumoconiosis, miliary tuberculosis or focal pneumonia.

The image shows small focal shadows

Important! Regardless of what changes are observed on an x-ray of the lungs, when analyzing the results, one should take into account the presence of a normal pulmonary pattern, which is characterized by the presence of shadows of the vascular system.

In the vast majority of cases, a final diagnosis cannot be made on the basis of lung x-rays, since analysis of the resulting image allows us to identify only a syndrome characteristic of a particular disease. If the x-ray showed darkening of any area, then to clarify the diagnosis and assess the dynamics of the development of the disease, it is necessary to carry out a complex laboratory research and additional diagnostics using MSCT, bronchography, biopsy, etc.

With smooth, clear contours of medium intensity - such a conclusion from a radiologist is often found. It reflects infiltrative changes in the lung tissue or “plus shadow” syndrome.

What to do if a white spot is detected on the x-ray

When performing a chest x-ray or fluorography on a patient with tuberculosis white spot The X-ray image reflects either an inflammatory lesion of the lung tissue or destructive changes in the parenchyma with the formation of abscesses, tubercles, and cavities. Right this symptom should be called darkening, since it reflects the characteristics of the passage of x-rays through objects and their color display on the x-ray.

Shadow in the photo white also observed with:

• atelectasis;
• exudative pleurisy;
• occupational diseases(silicosis, talcosis, asbestosis).

X-rays with white spots of various origins: 124.3 – breast piercing, 124.4 – fraction in soft tissues chest, 124.5 – professional cementosis, 124.6a – contrast during bronchography, 124.6b – pneumonic focus, 124.7 – interlobar pleurisy (arrows indicate artifact)

This syndrome is a sign of many pathological changes in the lungs, but we will consider the most common options.

If stains are found, it is necessary additional research, allowing us to establish the cause of the pathology. For these purposes, a radiologist may prescribe an X-ray examination in additional projections or perform layer-by-layer computed tomography or magnetic resonance imaging.

What does a spot look like on an x-ray with pneumonia?

In pneumonia, the spot on the x-ray image has a length depending on the size of the lesion in the pulmonary parenchyma:

• limited – up to 3 cm in diameter;
• segmental – within a segment;
• subtotal – the entire field, with the exception of the tops;
• total.

Pneumonia - inflammatory disease, in which the alveolar tissue is affected with the accumulation of fluid in the acini. Pathogenesis forms a specific x-ray picture of the disease.

X-ray. Focal pneumonia in the lower lobe on the right

The white spot with pneumonia has fuzzy, blurry contours. Its intensity can be low or high, depending on the characteristics of the exudate (inflammatory fluid in the lumen of the alveoli). A path from the root approaches the site of its localization due to lymphangitis.

Lung atelectasis or x-ray semiotics of triangular spots on the image

Lung atelectasis is a disease accompanied by the collapse of a segment, lobe or lung tissue completely against the background of cessation of bronchial ventilation. Radiologically, such changes are called limited darkening, since they do not extend beyond the boundaries of the segment or subsegment and have a triangular shape.

Atelectasis of the middle lobe of the right lung - frontal and lateral radiographs

How to identify atelectasis in an image:

• the size of the spot coincides with the size of the changed segment;
• triangular darkening in the lungs can be seen in frontal and lateral projections;
• during inhalation photographs the size of the spot does not increase;
• the narrow end of the triangular shadow is directed towards the root;
• Holtzknecht-Jacobson symptoms are observed during fluoroscopy (suction of the mediastinum towards the lesion during exhalation).

The morphological substrate of the pathology is the accumulation of infiltrative fluid in the alveoli, infiltration of lung tissue, tumor growth in the pulmonary parenchyma.

Spontaneous atelectasis occurs in 1-3% of patients due to a defect in surfactant (the substance that forms the framework of the alveoli).

Limited darkening during collapse of the lungs requires knowledge of the segmental structure of the lungs, as it reflects atelectasis of a certain segment. By establishing the topography of the shadow, the doctor can guess which bronchus is affected. The substrate of formation (infiltrate, additional tissue, exudate) is almost impossible to establish on the basis of a radiograph.

What does a white spot mean in a picture of tuberculosis?

A focal spot on a chest x-ray indicates the infiltrative stage of the disease, when mycobacteria begin to infect the lung tissue. In this case, the x-ray shows a path to the root from the side of the lesion (due to lymphangitis). Such radiographic symptoms received the name “primary tuberculosis focus”.

Radiographs at various types tuberculosis

Multiple small disseminated shadows on both sides indicate miliary tuberculosis.

A single large shadow with a cavity inside (clearance) and a fluid level is an abscess formed against the background of destruction of the lung parenchyma - “ring shadow” syndrome.

The spot on the X-ray of the lungs in the projection of the pulmonary fields reflects pathological process, the reasons for which should be established by additional research.

Carrying out fluorography

Fluorography is a study of the condition of the lungs using X-ray method. It is cheaper than standard x-ray examination, so it is used more often.

Every adult is required to undergo fluorography once a year. Exceptions include people working in the steel or mining industries, relatives of people with tuberculosis, maternity hospital workers, blacksmiths, and asbestos production workers. They spend X-ray examination 2 times a year.

In general, fluorography is a detailed examination of the chest organs performed using X-rays. They, penetrating through the lung tissue, transfer a specific pattern of the lungs onto the film using fluorescent microparticles. The question often arises: “What is the difference between fluorography and x-rays?”

The difference between fluorography and x-rays

Fluorography provides only a general picture of the condition of the heart and lungs.
X-ray has higher accuracy in determining the condition internal organs.
Fluorography (FLG, FG) is considered to be a mandatory preventive procedure, and x-rays are done only after a doctor’s prescription. Fluorography is allowed 2 times a year, x-rays - 1 time.

According to doctors, x-rays are more informative than FLG. On x-rays, the pathological changes that have arisen are more clearly visible. Why is this so? The fact is that the size of a fluorography image is 40 x 40 mm, and an x-ray image is 300 x 300 mm! And besides, accordingly, it is easy to calculate that the film used for x-ray You can print approximately 7 prints of fluorography images.

You have a question: “Why then is everyone supposed to undergo fluorography every year, and not x-rays?” The answer is quite obvious. Price. Fluorography is much cheaper, since the film used for it is smaller in area, and therefore costs less. But don’t be offended by doctors or employers! Yes, you tell me that nothing can be seen in a small photograph. Yes, it really seems like there’s nothing special, but if a person feels great and has no complaints, then there shouldn’t be anything “like that” visible there. But in fact, this picture is not as small as it seems. You see a lot of things on your phone screens! So the doctor will see the darkening in the fluorography picture!

Why does darkening occur on fluorography? Reasons for doctors' anxiety

In the image after the study, you can detect some darkening in the lungs. They can be explained by several reasons:

Availability oncological processes in the lungs
fluorography shows tuberculosis
fluorography also shows pneumonia

However, often due to the fact that the photograph is small, only very gross changes in paired organs are revealed when the disease is already very advanced. A fluorogram will not determine the presence of, say, ordinary bronchitis. The main task of fluorography is to detect tuberculosis or cancer, since these diseases are very dangerous to human life.

Known some contraindications for fluorography. These include:

Pregnancy
Breastfeeding period
Age up to 14 years
Availability of accompanying serious illnesses, oncology.

Possible harm from fluorography

Since most people believe rumors and conjectures that mislead them, and do not double-check the facts themselves, this is why there is a growing opinion among the people that radiation from X-rays and fluorography is harmful to health. But is this true? Let's figure it out for ourselves...

Everyone knows that all people receive some dose of radiation in everyday life. This is the natural background of the Earth in a given area. It is approximately 15 microroentgen per hour (0.15 microsievert/hour). A safe dose is considered to be 50 microroentgen/hour (0.5 microsievert per hour). Radiation exposure to the body during fluorography is 0.150-0.250 mSv; with x-rays - 0.150-0.400 mSv. If in both cases we take the lower limit, then it is 150 microsievert (µSv). At first glance, the value significantly exceeds the norm, but this safe dose. Let me explain why. The fact is that in this case it is the time of exposure that is important. It is minimal - a few seconds. Research has long confirmed this idea and scientists have long known that people without special harm can tolerate radiation up to several (2-3) millisieverts per hour. Let me remind you that 1 milliSievert (mSv, mSv) = 1000 microsievert (µSv, mkSv, µSv). As you can see, in the case of fluorography and x-rays, the radiation is much less.

Where did the fears come from?

The fact is that radiation exposure from old X-ray machines reached 0.8 mSv. And this is 800 microsievert (µSv). This figure is comparable to the permissible short-term 1000-3000 microsieverts, especially if we assume that in case of damage to the film it was necessary to redo the picture, and sometimes twice. At present, the radiation exposure is weaker and only 15% of images are rejected.

Therefore, when applying for a job, calling for military service, before giving birth to a pregnant woman, people living with her, as well as once a year, workers in food and medical institutions, signalmen, and teachers - all must undergo an appropriate medical examination and fluorography. Don't be afraid, you won't get radiation sickness! You will not get sick even if, when you go to the hospital within a year, you are asked to repeat the image again. All the pictures in your entire life will also lead to nothing.

What is the photo for? What can be seen in the photo?

The organs located inside the chest are endowed with the peculiarity of absorbing radiation differently. That is why the resulting image looks heterogeneous. There are bright, uniform places, and sometimes there are dark spots. Light spots show:

Heart
Bronchi
Bronchioles.

The lungs, if healthy, appear uniform in color. If they are inflamed, then characteristic darkening will be visible in the picture (with increased density lung tissue) or, conversely, lightened areas (with increased airiness of the lung tissue).

Interpretation of a fluorography image

The results, after the study, are prepared within a few days. The finished fluorogram is examined by a radiologist. If all indications are normal, then the patient is not sent for additional examination. Darkening in the lungs on fluorography alarms doctors and the patient is sent for radiography to clarify the diagnosis.

If there are darkened or lightened areas, the radiologist issues similar conclusions with a presumptive diagnosis:

1. Expansion and compaction of roots. The compaction of this area is characteristic of: pneumonia, bronchitis and some other inflammatory or chronic processes.

2. The roots are heavy. This conclusion indicates the presence of bronchitis or another acute (chronic) process. It is typical for images of the lungs of a smoker.

3. Strengthening the vascular pattern. It is usually formed by the shadows of the pulmonary veins and arteries. Its increased manifestation may be a sign of bronchitis, pneumonia or the early stages of cancer. It also indicates problems in the cardiovascular system.

4. Fibrous tissue. Its presence is evidence of the patient’s history of lung disease.

5. Focal shadows. Darkening about 1 cm in size. May indicate the occurrence of pneumonia (foci of the lower and middle parts of the lungs) or tuberculosis (foci of the upper parts).

6. Calcifications. Dense shadows, rounded. Not dangerous. Indicate the presence of contact with a patient with: tuberculosis, pneumonia. That is, the infection does not develop, but is isolated by deposits of calcium salts.

7. Aperture changes. Shows aperture anomalies. It develops due to bad heredity, deformation by adhesions, obesity, past diseases(esophagus, liver, stomach, intestines).

8. The sinus is sealed (free). The pleural sinus is the cavity formed by the pleural folds. The sinus is free in healthy lungs, and, conversely, sealed in sick ones.

9. Adhesions, pleuroapical layers. The presence of adhesions or pleuroapical layers indicates a history of pleural inflammation.

10. Displacement (expansion) of the mediastinal shadow. The mediastinum is the space between the lungs + the organs located in it (heart, aorta, esophagus, trachea, thymus, lymph nodes and vessels). Enlargement indicates hypertension, cardiac enlargement, myocarditis, or heart failure.

Fluorography on photographic film in our time is still the main way to check the overall picture of internal organs. If, after this, the doctor orders an x-ray, you should follow his recommendation.

Spots on the lungs during fluorography can certainly alert any person. However, there is no need to panic - darkening of a certain area of ​​the lung may be a simple film defect. However, even if the spot indicates a disease, there is also no need to worry seriously - it is likely that the disease has not yet developed into something more than just a mark on the picture, which can be quickly and easily eliminated.

Why might darkening appear on the lungs?

IN for preventive purposes It is recommended to undergo fluorography at least once a year. If darkening is visible in the image, you should immediately consult a doctor who can identify or exclude the presence dangerous disease. In this case, vigilance on the part of the patient is important, since the course of treatment of the pathology and rehabilitation depend on it.

A spot on an x-ray may appear:

• after inflammatory process;
• due to bronchitis;
• for tuberculosis;
• if any malignant formations;
• as a result of injury;
• when hit foreign body;
• with fluid accumulation;
• due to prolonged smoking;
• for abscesses.

Among these causes of darkening of the lungs, there are those that are dangerous not only for the life of the sick person, but also for the society around him. In any case, if you find a darkening on fluorography, you need to undergo a more detailed examination to confirm or refute the diagnosis.

Sometimes the following can act as a stain:

• enlarged lymph node;
• formation on the rib;
• dilatation of the esophagus;
• formation on the spine.

What is the significance of the shape and location of darkening on the lung?

If only one spot is visible on fluorography, this may indicate the presence of a tumor. The presence of multiple spots on the image indicates inflammation, fluid accumulation, tuberculosis or the presence of a tumor in the neighboring organs.

If dark spot located at the top of the lung, then most likely the patient has tuberculosis. Its blurred boundaries may indicate the presence of pneumonia. In the latter case, the disease is accompanied by weakness and fever. Sometimes body temperature rises slightly.

Based on the shape of the spot, the doctor can identify whether the patient is experiencing a pulmonary infarction or hemorrhage.

Read about what diseases a chest x-ray can reveal. About all methods for diagnosing lung diseases and respiratory tract you can find out.

Methods for deciphering a fluorogram

After passing diagnostic procedure The patient is given a photograph and its description. Often, darkening in the lungs on fluorography is accompanied by some features. Let's pay attention to the most frequent comments and their meaning.

1. If the roots enlarge, suspicions arise about the presence of bronchitis or inflammation;
2. If a person smokes regularly or has bronchitis, stringy roots will be visible in the picture;
3. Deep drawing of blood vessels indicates poor circulation in the lungs, the presence of heart pathologies and problems cardiovascular system. Also, such a picture may mean that the patient has bronchitis, pneumonia or the initial stage of cancer;
4. Fibrous tissue may be the result of previous operations, illnesses or injuries;
5. If a clear vascular pattern is visible in the darkened area, then it should be assumed that the patient has pneumonia;
6. The presence of calcifications indicates that the patient had previously been in contact with a person sick with tuberculosis, but his body did not allow the infection to spread by forming calcium inclusions;
7. Changes in the diaphragm can be diagnosed due to obesity or diseases of the gastrointestinal tract;
8. A sinus is detected if the pleural folds form fluid cavities of an adhesive nature.

A spot on a fluorography image may indicate the presence various diseases and pathologies, therefore, to make an accurate diagnosis, it is necessary to undergo additional examination. For this, a pulmonologist (or oncologist) prescribes special procedures.

List of procedures for additional examination

Using a method for determining tuberculosis, called Diaskintest, you can accurately diagnose. Compared to mantoux, in this case there is no reaction to BCG.

Sputum collection is carried out if there is a need to confirm or exclude the presence of tuberculosis bacteria, cancer cells and harmful impurities that can cause one or another pathological condition.

An informative diagnostic method is computed tomography of the respiratory system.

To perform pulmonary bronchoscopy and tracheobronchoscopy, a flexible endoscope is used, which is inserted through the nose. Before doing this procedure, the patient undergoes an x-ray to confirm the patency of the airway. Using this study, you can not only assess the condition of the lungs, but also take material for histological, cytological and bacterial analysis.

Donating blood for tumor markers is additional method detection of cancer, without which a final diagnosis cannot be made. Based on the results of this analysis, the doctor will see whether there are proteins in the blood that are produced only due to the presence cancerous tumor. To pass this survey the patient must donate blood from a vein. It is important that he does not eat food for 12 hours before the analysis. The number of cancer markers may increase not only with cancer diseases, but also in the presence of inflammation or infections.

A diagnostic method such as fluorography cannot be called highly accurate, since in some cases errors may occur. To put accurate diagnosis, you should undergo additional examination and consult with a pulmonologist or oncologist. However, detect tuberculosis or lung cancer With the help of fluorography it is still possible. The advantages of this diagnostic method also include the speed of examination and accessibility for any person. In some cases, fluorography is the only method for detecting tuberculosis in a patient.