home Audience 6 Pulmonary syndromes. What is pulmonary infiltration syndrome Belarusian State Medical University

Pulmonary syndromes. What is pulmonary infiltration syndrome Belarusian State Medical University

Lung infiltration is the process of replacing lung tissue of normal airiness with an area with increased density and increased volume, containing cellular elements unusual for this tissue (leukocytes, lymphocytes, macrophages, eosinophils, etc.). This syndrome consists of characteristic morphological, radiological and clinical signs.

What diseases does it occur in?

The most common cause of infiltration in the lungs is pneumonia.

Pulmonary tissue infiltration syndrome can be a manifestation of various pathological conditions. Most often, an infiltrate in the lungs is formed in the following diseases:

Inflammatory processes in the lungs of various natures:

viral;
bacterial;
fungal;
congestive pneumonia;
hypostatic pneumonia, etc.

Damage to the respiratory system with.
Developmental anomalies:

(pathological anastomosis between the arteries and veins of the lung);
sequestration of the lung (part of the lung tissue is separated from the bronchi, pulmonary blood vessels and is supplied with blood from the arteries branching from the aorta);
(disembryonic formation consisting of elements of the pulmonary parenchyma and bronchial wall).

Allergic infiltrate in the lungs.
or benign neoplasms.
Focal pneumosclerosis.

How it manifests itself

The clinical picture of pulmonary infiltration is determined by the disease that caused the pathological process. The severity of symptoms depends on the area of the lesion and the general reactivity of the body. But there are general manifestations of this syndrome, characteristic of any disease that occurs with the formation of infiltrate in the lungs. These include:

complaints of cough, hemoptysis, pain in the chest (with damage to the pleural layers);
change in general condition (fever, intoxication);
objective data: lag of half of the chest in the act of breathing (on the “sick” side), increased vocal tremors and dullness of percussion sound over the pathological focus, weakening of respiratory sounds in this area, less often dry and moist rales during auscultation;
X-ray data: limited or diffuse darkening of the pulmonary field.

Below we will dwell on the features of infiltration syndrome in the most common pathological conditions.

Infiltration with pneumonia

The inflammatory process in the lungs can be caused by a large number of different pathogens, and therefore its course has certain differences.

Staphylococcal differs from other inflammatory processes in the lungs by its tendency to destructive changes with the formation of cavities.
Pneumonia caused by Klebsiella occurs in weakened patients or the elderly. It can occur with mild intoxication, cough with bloody sputum with the smell of burnt meat. Already on the first day, the collapse of lung tissue in the affected area is possible with the formation of thin-walled cyst-like cavities.
With anaerobic pneumonia, microabscesses form at the site of infiltration, which, merging with each other, break into the bronchus, which leads to the release of foul-smelling sputum with coughing. Often their breakthrough occurs towards the pleura and patients develop empyema.
Candida pneumonia is characterized by a sluggish course with repeated relapses, migration of pneumonic foci and the formation of effusion in the pleural cavity.
The incidence of influenza pneumonia increases sharply during an epidemic. Its clinical course varies from mild forms to death. The disease occurs with characteristic symptoms (fever, pain in the eyeballs, muscles, adynamia, runny nose). Then comes a paroxysmal cough with sputum mixed with blood and shortness of breath. In the lungs, uneven darkening is detected in the form of foci or affecting the entire lobe of the lungs. Later, nausea, vomiting, and disturbances of consciousness may appear.

The classic course of inflammatory infiltration syndrome can be traced using the example of lobar (lobar) pneumonia.

This pathology is usually caused by pneumococci and has an acute onset. The patient suddenly experiences the following complaints:

high body temperature (up to 39-40 degrees);
chills;
severe general weakness;
labored breathing;
nonproductive cough;
chest pain when coughing and deep breathing.

During this period, swelling of the walls of the alveoli and accumulation of inflammatory exudate in their lumens is observed in the lungs, and the elasticity of the lung tissue decreases. An objective examination reveals typical signs of infiltration of lung tissue and additional crepitus “hot flashes” upon auscultation.

Gradually, the alveoli are completely filled with pathological secretions, and the cough becomes wet with difficult to separate sputum, sometimes rusty in color. The lung tissue in the affected area becomes dense and resembles the density of the liver. The auscultatory picture changes - bronchial breathing is heard over the pathological focus. The general condition of patients can be severe, and some of them have impaired consciousness.

Timely treatment in most patients quickly leads to a decrease in intoxication and a decrease in body temperature. During the resolution phase of the process, inflammation in the lesion decreases and exudate gradually resolves. In this case, patients are bothered by a cough with mucus-purulent sputum; on auscultation above the surface of the lungs, moist rales (mostly fine bubbles) and crepitus “low tide” are heard.

Aspiration pneumonia also has a severe course. It develops when acidic stomach contents or food enter the lower respiratory tract. This is possible with severe vomiting, reflux esophagitis, during or after anesthesia. A few hours after aspiration, the patient experiences:

asthmatic shortness of breath;
cyanosis;
fever;
paroxysmal cough;
wet rales;

Subsequently, inflammatory infiltrates form in the lungs, which can fester.

Clinically, this pathology manifests itself with vague symptoms:

malaise;
slight cough;
chest discomfort.

In some cases it is asymptomatic. The x-ray reveals homogeneous darkening without clear contours, and a high level of eosinophils in the blood. Such infiltrates can be located in any part of the lungs, either disappearing or appearing again.

Typically, the formation of an infiltrate in the lungs is preceded by characteristic symptoms (suffocation, cyanosis, chest pain). In this case, the infiltrate has a wedge-shaped shape and its apex is directed towards the root.

Developmental anomalies

Pulmonary tissue infiltration syndrome can be a sign of various developmental anomalies. The latter are most often asymptomatic, so the infiltrate is an incidental finding on an x-ray.

With sequestration of the lungs, an irregularly shaped darkening or a group of cysts with a perifocal inflammatory reaction is revealed. This pathology can manifest itself during suppuration.
If there is a hamartoma in the lungs, an infiltrate with clear contours is detected, sometimes with focal calcifications. It is usually located deep in the lung tissue and does not affect the function of the lung tissue. But sometimes a hamartoma is located on the inner surface of the bronchi and can lead to atelectasis and obstructive pneumonia.
On an x-ray, arteriovenous aneurysms look like rounded, clearly contoured shadows, to which dilated vessels approach from the root of the lung. If the discharge of blood exceeds a third of the total volume of blood flowing through the pulmonary circulation, then the person develops signs of hypoxemia (weakness, decreased ability to work, shortness of breath, etc.).

Lung infiltration in cancer patients

With lung cancer, on an x-ray, the infiltration appears as a darkening with smeared, blurred edges.

Infiltration in the lungs may be associated with malignant or benign tumor processes. They can be hidden for a long time, revealed only by X-ray examination.

Malignant processes should be suspected if an intensively growing formation is detected on the radiograph, having the appearance of a darkening with pitted or blurred edges. A particularly high risk of developing this pathology is observed in individuals with a long history of smoking. The first sign of the disease may be intoxication syndrome; as the tumor grows, characteristic pulmonary symptoms appear (painful cough, shortness of breath, hemoptysis). When a bronchial tube is blocked by a growing tumor, a

Infiltration – excessive penetration and accumulation of effusion in the alveoli, containing various cellular elements, chemicals (biologically active substances).

Depending on the cause and nature of the effusion, infiltration occurs:

- inflammatory(for pneumonia, tuberculosis, fibrosing alveolitis, diffuse connective tissue diseases);

- non-inflammatory(for lung cancer, leukemia, pulmonary infarction).

Clinical manifestations:

· cough;

shortness of breath;

· pain in the chest - only when the pleura is involved in the pathological process;

· hemoptysis – with destruction of lung tissue, tuberculosis, staphylococcal pneumonia, lung cancer.

General inspection:

“warm cyanosis” caused by respiratory failure;

· forced position on the sore side when the pleura is damaged.

General examination of the chest:

· static – asymmetrical bulge on the affected side in children;

· dynamic – lag of the affected half in the act of breathing, tachypnea.

Palpation of the chest:

· in the initial and final stages of infiltration - tympanic sound;

· at the height of infiltration – dull or dull sound.

Topographic percussion: decreased mobility of the lower pulmonary edge on the affected side.

Auscultation of the lungs:

In the initial stage of infiltration:

The appearance of silent crepitation (crepitatio indux).

In progress:

Vesicular breathing and crepitus disappear, bronchial breathing appears.

In the stage of resolution (resorption) of the infiltrate:

Weakening of vesicular breathing;

Sound crepitation (crepitatio redux) + sonorous moist fine rales;

There may be wheezing, pleural friction noise;

Bronchophony is increased.

Instrumental diagnostics:

· the main method of examination is radiography of the lungs in frontal and lateral projections - the presence of shadows;

· spirography is a restrictive type of dysfunction of external respiration caused by respiratory failure or mixed with broncho-obstructive syndrome.

Clinical symptoms of intoxication syndrome:

Complaints:

general complaints:

Fever;

General weakness, malaise;

Sweating;

Myalgia;

Cardiac complaints - palpitations, fainting, asthma attacks;

· cerebral complaints – headaches, sleep disturbances, delirium, hallucinations, confusion;

· dyspeptic complaints – loss of appetite, nausea, vomiting.

Peculiarity: pneumonia caused by mycoplasma, chlamydia, legionella occurs with a predominance of general intoxication syndrome, bronchopulmonary manifestations are scanty, therefore these pneumonias are called “atypical”.

Changes detected during general examination patients with pneumonia:

· consciousness – depressed to the point of hypoxic coma with extremely severe pneumonia, acute respiratory failure;

Delusions, hallucinations in children, alcoholics due to intoxication;

· there may be a forced position on the sore side;

· cold skin, cyanosis with a marble tint;

· herpetic rashes on the lips and wings of the nose;

· feverish face, blush on the affected side.

Respiratory examination– manifestations of pulmonary tissue infiltration syndrome.

– tachycardia, accent of the second tone on the pulmonary artery, hypotension.

Laboratory diagnosis of pneumonia:

· general blood test: leukocytosis, shift of the formula to the left, toxigenic granularity of neutrophils, increased ESR - inflammatory changes;

for viral pneumonia: leukopenia, relative lymphocytosis.

· biochemical blood test – increased fibrinogen levels, positive C-reactive protein – acute phase indicators; in severe cases - laboratory manifestations of renal and liver failure;

· immunological blood test - for viral, atypical pneumonia - detection of diagnostic titer of specific antibodies;

· sputum analysis: - general (microscopic): many leukocytes, macrophages, bacterial flora - Gram staining, identification of atypical cells, BK - differential. diagnostics;

Bacteriological: pathogen verification, identification

its sensitivity to antibiotics; significant amount

10 5 – 10 7 microbial bodies in 1 ml.

· General urine analysis - there may be febrile proteinuria, hematuria.

Instrumental diagnosis of pneumonia:

· R-graphy of the chest organs in 2 projections – the main method is focal and infiltrative opacities, enhancement of the pulmonary pattern;

· R-tomography, computed tomography of the lungs - for abscess formation - for differential diagnosis with tuberculosis, lung cancer.

· Bronchoscopy – for suspected cancer, foreign body, therapeutic – for abscess formation.

· ECG – in severe cases to identify signs of overload of the right side of the heart.

· Spirography – in the presence of other diseases of the respiratory system.

Basic principles of treating pneumonia:

· gentle mode;

· good nutrition;

· drug therapy:

Etiotropic: antibacterial, antiviral, fungal, antiprotozoal;

Detoxification - saline solutions;

Pathogenetic – for severe and complicated pneumonia:

anticoagulants (heparin), antienzyme drugs (contrical), glucocorticoids, oxygen therapy, antioxidant therapy, immunocorrective therapy;

Symptomatic therapy: bronchodilators, mucolytics, analgesics, antipyretics;

Non-drug treatment:

Physiotherapeutic treatment – UHF, magnetic therapy, laser therapy, EHF therapy;

Exercise therapy, breathing exercises.

Pleurisy is an inflammation of the pleura with the formation of effusion on its surface or accumulation in its cavity.

This is not an independent disease, but a manifestation or complication of many diseases.

Etiopathogenetic classification of pleural lesions:

1. Inflammatory (pleurisy):

a) infectious

b) non-infectious:

allergic and autoimmune:

for rheumatic diseases:

· enzymatic: pancreatogenic;

· traumatic, radiation therapy, burns;

· uremic.

2. Non-inflammatory:

· tumor lesions of the pleura;

· congestive – with left ventricular heart failure;

dysproteinemic pleural effusions;

· other forms of effusion accumulation - hemothorax, chylothorax;

· presence of air in the pleural cavity – pneumothorax.

By criterion for the presence of effusion pleurisy occurs:

Dry (fibrinous);

Exudative.

By character effusion exudative pleurisy occurs:

Serous;

Serous-fibrinous or hemorrhagic;

Purulent (pleural empyema).

By flow pleurisy is:

Subacute;

Chronic.

Pathogenesis:

1. increased permeability of the vessels of the parietal pleura with excessive sweating of fluid, proteins and blood cells into the pleural cavity;

2. disturbance of resorption of pleural fluid by the diaphragmatic part of the parietal pleura and lymph flow;

3. a combination of the first 2 factors most often.

With moderate exudation into the pleural cavity with preserved outflow, fibrinous pleurisy is formed due to the loss of fibrin from the exudate onto the surface of the pleura. With severe exudation and impaired resorption - exudative pleurisy. When the exudate is infected with pyogenic flora - pleural empyema.

Clinical manifestations of fibrinous (dry) pleurisy syndrome:

Complaints: 1) acute pain in the chest, aggravated by taking a deep breath, coughing, or bending to the healthy side;

2) non-productive cough.

During general examination a forced position on the sore side is revealed.

Chest examination– tachy-, hypopnea, lag of the affected half of the chest in the act of breathing, decreased excursion of the chest.

Palpation of the chest: pain when pressing in the area of pleural overlays. A pleural friction rub may be detected.

Percussion – limited mobility of the lower edge of the lungs on the affected side is determined.

Auscultatory a sign of fibrinous pleurisy is a pleural friction noise.

Clinical manifestations of exudative pleurisy:

Complaints 1) a feeling of heaviness, fullness in the affected half of the chest;

2) inspiratory dyspnea;

3) non-productive cough;

4) fever, chills, sweating.

During general examination a forced position on the sore side is revealed; for massive effusion - sitting; "warm" cyanosis.

Chest examination:

Enlargement of the affected half of the chest;

Expansion and bulging of intercostal

gaps;

Lagging of the affected half of the chest in the act of breathing.

Percussion a dull sound with an oblique upper border is detected (Damoizo-Sokolov line).

Auscultation of the lungs. In the area of accumulation of effusion, breathing is not detected; pleural friction noise can be heard above its upper border; in the area of Garland’s triangle, bronchial breathing can be heard. There is no bronchophony over the effusion.

Cardiovascular examination: swelling of the neck veins, rapid pulse, tachycardia. The apical impulse and the boundaries of relative dullness of the heart are shifted to the “healthy” side. On the affected side, manifestations of lung collapse can be detected.

Clinical manifestations of pleural empyema the same as for exudative pleurisy. The peculiarity of the expression of intoxication is febrile hectic fever, shaking chills, profuse sweating.

Non-inflammatory pleural syndromes:

2.1 Hydrothorax is an accumulation of non-inflammatory effusion (transudate) in the pleural cavity.

Pathophysiological mechanisms of hydrothorax:

Increased hydrostatic pressure in the pulmonary capillaries - with heart failure, hypervolemia, difficulty in venous outflow;

Reduced colloid-oncotic pressure of blood plasma - with nephrotic syndrome, liver failure;

Impaired lymphatic drainage – vena cava syndrome, tumors of the pleura, mediastinum.

2.2 Chylothorax- This is an accumulation of lymph in the pleural cavity.

Damage to the thoracic lymphatic duct during surgical interventions, chest injuries;

Blockage of the lymphatic system and veins of the mediastinum by a tumor or metastases;

2.3 Hemothorax- This is an accumulation of blood in the pleural cavity.

Possible causes of hemothorax:

1) wounds and injuries of the chest;

2) rupture of an aortic aneurysm;

3) iatrogenic – with catheterization of the subclavian vein, translumbar aortography, uncontrolled treatment with anticoagulants;

4) spontaneous bleeding in patients with hemophilia, thrombocytopenia.

The clinical manifestations of hydrothorax, chylothorax and hemothorax are caused by the presence of pleural effusion and correspond to those in the syndrome of exudative pleurisy. However, there are distinctive signs: the absence of intoxication syndrome; with hemothorax - manifestations of posthemorrhagic anemia.

2.4 Pneumothorax syndrome is a pathological condition caused by the presence of air in the pleural cavity.

Clinical manifestations of pneumothorax syndrome:

Complaints:

1) pain in the chest - occurs suddenly with coughing, physical stress, intensifies with deep breathing;

2) inspiratory dyspnea, occurs suddenly;

3) non-productive cough.

Sometimes pneumothorax is asymptomatic and is a diagnostic finding during X-ray examination.

General inspection. With the rapid development of pneumothorax, the patient takes a forced sitting position, the skin is moist, cold, pale due to reflex collapse.

Examination of the chest. The affected half is increased in volume and lags behind in the act of breathing. Tachypneous. Reducing chest excursion.

Percussion of the lungs: There is a tympanic sound above the area of pneumothorax, the lower border of the affected lung is raised, the mobility of the lower pulmonary edge is limited.

Auscultation of the lungs: weakening or absence of vesicular breathing and bronchophony. On the affected side, manifestations of lung collapse syndrome can be detected.

Cardiovascular research: swelling of the neck veins, frequent, small, thread-like pulse, tachycardia, displacement of the apical impulse and the boundaries of relative dullness of the heart to the healthy side.

2.4 Fibrothorax syndrome is a pathological condition caused by obliteration (fusion) of the pleural cavity. Fibrothorax is formed as a result of conditions such as hemothorax, pleural empyema, tuberculosis, and chest surgery.

Clinical manifestations of fibrothorax:

Complaints:

1) shortness of breath;

2) periodic pain in the chest, aggravated by deep inspiration, physical activity, and changes in weather conditions.

Chest examination: the affected half is reduced in volume, respiration lags behind, and chest excursion is limited.

Percussion– dull sound, decrease in the height of the apexes and the width of the Krenig fields, the lower border of the affected lung is raised, the mobility of the lower pulmonary edge is reduced.

Auscultation of the lungs– weakening of vesicular respiration.

Pathologically, pulmonary infiltration refers to the penetration into lung tissue and the accumulation of cellular elements, fluids and various chemicals in them. Impregnation of lung tissues only with biological fluids without admixture of cellular elements characterizes pulmonary edema, and not infiltration.

Pulmonary infiltration syndrome consists of characteristic morphological, radiological and clinical manifestations. In practice, this syndrome is most often diagnosed on the basis of clinical and radiological data. A morphological examination (biopsy) is carried out if a more in-depth examination of the patient is necessary.

In pathology, lung infiltration of inflammatory origin is most common. Inflammatory infiltration of the lungs can be leukocyte, lymphoid (round cell), macrophage, eosinophilic, hemorrhagic, etc. Other components of connective tissue - interstitial substance, fibrous structures - also play an important role in the formation of the inflammatory infiltrate.

Leukocyte inflammatory infiltrates

Leukocyte inflammatory infiltrates are often complicated by suppurative processes (for example, lung abscess), since proteolytic substances that appear during the release of lysosomal enzymes of polymorphonuclear leukocytes often cause melting of infiltrated tissues. Loose, transient (for example, acute inflammatory) infiltrates usually resolve and do not leave noticeable marks. Infiltration with significant destructive changes in the lung tissue in the future most often produces persistent pathological changes in the form of sclerosis, decreased or loss of lung function.

Lymphoid (round cell), lymphocyte-plasma cell, macrophage infiltrates

Lymphoid (round cell), lymphocyte-plasma cell and macrophage infiltrates in most cases are an expression of chronic inflammatory processes in the lungs. Against the background of such infiltrates, sclerotic changes often occur. The same infiltrates can be a manifestation of extramedullary hematopoietic processes, for example, lymphocytic infiltrates.

Tumor infiltration

Lung tissues are infiltrated with hematopoietic cells. In such cases, they talk about tumor infiltration, or infiltrative tumor growth. Infiltration by tumor cells leads to atrophy or destruction of lung tissue.

X-ray signs of pulmonary infiltration

Infiltration is characterized by a moderate increase in the volume of lung tissue and its increased density. Therefore, radiological signs of pulmonary infiltration have their own characteristics. For example, inflammatory infiltration is characterized by an irregular form of darkening and uneven outlines. In the acute stage, the contours of the darkening are blurred, gradually moving into the surrounding lung tissue. Areas of chronic inflammation cause sharper, but also uneven and jagged contours. Against the background of the shadow of inflammatory infiltration of the lung, you can often find light branching stripes - these are the lumens of the air-filled bronchi.

Infiltration – excessive penetration and accumulation of effusion in the alveoli, containing various cellular elements, chemicals (biologically active substances).

Depending on the cause and nature of the effusion, infiltration occurs:

inflammatory(for pneumonia, tuberculosis, fibrosing alveolitis, diffuse connective tissue diseases);

non-inflammatory(for lung cancer, leukemia, pulmonary infarction).

Clinical manifestations:

chest pain - only when the pleura is involved in the pathological process;
hemoptysis – with destruction of lung tissue, tuberculosis, staphylococcal pneumonia, lung cancer.

General inspection:

“warm cyanosis” caused by respiratory failure;

forced position on the sore side when the pleura is damaged.

General examination of the chest:

static – asymmetry of the bulge on the affected side in children;

dynamic – lag of the affected half in the act of breathing, tachypnea.

Palpation of the chest:

in the initial and final stages of infiltration - tympanic sound;

at the height of infiltration - a dull or dull sound.

Topographic percussion: decreased mobility of the lower pulmonary edge on the affected side.

Auscultation of the lungs:

In the initial stage of infiltration:

the appearance of silent crepitation (crepitatio indux).

In progress:

vesicular breathing and crepitus disappear, bronchial breathing appears.

In the stage of resolution (resorption) of the infiltrate:

weakening of vesicular respiration;

sonorous crepitation (crepitatio redux) + sonorous moist fine rales;

There may be wheezing, pleural friction noise;

bronchophony is increased.

Instrumental diagnostics:

the main research method is radiography of the lungs in frontal and lateral projections - the presence of shadows;

spirography is a restrictive type of dysfunction of external respiration caused by respiratory failure or mixed with broncho-obstructive syndrome.

Clinical symptoms of intoxication syndrome:

Complaints:

general complaints:

fever;

general weakness, malaise;

sweating;

cardiac complaints - palpitations, fainting, asthma attacks;

cerebral complaints - headaches, sleep disturbances, delirium, hallucinations, confusion;

dyspeptic complaints – loss of appetite, nausea, vomiting.

Changes detected during general examination patients with pneumonia:

consciousness – depressed to the point of hypoxic coma with extremely severe pneumonia, acute respiratory failure;

Delusions, hallucinations in children, alcoholics due to intoxication;

there may be a forced position on the sore side;

cold skin, cyanosis with a marbled tint;

herpetic rashes on the lips and wings of the nose;

feverish face, blush on the affected side.

Respiratory examination – manifestations of pulmonary tissue infiltration syndrome.

Cardiovascular research – tachycardia, accent of the second tone on the pulmonary artery, hypotension.

Laboratory diagnosis of pneumonia:

general blood test: leukocytosis, shift of the formula to the left, toxigenic granularity of neutrophils, increased ESR - inflammatory changes;

for viral pneumonia: leukopenia, relative lymphocytosis.

biochemical blood test - increased fibrinogen levels, positive C-reactive protein - acute phase indicators; in severe cases - laboratory manifestations of renal and liver failure;

immunological blood test - for viral, atypical pneumonia - detection of diagnostic titer of specific antibodies;

sputum analysis: - general (microscopic): many leukocytes, macrophages, bacterial flora - Gram staining, identification of atypical cells, BK - differential. diagnostics;

Bacteriological: pathogen verification, identification

its sensitivity to antibiotics; significant amount

10 5 – 10 7 microbial bodies in 1 ml.

General urine analysis - there may be febrile proteinuria, hematuria.

Instrumental diagnosis of pneumonia:

R-graphy of the chest organs in 2 projections – the main method is focal and infiltrative opacities, enhancement of the pulmonary pattern;

R-tomography, computed tomography of the lungs - for abscess formation - for differential diagnosis with tuberculosis, lung cancer.

Bronchoscopy - for suspected cancer, foreign body, therapeutic - for abscess formation.

ECG - in severe cases to identify signs of overload of the right side of the heart.

Spirography – in the presence of other diseases of the respiratory system.

Basic principles of treating pneumonia:

gentle regime;

good nutrition;

drug therapy:

etiotropic: antibacterial, antiviral, fungal, antiprotozoal;

detoxification - saline solutions;

pathogenetic – for severe and complicated pneumonia:

anticoagulants (heparin), antienzyme drugs (contrical), glucocorticoids, oxygen therapy, antioxidant therapy, immunocorrective therapy;

symptomatic therapy: bronchodilators, mucolytics, analgesics, antipyretics;

non-drug treatment:

physiotherapeutic treatment – UHF, magnetic therapy, laser therapy, EHF therapy;

Exercise therapy, breathing exercises.

Pleurisy is an inflammation of the pleura with the formation of effusion on its surface or accumulation in its cavity.

This is not an independent disease, but a manifestation or complication of many diseases.

Etiopathogenetic classification of pleural lesions:

Inflammatory (pleurisy):

a) infectious

b) non-infectious:

allergic and autoimmune:

for rheumatic diseases:

enzymatic: pancreatogenic;

traumatic, radiation therapy, burns;

uremic.

Non-inflammatory:

tumor lesions of the pleura;

congestive – with left ventricular heart failure;

dysproteinemic pleural effusions;

other forms of effusion accumulation - hemothorax, chylothorax;

the presence of air in the pleural cavity – pneumothorax.

By criterion for the presence of effusion pleurisy occurs:

dry (fibrinous);

exudative.

By character effusion exudative pleurisy occurs:

serous;

serous-fibrinous or hemorrhagic;

purulent (pleural empyema).

By flow pleurisy is:

Subacute;

Chronic.

Pathogenesis:

increased permeability of the vessels of the parietal pleura with excessive sweating of fluid, proteins and blood cells into the pleural cavity;

disturbance of resorption of pleural fluid by the diaphragmatic part of the parietal pleura and lymph flow;

a combination of the first 2 factors most often.

Clinical manifestations of fibrinous (dry) pleurisy syndrome:

Complaints: 1) acute pain in the chest, aggravated by taking a deep breath, coughing, or bending to the healthy side;

2) non-productive cough.

During general examination a forced position on the sore side is revealed.

Chest examination– tachy-, hypopnea, lag of the affected half of the chest in the act of breathing, decreased excursion of the chest.

Palpation of the chest: pain when pressing in the area of pleural overlays. A pleural friction rub may be detected.

Percussion – limited mobility of the lower edge of the lungs on the affected side is determined.

Auscultatory a sign of fibrinous pleurisy is a pleural friction noise.

Clinical manifestations of exudative pleurisy:

Complaints 1) a feeling of heaviness, fullness in the affected half of the chest;

2) inspiratory dyspnea;

3) non-productive cough;

4) fever, chills, sweating.

During general examination a forced position on the sore side is revealed; for massive effusion - sitting; "warm" cyanosis.

Chest examination:

Enlargement of the affected half of the chest;

Expansion and bulging of intercostal

gaps;

lag of the affected half of the chest in the act of breathing.

Percussion a dull sound with an oblique upper border is detected (Damoizo-Sokolov line).

Clinical manifestations of pleural empyema the same as for exudative pleurisy. The peculiarity of the expression of intoxication is febrile hectic fever, shaking chills, profuse sweating.

Non-inflammatory pleural syndromes:

Hydrothorax is an accumulation of non-inflammatory effusion (transudate) in the pleural cavity.

Pathophysiological mechanisms of hydrothorax:

increased hydrostatic pressure in the pulmonary capillaries - with heart failure, hypervolemia, difficulty in venous outflow;

decrease in colloid-oncotic pressure of blood plasma - with nephrotic syndrome, liver failure;

impaired lymphatic drainage – vena cava syndrome, tumors of the pleura, mediastinum.

Chylothorax - This is an accumulation of lymph in the pleural cavity.

Damage to the thoracic lymphatic duct during surgical interventions, chest injuries;

Blockage of the lymphatic system and veins of the mediastinum by a tumor or metastases;

Hemothorax - This is an accumulation of blood in the pleural cavity.

Possible causes of hemothorax:

chest wounds and injuries;

rupture of aortic aneurysm;

Iatrogenesis – with catheterization of the subclavian vein, translumbar aortography, uncontrolled treatment with anticoagulants;

spontaneous bleeding in patients with hemophilia, thrombocytopenia.

Pneumothorax syndrome is a pathological condition caused by the presence of air in the pleural cavity.

Infiltration of lung tissue - what is it and how to treat?

The pathogenesis of these changes is not well understood. There is an idea about the leading role of sensitization and allergies that arise during helminthic infestation. One of the proofs of this point of view is the increase in the level of IgE in the blood serum of patients.

Pathoanatomical changes consist of the appearance of infiltration foci in the lungs, which upon microscopic examination represent alveolar exudation with a large number of eosinophils. In some cases, perivascular infiltration of leukocytes and minor thrombosis were observed.

In most patients, pulmonary eosinophilic infiltrate associated with ascariasis and other helminthic infestations is asymptomatic and is detected during preventive fluorographic studies.

Body temperature, as a rule, is normal, sometimes it rises to subfebrile levels with normalization within several days.

Physical examination may reveal a slight shortening of the percussion tone and moist rales over the area of infiltration in the lungs. All of the above symptoms and physical signs disappear quickly, within 1-2 weeks.

X-ray examination reveals mild, homogeneous shadowing of various parts of the lungs without clear boundaries.

Shadows can be localized in both or one of the lungs, they can disappear in one place and appear in others. More often the shadows are small in size, but sometimes they spread to almost the entire lung.

In most cases, shading disappears after 6-12 days. The formation of cavities in the pulmonary parenchyma and pleural changes are not typical.

Differential diagnosis includes tuberculosis, pneumonia and pulmonary infarction. Distinctive features of pulmonary eosinophilic infiltrate are the ease of the disease, “volatility” and rapid disappearance of pulmonary infiltrates and eosinophilia in the peripheral blood.

The course should include the appointment of special means for deworming.

Any treatment aimed directly at the pulmonary infiltrate is usually not required, since the infiltrate in most patients disappears after a few days and without special treatment.

If the manifestations of the disease are pronounced or persist for a long time, treatment with corticosteroid hormones can be carried out.

The clinical picture is characterized by a latent onset with the appearance and constant intensification of a cough - dry or with the appearance of a small amount of mucous sputum.

Some patients experience hemoptysis and unspecified pain in the chest. Auscultation of the lungs reveals scattered dry rales.

In half of the patients, diffuse small-focal changes in both lungs are noted on radiographs. Some patients have localized infiltrates in the lungs.

A functional examination of the lungs reveals predominantly obstructive changes.

Characterized by pronounced eosinophilia in the peripheral blood, leukocytosis, the presence of eosinophils in the sputum and a positive reaction of complement fixation with filarial antigen. Filariae can be detected by lymph node biopsy.

The most effective antifilarial drug is diegilcarbamazine. In some patients, spontaneous recovery is possible, but in patients who have not received special treatment, the disease can last a long time - months and years, with repeated exacerbations, leading to the development of pneumosclerosis.

Pulmonary eosinophilic infiltrates can occur from exposure to drugs and chemical compounds.

Pulmonary eosinophilic infiltrates developing under the influence of furadoin, acetylsalicylic acid, azathioprine, chlorpropamide, chromoglycate, isoniazid, metatrexate, penicillin, streptomycin, sulfonamides, beryllium, gold and nickel salts and other compounds have been described. In addition, eosinophilic pulmonary infiltrates may appear after inhalation of pollen from certain plants.

In the acute version of the reaction, 2 hours to 10 days after starting to take furadonin, fever, dry cough, runny nose, and shortness of breath appeared.

Radiographs usually reveal diffuse changes in the lungs, sometimes focal irregularly shaped infiltrates in the lungs, the rapid disappearance and migration of infiltrates typical of Loeffler syndrome was absent, sometimes effusion pleurisy appears, and the pleural fluid contains many eosinophils.

An increased level of eosinophils in the blood is characteristic. In the acute course of the disease, soon after discontinuation of the drug, the eosinophilic infiltrate in the lung disappears. In the chronic course of the disease, the resorption of the pulmonary eosinophilic infiltrate is delayed, and in some cases pneumosclerosis develops in its place.

Treatment. Acute reactions to medications and chemical agents do not require special therapy, and cessation of the action of the factor that caused the pulmonary infiltrate leads to the complete disappearance of signs of the disease. In some cases, with a protracted course of the disease, it is necessary to take glucocorticosteroid drugs.

Pulmonary eosinophilic infiltrates in patients with bronchial asthma are associated in half of the cases with exposure to Aspergillus fumigatus. In some cases, eosinophilic infiltrates are caused by inhalation of plant pollen, house dust, and animal dander.

Dry air contributes to the occurrence of this condition, which causes drying of the mucous membrane of the respiratory organs, the formation of thick mucus in the bronchi and impaired mucus secretion.

Changes more often occur in patients with bronchial asthma over 40 years of age and mainly in women.

The clinical picture in a significant proportion of patients is characterized by severe bronchial asthma. An exacerbation of the disease is accompanied by an increase in body temperature, sometimes to high numbers. A characteristic symptom is a cough, which can be paroxysmal and is accompanied by the discharge of thick sputum in the form of plugs and casts of the bronchi.

Pulmonary eosinophilic infiltrates occur with systemic connective tissue lesions: periarterin nodosa (see p. 379), Wegener's granulomatosis (see p. 357), J. Churg and L. Strauss syndrome (see p. 384).

In some diseases of the respiratory system, lung infiltration occurs. This medical concept characterizes the saturation of lung tissue with cellular elements, fluid and other substances.

The phenomenon differs from edema in that in the latter case there is an accumulation of only biological fluid.

Let's take a closer look at infiltration in the lungs: what it is, in what pathologies it occurs and how to treat it.

Most often in clinical practice, infiltration occurs that occurs at the site of the inflammatory process - leukocyte, lymphocytic, eosinophilic, hemorrhagic. If it occurs as a result of the germination of neoplasm cells, then in this case the infiltration is caused by a tumor process.

On an x-ray, in the presence of this pathology, a slight increase in the volume of lung tissue and an increase in its density are visualized. It looks like dissemination, one or more rounded shadows, a limited focus with various types of edges. Sometimes there is only an increase in the pulmonary pattern.

Less commonly, pulmonary infiltration accompanies pulmonary tissue infarction after thromboembolism, hemosiderosis, hemosiderosis, echinococcosis, sarcoidosis.

Symptoms

Pulmonary infiltrate usually does not have any specific manifestations. Most often the patient experiences:

dyspnea;
cough - with or without phlegm
;
pain during breathing (with damage to the pleura).

Upon objective examination, a lag in breathing of one of the halves of the chest, the appearance of moist rales and crepitus during auscultation become noticeable.

Manifestations are directly dependent on the size of the infiltrate, the cause of its appearance and the location of the pathological process. With a tumor or disruption of the bronchial drainage system, only a slight weakening of breathing is noted, and all other clinical symptoms are absent.

In the presence of such a formation as infiltration in the lungs, it is necessary to carry out differential diagnosis with many diseases. Anamnesis, features of the course of the disease, the patient’s age, the results of clinical and additional research methods should be taken into account.

Pneumonia

This is an infectious disease that can be caused by a wide variety of pathogenic flora - pneumococci, staphylococci, mycoplasma, legionella, viruses, fungi.

After a viral illness, the patient suddenly develops a high fever, shortness of breath, and a cough with varying amounts of sputum.

The correctness of treatment is determined by a decrease in the intensity of the inflammatory process - a decrease in temperature, shortness of breath, and some improvement in general condition.

Tuberculosis

An infiltrative form of pulmonary tissue damage is observed in tuberculosis. It is exudative in nature, but no destructive changes occur.

Lung infiltration– a condition in which an accumulation of cellular elements, fluids, and other components that are not characteristic of a healthy person occurs in a local part of an organ.
This phenomenon can be compared with edema, but in the latter case there is an accumulation of biological fluids, and infiltrative changes include almost any element.
What can precede this disease and what therapy do doctors prescribe in this situation?

The most common types of infiltrates:

Now, let's talk about each type of infiltration separately.

In some cases, the cause of infiltration is already clear from its name. For example, post-injection infiltrate occurs after an injection (injection). Outwardly, it looks like a small reddened lump (bump) that appears at the injection site. If you press on the affected area, quite painful sensations arise.

The reasons for its occurrence may be a dull needle, injection of drugs repeatedly into the same place, failure to comply with aseptic rules, or simply choosing the wrong place for the injection. It occurs more often in people with weakened immune systems.

The occurrence and development of an abscess

The infiltration itself is not scary, since there is no infection in it yet, but its appearance is the first sign that something has gone wrong.

The main and most dangerous complication that infiltration can lead to is an abscess (abscess, purulent inflammation of tissue).

Trying to squeeze it out, cut out or remove an abscess at home is highly discouraged. Treatment of an abscess should only be done under the supervision of a surgeon.

A well-known way to treat any disease is the iodine grid.

All people are different. For some, post-injection infiltration occurs after any injection, and some have never encountered it. It depends on the individual characteristics of the person himself. Post-injection infiltration can be treated at home. Vishnevsky ointment or Levomekol are very suitable for this. In addition, you can draw an iodine mesh on the surface of the skin.

Among traditional medicines, cabbage compress works well against infiltrates of this kind. More precisely, the juice contained in the cabbage leaf. For it to appear, before applying the sheet, it must be lightly beaten with a rolling pin. The sheet can then simply be secured to the problem area using cling film.

Raw potatoes are another popular helper. The potatoes are peeled and grated. The resulting composition is also fixed to the sore spot using cling film or a towel. You can apply such compresses throughout the night.

Now let's see what postoperative infiltration is. The name speaks for itself. This type of infiltration can occur after any surgical intervention, regardless of the complexity of the operation. Be it tooth extraction, appendicitis or heart surgery.

The most common cause is infection in an open wound. Other reasons include damage to the subcutaneous tissue or the actions of the surgeon, which led to the formation of hematomas or damage to the subcutaneous fat layer. Rejection of suture tissue by the patient's body or improperly installed drainage can also lead to postoperative infiltration.

Less common causes of infiltration include allergies, weak immunity, as well as chronic or congenital diseases in the patient.

The emergence and development of postoperative infiltrate can occur within several days. The main symptoms of postoperative infiltration:

The appearance and redness of a small swelling. The patient feels slight discomfort. When pressing on the swelling, pain occurs.
Over the next few days, the patient experiences an elevated temperature.
The skin around the scar becomes red, inflamed and swollen

First of all, it is necessary to relieve inflammation and eliminate the possibility of an abscess. For these purposes, various antibiotics and physiotherapy are used. The patient is prescribed bed rest.

True, if purulent inflammation already exists, physiotherapy is unacceptable. In this case, heating the affected area will only be harmful to the patient, as it will accelerate the spread of infection throughout the body.

In particularly severe cases, repeated surgery is necessary.

This is not a single disease, but a whole group of pathologies. They mainly occur due to weakened immunity. Their presence indicates the presence of acute inflammation, possibly allergic reactions or a long-standing infectious disease.

As recent studies show, the cause of the inflammatory infiltrate in almost 40% of cases is various injuries (for example, unsuccessful actions during tooth extraction).

The terms abscess and phlegmon are used to denote possible complications that arise if the inflammatory infiltrate is not treated in time. At the same time, the doctor’s task is precisely to prevent the development of phlegmons and abscesses. Since it is already more difficult to treat them and the consequences can be very sad.

The appearance of tissue compactions in the area of infiltration. The contours of the seal are quite clear.
If you press on the seal, minor pain occurs. Skin of normal color or slightly reddened.
With stronger pressure, a small depression appears, which gradually levels out.

The inflammatory infiltrate usually develops over several days, while the patient's temperature remains normal or slightly higher. A small swelling with a clearly visible outline appears at the site of infiltration. When you press on this swelling, pain occurs.

It is not possible to determine the presence of fluid (fluctuation for pus, blood) in the resulting cavity. The skin at the site of the lesion is tense, red or slightly hyperemic. Treatment is assumed to be conservative methods - anti-inflammatory therapy plus laser irradiation. Bandages with Vishnevsky ointment and alcohol help well.

If, however, suppuration occurs with the formation of phlegmon or an abscess, then it is necessary to resort to surgical intervention.

This is an infiltrate containing mainly lymphocytes. Moreover, they can accumulate in various tissues of the body. The presence of lymphoid infiltrate is a sign of serious problems with the human immune system. Occurs in some chronic infectious diseases.

Another type of infiltration. Occurs as a complication of acute appendicitis. Appendiceal infiltrate is a collection of inflamed tissue around the appendix. Outwardly it looks like a tumor with clear boundaries.

Appendiceal infiltration occurs mainly due to the patient’s late presentation to the doctor. Usually only the next day after the first symptoms of appendicitis appear.

There are 2 stages of infiltration - early (2 days) and late (5 days). In children, appendiceal infiltration is diagnosed more often than in adults.

If you do not consult a doctor in time, the infiltrate may develop into a periappendiceal abscess.

Treatment of appendiceal infiltrate can only occur in the clinic. It involves antibacterial therapy, following a certain diet and reducing physical activity.

Usually within a couple of weeks the inflammation resolves and the patient recovers.

In the future, in order to completely eliminate the possibility of appendiceal infiltration, it is recommended to perform an operation to remove the appendix.

Pulmonary infiltrate

Pulmonary infiltrate is a compaction in the tissues of the lungs. The cause may be a buildup of fluids or some other chemicals. Causes painful sensations.

Gradually the tissue density increases. This type of infiltration can occur at any age, in both men and women. Symptoms may be similar to those of pneumonia, but less severe.

The main symptom is the release of blood when coughing.

Pulmonary infiltration is best diagnosed based on radiography and bronchoscopy. The presence of a pulmonary infiltrate in a patient may also indicate the presence of other diseases, such as tuberculosis and pneumonia.

When treating pulmonary infiltration, it is very important to avoid physical activity, or better yet, completely go to bed rest until recovery.

Food should contain a large amount of vitamins, carbohydrates and at the same time be easily digestible. Antiviral, expectorant and diuretic drugs are usually prescribed.

In traditional medicine, inhaling garlic vapors is helpful because of its bactericidal properties. Moreover, you should breathe alternately through your nose and mouth.

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Infiltrate. Types and methods of treatment. Post-injection, postoperative, pulmonary and appendicular infiltration

With certain ailments of the respiratory system, an infiltrate appears in the lungs. In this case, the organ tissues are saturated with cell elements, liquid, and various substances. Lung infiltration does not resemble edema. With swelling, only fluid accumulates in the intercellular space.

What it is

The pathology is confirmed after studying the symptoms and diagnostic examination. The disease is detected using radiography and due to the manifested morphological signs, which are identified based on the results of a biopsy.

Infiltrate in the lungs forms in inflamed eyes. The following forms of pathology are distinguished:

leukocyte;
lymphocytic;
eosinophilic;
hemorrhagic.

If the infiltrate is formed during the germination of cancerous tumors, its formation is provoked by malignant, and not inflammatory, processes occurring in the body. Inflammation is not observed in 2 other pathologies - pulmonary infarction and leukemia.

The x-ray shows that the lung tissue is increased in volume and its density is increased. The doctor determines infiltration by rounded shadows, localized foci with different outlines, and an enhanced pattern on the lungs.

If a lung infiltrate is detected, the doctor makes a differentiation. He takes into account the patient’s medical history, the course of the disease, and the results of diagnostic tests.

Early signs of malignant neoplasms are mild.

In the central form of the disease, in the initial stages the temperature rises, there is pain in the chest, and a cough with sputum and blood inclusions opens up.

In severe cases, raspberry, jelly-like sputum appears. Disintegrating tissue comes out with it. A growing tumor leads to palpitations and shortness of breath.

Common signs include:

weakness;
blanching of the skin and mucous membranes;
dizziness;
progressive exhaustion.

The diagnosis is made based on the results of a biopsy. The only way to get rid of the disease is through surgery. The lung is excised completely (sometimes with adjacent lymph nodes) or partially. In the postoperative period, the patient is irradiated and prescribed a course of chemotherapy. Such treatment is resorted to if the patient cannot undergo surgery.

Folk remedies are prescribed in addition to drug therapy for pulmonary infiltration. They are unable to completely replace medications. Home remedies strengthen the immune system, relieve intoxication, and resolve the infiltrate.

Traditional methods help with mild cases of the disease. They are used after consultation with your doctor.

Lung infiltration is a severe pathology. It requires accurate diagnosis and immediate treatment. Only under such conditions do patients have a chance of recovery.