A lung cyst is a thin-walled air cavity of the lung tissue of a polyetiological nature, most often located directly under the visceral pleura (bullous lungs) or in the interlobar groove.

Diagnosis of lung cyst

On plain radiograph chest in persons with single uncomplicated cysts, a thin-walled cavity with contents is visible in a round shape, there is no perifocal inflammation and fibrotic changes in the surrounding lung tissue. The bullae are located subpleurally. In patients with polycystic disease, many thin-walled, round-shaped formations of the same type are detected, closely adjacent to each other, located intrapulmonary. On the tomogram, the affected lung has a cellular appearance (the appearance of a bunch of grapes). If the cyst communicates with the bronchial tree, its cavity can be contrasted during bronchography. However, more often the unchanged bronchus wraps around a round formation in the lung.

During angiopulmonography, unusual course and deformation of the branches are found pulmonary artery(symptom of arachnoid network in polycystic disease). On scintigrams, the cyst is characterized by the absence of zones of vascularization of the lung tissue. Visual condition lung surface assessed during (videothoracoscopy).

Treatment of lung cyst

The treatment method for lung cysts complicated by pneumothorax is pleural cavity with constant air aspiration. If external drainage is ineffective, temporary endoscopic bronchial occlusion is used. If it is impossible to straighten the lung within 2-3 days, in order to determine the extent of its damage, diagnostic thoracoscopy (videothoracoscopy) or traditional thoracotomy is performed, followed by refinement of the plan.

In patients with lung cysts large sizes From the thoracotomy access, suturing and ligation of the bronchus communicating with the cyst, resection of the cyst or lung are performed. Pulmonary bullae can be opened and sutured.

The scope of endoscopic interventions includes bullectomy, pleurodesis with medical glue (MK-7, MK-8, etc.), electrical and laser coagulation bull, lung resection.

Suppurating solitary cysts are excised with maximum sparing of unaffected lung tissue. When multiple cysts are infected, resection of the affected part of the lung is indicated. Lung resection can also be performed using the method of thoracoscopically assisted surgery (video-assisted thoracoscopy. Its essence is to supplement videothoracoscopy with a small thoracotomy (incision length from 3.5 to 5 cm).

The article was prepared and edited by: surgeon

The development of lung cysts in children is a phenomenon with different etymologies. Cysts, in all their diversity, appear as a closed cavity or capsule. The contents can be either air or liquid. Formations are divided into: congenital or acquired, single or multiple.

The size of the formations can be either microscopic or big size. In the first case, you may not be aware of the existence of the pathology, but in the second, the cyst becomes a cause of disruption of the functioning of internal organs.

Diagnosis of pathology is characterized by complexity associated with the factor of asymptomatic course of the disease in early stage development. Neoplasms in the respiratory organs traditionally lead to irreversible consequences, including death.

I classify cysts of the respiratory system according to their origin and formation mechanisms.

Congenital

Congenital cysts develop at the stage of lung formation in the fetus. This phenomenon allows us to talk about respiratory pathology from the first days of life.

Ultrasound is not always able to show lung damage. The born child is considered healthy because obvious signs no cyst is detected. But congenital diseases necessarily appear before the child reaches his first birthday. Doctors, in this case, diagnose diseases: cystic hypoplasia, accessory lung or.

Congenital anomalies have another form - dysontogenetic. Reason this phenomenon the incorrect formation of bronchopulmonary kidneys is recognized, which occurs after the birth of the baby. Specified pathologies are always diagnosed regardless of age. The diagnosis is announced by a pulmonologist and names the diseases: bronchogenic cysts or bronchogenic cystadenoma.

Problematic pregnancy and maternal illnesses associated with chronic nature– causes of the development of pathologies in children. In addition, lung cysts develop against the background of genetic changes, are formed as a result of a certain lifestyle of the mother, or become a consequence of the negative environmental background of the place of residence.

Purchased

Acquired forms of illness appear due to past diseases infectious type or inflammatory in nature: pneumonia, gangrene, tuberculosis.

Considering the topic of composition, cystic neoplasms are divided into: true; false. In this case, one or many cavities, open and closed forms are determined.

Attention! Doctors warn that lung cysts, regardless of their type, are dangerous. The disease negatively affects the patient’s ability to live fully. Such ailments in children become causes of suffocation and lead to death.

Symptoms

The manifestation of symptoms of the disease is determined by the typology and localization. Experts note the fact that there is no standardized list of signs indicating the development of lung pathology in children.

You need to know the symptoms of respiratory diseases that openly declare themselves:

• Cough. Neoplasms with liquid inside are declared the cause of a wet cough;
• Sputum when coughing and the presence of a rotten smell indicates the onset of gangrene;
• In the presence of sputum mixed with pus, an abscess of the respiratory organ is diagnosed;
• Blood in the sputum indicates the breakdown of the tissues of the respiratory organ;
• Pain behind the sternum, aggravated by coughing, inhalation and positioning the body on the side healthy lung, they talk about the beginning of an exacerbation;
• Shortness of breath is a sign that requires serious attention;
• Temperature, which is characterized by the duration and stability of high values. At elevated temperature the patient feels malaise and nausea, sweating appears, there is no appetite, and there is a significant loss of weight.

A single pulmonary formation without inflammation does not manifest itself in any way. However, a significant cavity size may be the basis for pain behind the sternum, the presence of cough and difficulties accompanying the breathing process. IN in rare cases The baby may complain about difficulties accompanying the process of eating food.

If a pulmonary tumor bursts, then children have a feeling of deterioration general condition, severe shortness of breath appears. If the pulmonary cavity becomes inflamed, then the patient's body temperature rises. The appearance of a cough, accompanied by the release of sputum and blood impurities, indicates a violation of bronchial patency.

Attention! Similar symptoms are characteristic of other respiratory diseases. Diagnosis should be carried out by a pulmonologist using different techniques.

Diagnostics

Talking about signs lung diseases, it is necessary to note once again that initial stages they don't show up. To identify such diseases, doctors use modern equipment: ultrasound, MRI and CT.

The main methods for identifying the disease:

• Blood test, general and biochemical;
• Microscopy;
• Sputum analysis.

The results of radiography and fiber-optic bronchoscopy clarify the overall picture of the disease. The disease can be detected in children, who often suffer from pneumonia, using x-rays.

Thanks to the totality of the results of the studies, doctors receive a complete picture of the disease: they find out its location, configuration, size. This is the only way doctors can not guess, but know exactly the degree negative impact respiratory diseases.

Treatment

Efficiency therapeutic measures The approach is based on a combination of factors: tumor typology, location, size and correctly selected medications. The level of inconvenience caused to the patient by the disease, the productivity of the functioning of the organs and systems of the body of children affected by the disease are taken into account.

Operation

The operation is prescribed when the patient is diagnosed with:

• A single neoplasm without complications;
• The development of complications dangerous to the child’s health is observed.

Methods of surgical intervention are determined by the type and complexity of neoplasms: careful removal, drainage, puncture, thoracotomy, excision, resection. Contraindications to surgical forms of treatment define the framework of the general principles of therapeutic measures aimed at eliminating purulent respiratory diseases.

Ambulatory treatment

At home, treatment of this disease is considered possible. When prescribing dispensary treatment, the patient is provided with acceptable conditions for staying at home and the timing of regular examinations and consultations is determined.

Drug treatment of cysts in children is prescribed by a doctor. The slightest deterioration in health becomes the basis for surgical intervention.

Folk remedies

If we talk about ways to combat the disease through recipes traditional medicine, then they are excluded. The use of certain recipes and folk methods is allowed as additional therapeutic measures and only after agreement with the attending physician.

Prevention

In medical circles there is an opinion that there is no real methods, preventing the formation of most pathological cavities. Research is still ongoing to identify true reasons development of cystic formations. But the experiments conducted provide serious grounds for asserting that the substances that make up grapefruit can have a positive effect on the ability to prevent the development of a dangerous disease, and not only with cystic kidney lesions.

- a pathological cavity in the lung parenchyma filled with air or liquid contents. The course of a lung cyst can be asymptomatic, clinically pronounced (with shortness of breath, cough, heaviness and chest pain) and complicated (infection, pneumothorax, bleeding, etc.). The main diagnosis of a cyst is radiological, including plain radiography of the chest organs, CT scan of the lungs, angiopulmonography, and bronchography. Treatment of pulmonary cysts is predominantly surgical - removal of the cyst or resection of the lung through thoracotomy or video-assisted thoracoscopic intervention.

ICD-10

Q33.0 J98.4

General information

Lung cysts are intrapulmonary cavities of polyetiological origin, usually containing mucous fluid or air. Due to the wide variety of pathomorphological forms of the disease, it is quite difficult to judge the true prevalence of lung cysts in the population. According to some researchers, among all patients with respiratory diseases, patients with lung cysts account for 2.9-5.3%. Lung cysts occur in people of all ages: from newborn babies to the elderly. Despite its benignity, when complicated, a lung cyst can pose a serious threat to life, therefore, in pulmonology, in relation to the data pathological formations surgery is accepted therapeutic tactics.

Classification of lung cysts

Depending on the etiopathogenesis (origin and mechanisms of formation), congenital, dysontogenetic and acquired lung cysts are distinguished.

• Congenital cysts form in the antenatal period, and the child is born with the presence of this lung malformation. Such cysts are usually detected in childhood. These include: cystic pulmonary hypoplasia, bronchiolar emphysema, cystic accessory lung, intralobar sequestration, congenital giant cysts.
• Dysontogenetic Lung cysts are also congenital formations caused by impaired development of bronchopulmonary kidneys in embryogenesis. However, the development of dysontogenetic cysts begins already in the postnatal period, so pathology can be detected in at different ages. Such formations include dermoid cysts, bronchogenic cysts, and bronchogenic cystadenomas of the lungs.
• Purchased cysts form at a certain stage of life under the influence of diseases and injuries of the lungs. These include hydatid cyst of the lung, bullous emphysema, pneumocele, tuberculous cavities, “melting lung”, emphysemato-bullous sequestration of the lungs, etc.

By morphological features Lung cysts are divided into true and false. The first of them are always congenital, their outer shell is represented by connective tissue with elements of the bronchial wall (cartilaginous plates, smooth muscle and elastic fibers, etc.). The inner layer of a true lung cyst is formed by an epithelial lining of cubic and columnar epithelial cells that produce mucous secretions (bronchogenic cysts) or alveolar epithelium ( alveolar cysts). False cysts are acquired in nature, and their wall lacks the structural elements of the bronchus and the mucous membrane.

Taking into account the number of cavities, cysts are divided into single (solitary) and multiple (in the latter case, polycystic pulmonary disease is diagnosed). If the cyst communicates with the lumen of the bronchus, it is called open; in the absence of such a message, they speak of a closed lung cyst. Based on the type of content, air cavities and filled cavities are distinguished; by cavity size – small (up to 3 segments), medium (3-5 segments) and large (more than 5 segments). Finally, the course of lung cysts can be uncomplicated or complicated.

Causes of lung cyst

Small and uncomplicated lung cysts are asymptomatic. Clinical signs appear when the size of cysts increases and compression of surrounding structures or due to a complicated course. Large or multiple cysts are accompanied by heaviness and chest pain, cough, shortness of breath, and sometimes dysphagia.

Transfer from asymptomatic complications can be initiated by ARVI or pneumonia. When a lung cyst suppurates, signs of severe intoxication (weakness, adynamia, anorexia) and hectic fever come to the fore. Against the background of general malaise, a cough with mucopurulent sputum occurs, and hemoptysis is possible.

A breakthrough of a pus-filled cyst into the bronchus is accompanied by coughing up copious, sometimes foul-smelling sputum, an improvement in general condition, and a decrease in intoxication. The cyst cavity is cleared of pus, but its complete obliteration rarely occurs. More often, the disease takes on a relapsing course, gradually leading to the formation of secondary bronchiectasis and diffuse pneumofibrosis.

When the contents of the cyst rupture into the pleural cavity, a clinical picture of spontaneous pneumothorax, pyothorax, and pleurisy may develop. Complications of this type are characterized by the sudden appearance of chest pain, severe, paroxysmal cough, increasing cyanosis, tachycardia and shortness of breath. Possible outcomes Similar complications may include the formation of a bronchopleural fistula and chronic pleural empyema.

Inflammatory process in the bronchus draining the cyst, it promotes the formation of a valve mechanism, leading to an increase in pressure inside the cyst cavity and its tension. The cyst quickly increases in size and compresses the surrounding lung segments, causes displacement of the mediastinal organs. Clinical picture a tense lung cyst resembles the clinical picture of valvular pneumothorax (shortness of breath, tachypnea, cyanosis, swelling of the neck veins, tachycardia). Serious condition patients due to respiratory failure and hemodynamic disorders. During a tense lung cyst, compensated, subcompensated and decompensated stages are distinguished. In addition to all of the above, a lung cyst can be complicated by pulmonary hemorrhage and malignancy. With draining cysts in children, there is a risk of asphyxia.

Diagnosis of lung cyst

Due to the absence or paucity of symptoms, uncomplicated lung cysts usually remain unrecognized. They can become an accidental finding during preventive fluorography. Physical findings may include shortening of the percussion sound, weakening of breathing, and sometimes “amphoric” breathing.

The main role in identifying lung cysts belongs to X-ray diagnostic methods. Changes determined by chest radiography are determined by the type and origin of the cysts. Usually a formation is found spherical with clear contours. A horizontal level of fluid is sometimes visible in the cyst cavity. To clarify the location and origin of cysts, MSCT and MRI of the lungs are used.

Lung cysts should be differentiated from benign and malignant lung tumors of peripheral localization, lung metastases, tuberculoma, blocked abscess, limited pneumothorax, coelomic pericardial cyst, mediastinal tumors, etc.

Treatment and prognosis of lung cyst

The treatment strategy for lung cysts is mainly surgical. An uncomplicated lung cyst must be removed routinely. At the same time, one should not delay surgical intervention, since the occurrence of complications can transfer the status of the operation to the category of emergency, which can negatively affect the prognosis and survival. Most often, in uncomplicated variants of the disease, isolated removal of the cyst or economical resection of the lung is performed. The operation is performed both through thoracotomy and using videothoracoscopy. For common processes (polycystic disease, secondary irreversible changes in the parenchyma), lobectomy or pneumonectomy can be performed.

For lung cysts complicated by suppuration, preoperative drug preparation is carried out, and surgical intervention is performed after the exacerbation has stopped. In case of development of pyo- or pneumothorax, emergency drainage of the pleural cavity is performed, followed by local and systemic antibiotic therapy. Emergency care for a tense lung cyst complicated by respiratory failure consists of urgent puncture and transthoracic drainage of the cyst under ultrasound guidance. In all these cases, surgical intervention is carried out in the second stage and is more radical.

The prognosis for planned treatment of an uncomplicated lung cyst is favorable; long-term postoperative results are good. In the case of a complicated course, the outcome depends on the timing and completeness of care primary care. IN acute period death of patients can occur from respiratory and cardiovascular failure, massive bleeding; postoperative mortality reaches 5%. In other cases, disability is possible due to persistent secondary changes in the lungs (bronchiectasis, widespread pulmonary fibrosis, chronic purulent processes). Such patients require lifelong dispensary observation pulmonologist. Prevention of acquired lung cysts involves preventing injuries, specific and nonspecific lung diseases.

A cyst is a limited cavity filled with liquid contents. The main reason for the appearance of these formations is considered to be blockage of the lumen of hormonal or sebaceous glands, But scientific research The etiological factors of cystic cavities have not been confirmed.

What is a lung retention cyst?

Morphologically, a retention cyst (valve) is an area of ​​dilated bronchus, localized after the narrowed segment. If the proximal fragment of the bronchial tree is sharply narrowed, a cavity filled with air is formed. If bacteria penetrate into the formation, a focus of inflammation occurs with the formation of a cystic cavity filled with fluid, pus, leukocytes and red blood cells. Both options occur without pronounced symptoms, which makes diagnosis difficult.

The presence of a congenital lung cavity in the fetus can lead to death, as it becomes a source of latent infection.

X-ray signs of retention cysts

A cyst on a chest x-ray is identified by the following signs:

• Typical localization;
• Ring shadow syndrome;
• Round or oval shape.

Where is the retention cystic cavity of the lung located in the fetus?

The most common location of retention cavities is at the level of the 7th and 8th segments of the lower lobes of both lungs. This arrangement allows the radiologist to differentiate the ring-shaped shadow syndrome, formed by the dilatation of the bronchi in the fetus, from tuberculomas (tuberculous cavities).

Schematic photo of the types of lung cysts in the fetus on an x-ray (option 1)

Rental formation is characterized by a spherical and round-oval shape. This structure is due to the local expansion of the bronchial tree, so its shape resembles a bronchus.

Ring shadow syndrome on x-ray – what is it?

Ring shadow syndrome is X-ray manifestations congenital or retention cysts. It is characterized by the following symptoms:

• Spherical homogeneous darkening;
• There is no perifocal focus of inflammation (unlike an abscess);
• A type of grape bunch, tree branch or “sausage”;
• There is no lymphangitis (inflammation of the lymphatic vessels) around the lesion.

X-ray of the lungs in two projections or X-ray of the chest

Obviously, cystic dilatation of the bronchus in a small fetus is not dangerous if it is not infected or severely dilated.

Ring shadow syndrome is best detected on lateral tomograms. There are multilocular cysts that are directly lung x-ray overlap each other. However, clinical standard An x-ray examination of a patient with suspected disease of the chest organs is an x-ray of the chest organs in frontal and lateral projections. It will reveal all the features of the ring-shaped shadow.

Photo of the diagram of ring shadow syndrome on an x-ray

The shape of cysts on an x-ray is rarely characterized by ideal sphericity. The cavities of large bronchi are more ideal. When small bronchioles of the 3rd-4th order are affected, small fusiform expansions with 2 horns can be observed on the x-ray. “Horns” are stretched bronchi that have not yet expanded significantly. There is also a two-humped shadow with numerous protrusions. They are formed by the presence of partitions between several affected bronchi. The cavity in such a situation resembles the following shapes:

• Grape;
• Retorts;
• Flasks.

As a rule, a cyst is a single formation, but due to humps and subtractions, radiologists create an impression of their multiplicity.

How to distinguish a cyst from a tuberculoma

The air cavity of the lung in the fetus is detected immediately after birth and is not difficult to diagnose. A retention analogue in an adult should be differentiated from tuberculoma. A qualified radiologist can determine the difference between these nosological forms based on an x-ray.

The structure of the cystic cavity in an adult contains lime inclusions in the center or along the contour of the lesion. Only a congenital fetal cyst may not contain deposits.

The surrounding lung tissue in cystic formations is not changed, unlike tuberculomas, in which lymphangitis and peripheral inhomogeneous darkening on the radiograph due to the inflammatory process are detected.

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Cystic lung lesions are a heterogeneous group of diseases, different in origin and morphological structure. What is common to all of them is the formation in the lung of one or more, most often thin-walled cavities, partially or completely filled with liquid contents or air.

General mechanisms of development. Depending on their origin, cysts can be congenital (true) or acquired (false).

Congenital (true) cysts are formed as a result of disruption of the processes of lung formation in the embryonic or postnatal periods. A characteristic morphological feature of true congenital cysts is the presence of an epithelial lining of the inner surface of its wall. In the development of true cysts, the main role is played by agenesis of the alveoli and expansion of the terminal bronchi or delayed development of the peripheral bronchi with expansion of their more distal sections that do not contain cartilaginous tissue in the wall. Alveolar congenital cysts, originating from the tissues of the alveoli, are also less common. There are bronchogenic true cysts, which have an epithelium consisting of cylindrical or cuboidal cells, and alveolar true cysts, the inner surface of which is covered with alveolar epithelium. Congenital cysts can be solitary (bronchogenic cyst) and multiple (cystic hypoplasia, microcystic lung), combined with other malformations (accessory cystic lung, intralobar sequestration).

The presence of cavitary formations is characteristic of a number of lung malformations: cystic hypoplasia, accessory cystic lung, lung sequestration, microcystic lung, congenital lobar emphysema, McLeod syndrome, congenital bronchogenic cysts, etc. Special group dysontogenetic pulmonary cysts are represented by cystic lymphangiomas and dermoid cysts, which, from the point of view of clinical feasibility, are usually considered among benign lung tumors.

Acquired (false) cysts are the result of any disease: abscess, echinococcosis, tuberculosis, intrapulmonary hematoma, bullous emphysema, etc. Their distinctive feature is the absence of the epithelial lining of the inner surface of the cyst, although, as some authors believe, false cysts can gradually lined with bronchial epithelium due to its spread to the walls of the cavity from the draining bronchus. On the other hand, with chronic suppuration of true pulmonary cysts, the epithelium lining them can gradually be destroyed and replaced first by granulation and then by scar tissue.

A convenient classification that has not lost its relevance today is the classification developed back in 1969 by V.I. Puzhaylo, which, by origin, divides all lung cysts into three groups.

Classification of lung cysts

1. Congenital cysts:
1. Polycystic pulmonary disease (cystic hypoplasia of the lungs).
2. Microcystic lung (bronchiolar emphysema).
3. Intralobar sequestration.
4. Accessory cystic lung.
5. Giant cyst in newborns and young children.
2. Dysontogenetic cysts.
1. Solitary bronchogenic cyst of the lung.
2. Giant bronchogenic cyst in adults.
3. Dermoid cyst of the lung.
4. Solitary bronchogenic cystadenoma of the lung.
3. Acquired cysts.
1. Abscess, echinococcus, tuberculous cavity.
2. Pneumocele.
3. Progressive emphysematous-bullous dystrophy of the lungs (“vanishing lung” by Burke, giant emphysematous cyst).
4. Emphysematous-bullous sequestration.
5. Bullous emphysema.

Dysontogenetic cysts are essentially congenital diseases, the development of which in the postnatal period is caused by defects in the embryonic development of the lungs.

Determining the congenital or acquired nature of cysts is not always easy. So, in last years All larger number There are supporters of the point of view according to which a number of bronchial cysts are acquired (Rozenstrauch JI.C. et al., 1987). In this case, the main factor in the development of these cysts is considered to be obstruction of the bronchi due to their stenosis due to inflammation. An example is retention cysts, which are dilated bronchi, i.e. valve or retention bronchiectasis, in which the proximal segment of the bronchus is sharply narrowed or obliterated (Kazak T.P., 1968). In the first case, air cysts are formed, and in the second, filled cysts are formed, the contents of which are mucus mixed with blood.

Pathological anatomy. Lung cysts can be either single or multiple. The latter can affect one or both lungs. IN right lung they occur somewhat more often than in the left, the frequency of damage to individual lobes is approximately the same, but to a greater extent this applies to true cysts. Acquired ones, especially those formed after an abscess, most often occupy the posterior sections of the lungs, and those arising from sanitized tuberculosis cavities occupy the apical-posterior sections of the upper lobes. Emphysematous bullae are also more likely to form in the upper lobes of the lungs.

The size of the cysts varies widely - from very small to gigantic, occupying almost the entire lobe or lung. Inner surface The cyst wall is usually smooth, lined with columnar or cuboidal epithelium. At histological examination elements of the bronchi are found in the wall of the cyst - cartilaginous plates, smooth muscle fibers.

Cysts can communicate with the bronchus - open cysts or be isolated - closed, contain air or liquid contents - airy or filled. Closed cysts usually contain a sterile mucous liquid, transparent, sometimes yellowish or brown in color. Cysts communicating with the bronchi most often contain air, and when inflammation is associated, pus. Suppuration can complicate the course of not only open cysts, but also closed ones due to hematogenous and lymphogenous infection. Suppuration of cysts is the most a common complication their currents. The general clinical classification of lung cysts, taking into account their origin, structure and clinical course, is given below.

Clinical classification of lung cysts.

1. By origin:

• congenital or true (bronchogenic, alveolar)
• acquired or false (post-traumatic, after illnesses)

By number of cavities:

• solitary (single)
• multiple (unilateral, bilateral)

Based on the presence of communication with the bronchus:

• communicating (open)
• not communicating (closed)

Based on content availability:

• air
• filled out

With the flow:

• uncomplicated cysts
• complicated cysts (suppuration, pyo- and pneumothorax, acute tension, bleeding, malignancy).

Clinic and diagnostics. Uncomplicated cysts are often asymptomatic. Complaints are either absent or are scanty and uninformative. However, with careful questioning, in some cases you can obtain information useful for diagnosis. Patients may complain of vague, usually not pronounced chest pain, cough, sometimes with the discharge of scanty, odorless sputum, which may be streaked with blood. Only giant or multiple cysts that replace large areas of the pulmonary parenchyma can cause severe chest pain, cough, shortness of breath, and rarely dysphagia. In children, even a small cyst can cause compression respiratory tract(Vishnevsky A.A., Adamyan A.A., 1977).

The data obtained during a physical examination of patients depend on the size of the cyst, the depth of its location in the lung, the nature of its contents and its relationship to the lumen of the bronchial tree. With large cysts, one can note a lag of the corresponding half of the chest during breathing, sometimes even a widening of the intercostal spaces. Percussion may reveal either a shortening of the percussion sound or tympanitis. Breathing over these parts of the lungs is weakened, and if there is communication between the cyst and the bronchus, it sometimes takes on an amphoric hue.

Clinical manifestations of the disease appear mainly with the development of complications, the most common of which is its suppuration. Infection of the cyst dramatically changes the symptoms of the disease. The patient's body temperature rises, a cough with mucous or mucopurulent sputum appears, chest pain, and hemoptysis is often observed. The clinical picture is very similar to the development of a lung abscess. However, intoxication with a suppurating cyst is much less pronounced, which is explained by the protective role of its epithelial lining. When the abscess breaks into the bronchus, copious purulent, sometimes foul-smelling sputum begins to be released. The patient's condition gradually improves, intoxication decreases, and if the cyst is well drained by the bronchus, the cyst cavity is gradually cleared of pus. Clinical recovery may occur. However, unlike acute abscess lung, it is usually not possible to achieve complete obliteration of the cyst cavity resulting in limited pneumofibrosis. The disease most often takes on a chronic nature with alternating stages of remission and exacerbation. With a long course of the disease and frequent exacerbations the epithelial lining of the cyst is destroyed, each time the manifestations of general intoxication intensify, the surrounding lung tissue and bronchi are involved in the process, which can lead to the development of secondary bronchiectasis and widespread pneumofibrosis.

Breakthrough of a suppurating cyst with the entry of pus into the free pleural cavity leads to the development of pyopneumothorax. This significantly worsens the condition of patients and the prognosis of the disease, as it can lead to the development of persistent bronchopleural fistula and chronic pleural empyema.

In addition to acute, prolonged and chronic inflammatory changes, pulmonary cysts can be complicated by tension, as well as a breakthrough into the pleural cavity with the development of pneumothorax.

A tense cyst occurs when it communicates with a bronchus, usually against the background of pneumonia or acute respiratory disease. The leading role in its pathogenesis is played by the formation of the valve mechanism as a result of endobronchitis, causing stenosis of the adductor bronchus. The cyst quickly increases in size, the lung tissue is compressed, and mediastinal displacement occurs and associated respiratory and cardiac disorders occur. The clinical picture is very similar to a tension pneumothorax. The patient behaves restlessly, complains of lack of air, a feeling of tightness in the chest. He develops cyanosis, swelling of the neck veins, severe shortness of breath, and tachycardia. There is a lag in the affected half of the chest when breathing, sometimes even bulging. The boundaries of the mediastinum shift to the healthy side. Breathing over the affected lung is weakened or absent. Tympanitis is determined by percussion. Respiratory failure progressively increases. In young children, the condition can deteriorate so quickly that it turns out necessary urgent therapeutic measures(Libov S.L., Shiryaeva K.F., 1973).

The rupture of a subpleurally located cyst into the pleural cavity with the formation of pneumothorax is very dangerous with a valve mechanism, the occurrence of which is not uncommon in this pathology. Physically and radiologically, all the typical signs of spontaneous pneumothorax are revealed (box percussion sound, sharp weakening of breathing, displacement of cardiac dullness to the healthy side, collapse of the lung and air in the pleural cavity). However, it should be borne in mind that with giant subpleurally located air cysts, both clinically and radiologically, they can be difficult to distinguish from pneumothorax, and if a tension cyst occurs, they can be difficult to distinguish from tension pneumothorax.

Not frequent, but very serious complication pulmonary cysts is the development of hemoptysis, sometimes acquiring the character of pulmonary hemorrhage.

A very rare complication of this disease is the development of a malignant tumor from the cyst wall, although, compared with the general morbidity of the population, the frequency lung cancer in patients with pulmonary cysts (polycystic disease) is significantly higher, which prompts the expansion of indications for surgical treatment of uncomplicated cysts.

The leading method for diagnosing pulmonary cysts is X-ray. The changes revealed depend on the pathological features of the cysts. With closed cysts containing fluid, the presence of a round or spherical shadow of various sizes with clear, even contours is determined by x-ray. If the cyst is located peripherally, deformation of the contours of its shadow is possible due to fusion with the parietal pleura. Open cysts, that is, communicating with the bronchial tree, contain only air or a small amount of liquid (a horizontal level appears). The wall of air cysts is usually smooth, thin, and clearly defined. Occasionally, marginal calcification is observed. JI.C. Rosenshtraukh and A.I. Rozhdestvenskaya (1968) described the symptom of “lime meniscus” caused by the presence of lime grains at the bottom of the cavity. In the absence of complications, as a rule, the lung tissue surrounding the cyst is not changed. Multiple open cysts are characterized by the presence of ring-shaped thin-walled cavities in the lung, without pronounced inflammatory and sclerotic changes in the circumference. Layering one on top of the other, they resemble a “honeycomb” in their structure. X-ray tomography and especially CT scan allow you to detail the x-ray picture and clarify the localization of cystic cavities. With bronchography contrast agent enters the cysts only when they communicate with the bronchial tree. In the case of closed cysts, bronchography and angiopulmonography can reveal that the bronchial and vascular branches bend around round formation in the lung.

The X-ray picture of acquired retention cysts is very specific. They are characterized by pear-shaped, spindle-shaped, often bizarre shapes (flasks, bunches of grapes, etc.). In this case, the length of the formation corresponds to the course of the bronchi, the proximal end is oriented towards the root of the lung. In 25% of cases (Shulutko M.L. et al., 1967), calcification is noted in the walls of the retention cyst. Bronchography determines the amputation of the bronchus suitable for the formation and the deformation of the adjacent bronchial branches.

The main diseases that should be differentiated from closed, fluid-filled lung cysts are peripheral malignant and benign tumors, solitary metastases malignant tumors, echinococcus, tuberculoma, blocked abscess, as well as some spherical formations emanating from the mediastinum, diaphragm and chest wall.

Open and closed air cysts of the lungs require differential diagnosis with a cavitary form of peripheral lung cancer, open abscesses, thin-walled sanitized tuberculous cavities, limited spontaneous pneumothorax, post-pneumonic false cysts, an echinococcal cyst that has broken into the bronchus and other cavitary formations of the lungs.

Treatment. Treatment of uncomplicated true pulmonary cysts, in the absence of general contraindications to surgery, is predominantly surgical, since only surgery is a reliable prevention of the development of complications. The only exceptions may be small closed air cysts or, conversely, widespread polycystic disease with extensive damage to both lungs. The operation is performed as planned after a comprehensive examination of the patient and thorough preoperative preparation. For solitary cysts, isolated removal of the cyst is performed with maximum sparing of the lung tissue. Performing such an operation, as a rule, is possible in the absence of suppuration and perifocal changes in the lung tissue. Enucleation of the cyst or economical resection of the lung is performed. If the cyst is located superficially, it is possible to perform video-assisted thoracoscopic intervention.

With polycystic disease, secondary sclerotic changes in the pulmonary parenchyma, with cysts that are a developmental defect and are accompanied by underdevelopment of the respiratory sections (cystic hypoplasia, sequestration, etc.), the only radical method of treatment is resection of the affected part of the lung. Its volume is determined by the prevalence of the process and secondary irreversible changes in the pulmonary parenchyma (pneumofibrosis, bronchiectasis). A lobectomy is usually performed, but in rare cases a pneumonectomy may be required.

During surgical interventions for birth defects development of the lungs, the possibility of anomalous structure and the location of blood vessels and bronchi. Thus, with intralobar sequestration there is an additional arterial vessel, sometimes several, coming from the aorta. The place of their origin from the aorta can be located both within the thoracic and abdominal sections. Specifying the topic and the number of additional vessels allows you to avoid dangerous complications and, above all, profuse intraoperative bleeding that occurs when they are accidentally damaged during the separation of the pulmonary ligament or pneumolysis. Ligation of an anomalous artery in case of accidental damage in some cases presents significant difficulties and sometimes such a complication can lead to death. Therefore, the pulmonary ligament should be divided under visual control, grasping in portions with clamps and stitching. The additional vessel, which, as a rule, can be seen, is additionally ligated.

Indications for surgery for cysts complicated by suppuration are especially urgent. Conservative treatment In such patients during an exacerbation, it usually gives a good but temporary effect and is important mainly for preparing for surgery. It is advisable to undertake surgical intervention outside of exacerbation after appropriate preparation. Isolated removal of the cyst, as a rule, is technically impossible and in most cases impractical, since it is intimately fused with the surrounding lung tissue. The only radical treatment method is resection of the affected part of the lung. The extent of resection is determined by the extent of the lesion and secondary changes in the pulmonary parenchyma.

With the development of pyo- or pneumothorax, drainage of the pleural cavity is indicated with appropriate therapy for these conditions.

With a tense cyst with signs respiratory failure and mediastinal displacement, surgical treatment is indicated. In order of delivery emergency care It is urgent to perform a puncture, followed by transthoracic drainage of the cyst cavity.

However, it must be remembered that even complete transthoracic drainage of such a cyst is sometimes complicated by the development of pneumothorax, often tense, accompanied by the rapid and progressively increasing development of subcutaneous and mediastinal emphysema. In such cases, emergency surgery is required. To prevent the development of these complications, it is advisable to combine transthoracic drainage of the cyst cavity with temporary endobronchial occlusion of the bronchus ventilating the affected area of ​​the lung.

Indications for urgent surgical intervention are also pulmonary hemorrhage, the threat of asphyxia with draining cysts in children, tension pneumothorax that cannot be relieved by closed drainage, and progressively increasing mediastinal emphysema.

Treatment of patients in postoperative period carried out in accordance with general principles accepted in thoracic surgery, and depends on the nature and extent of the operation performed, the presence of complications in the course of the disease. The prognosis for patients undergoing elective surgery is usually favorable. The most dangerous are surgical interventions performed for complications of lung cysts, especially in children. Postoperative mortality in such cases can reach 5%.