What kind of lungs does a person have? Lungs and pulmonology (the science that studies diseases of the lungs and respiratory tract)

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Basic information

Definition

Its edges may be smooth or uneven, but they must be distinct enough to determine the contour of the defect and allow its diameter to be measured in two or more projections.

Rice. 133. X-ray chest in frontal and lateral projections, a 40-year-old patient.
Focal darkening with clear boundaries is visible. When compared with previous radiographs, it was found that over a period of more than 10 years the formation did not increase in size. It was considered benign and resection was not performed.

The size of the defect is also one of the criteria for determining focal formations in the lung. The authors believe that the term “focal formation in the lungs” should be limited to a defect size of no more than 4 cm. Formations with a diameter of more than 4 cm are more often of a malignant nature.

Therefore the process differential diagnosis and the examination tactics for these large formations are somewhat different than for typical small focal opacities. Of course, accepting a diameter of 4 cm as a criterion for classifying pathology as a group of focal formations in the lung is to a certain extent conditional.

Causes and prevalence

Table 129. Causes of focal formations in the lungs

There are many reasons for this variability. For example, in studies conducted in surgical clinics, calcified defects are usually excluded, therefore, in such populations a higher percentage of malignant tumor is obtained compared with groups of patients from which calcified defects are not excluded.

In studies conducted in geographical areas, where coccidioidomycosis or histoplasmosis is endemic will also, of course, show a higher percentage of benign changes. An important factor Age is also a factor; in persons under 35 years of age, the likelihood of malignant lesions is low (1% or less), and in older patients it increases significantly. A malignant nature is more likely for large opacities than for smaller ones.

Anamnesis

Clinical symptoms of pulmonary pathology are more common in patients with a malignant origin of the opacities than in patients with benign defects.

History of present illness

The presence of chronic cough, sputum, weight loss or hemoptysis in the patient increases the likelihood of a malignant origin of the defect.

Status of individual systems

However, if a patient’s malignant process manifests itself only as an isolated darkening in the lung, all these signs are rare. The main purpose of such a survey is usually to try to identify extrapulmonary symptoms, which may indicate the presence of a primary malignant tumor in other organs or detect distant metastases of a primary lung tumor.

The presence of an extrapulmonary primary tumor can be suspected by symptoms such as changes in stool, the presence of blood in the stool or urine, detection of a lump in the breast tissue, and the appearance of discharge from the nipple.

Past illnesses

To others systemic diseases which may be accompanied by the appearance of isolated opacities in the lungs include rheumatoid arthritis And chronic infections arising against the background of immunodeficiency states.

Social and professional history, travel

It is necessary to ask the patient in detail about his working conditions, since some types of professional activity(asbestos production, uranium and nickel mining) are accompanied by increased risk the occurrence of malignant lung tumors.

Peripheral affects smaller bronchi, therefore, there is usually uneven radiance around the node, which is more typical for fast-growing low-grade tumors. Also, there are cavitary forms of peripheral lung cancer with heterogeneous areas of decay.

The disease begins to manifest itself when the tumor rapidly develops and progresses, involving the large bronchi, pleura and chest. At this stage, peripheral, turns into central. Characterized by increased cough with sputum discharge, hemoptysis, pleural carcinomatosis with effusion in pleural cavity.

How to detect peripheral lung cancer?

Forms of peripheral lung cancer

One of the main differences between the tumor process in the lungs is the variety of their forms:

1. The cortico-pleural form is an oval-shaped neoplasm that grows into the chest and is located in the subpleural space. This form applies to . The structure of the tumor is most often homogeneous with a tuberous inner surface and fuzzy outlines. It tends to grow both into adjacent ribs and into the bodies of nearby thoracic vertebrae.
2. The cavity form is a neoplasm with a cavity in the center. The manifestation occurs due to the disintegration of the central part of the tumor node, which lacks nutrition during the growth process. Such neoplasms usually reach sizes of more than 10 cm and are often confused with inflammatory processes(cysts, tuberculosis, abscesses), which lead to the diagnosis initially not correct diagnosis, which in turn contributes to progression. This form of neoplasm is often asymptomatic.

Important! The cavitary form of peripheral lung cancer is diagnosed mainly on late stages when the process becomes irreversible.

In the lungs, flat formations of a rounded shape with a tuberous outer surface. As tumors grow, they also increase in size cavity formations in diameter, while the walls thicken and the visceral pleura is pulled towards the tumor.

Peripheral cancer of the left lung

For cancer upper lobe left lung tumor process on x-ray clearly visualizes the contours of the neoplasm, which have a heterogeneous structure and irregular shape. In this case, the roots of the lungs are expanded by vascular trunks, The lymph nodes not enlarged.

For cancer of the lower lobe of the left lung, all it happens quite the opposite, in relation to the upper lobe of the left lung. There is an increase in the intrathoracic, prescalene and supraclavicular lymph nodes.

Peripheral cancer of the right lung

Peripheral cancer of the upper lobe right lung has the same features as the previous form, but is much more common, like cancer of the lower lobe of the right lung.

Nodal form lung cancer originates from the terminal bronchioles. It appears after soft tissue has grown into the lungs. At x-ray examination you can see the formation of a nodular shape with clear contours and a bumpy surface. A small depression may be visible along the edge of the tumor (Rigler's sign), this indicates the entry of a large vessel or bronchus into the node.

Important! Special attention it is worth paying attention to the correct and healthy diet, you need to eat only healthy and quality products enriched with vitamins, microelements and calcium.

Pneumonia-like peripheral lung cancer – it's always . Its form develops as a result of spread along the lobe of peripheral cancer growing from the bronchus, or with the simultaneous manifestation large quantity primary tumors in the pulmonary parenchyma and their fusion into a single tumor infiltrate.

This disease does not have any specific clinical manifestations. At first, it is characterized as a dry cough, then sputum appears, initially scanty, then abundant, liquid, foamy. With the addition of infection clinical course resembles recurrent pneumonia with severe general intoxication.

Apical lung cancer with Pancoast syndrome - This is a type of disease in which malignant cells penetrate the nerves and vessels of the shoulder girdle.

The Pancoast syndrome (triad) is:

• apical localization of lung cancer;
• Horner's syndrome;
• pain in the supraclavicular region, usually intense, initially paroxysmal, then constant and prolonged. They are localized in the supraclavicular fossa on the affected side. The pain intensifies with pressure, sometimes spreading along the nerve trunks emanating from brachial plexus, accompanied by numbness of the fingers and muscle atrophy. In this case, hand movements can be disrupted to the point of paralysis.

X-ray examination of Pancoast syndrome reveals: destruction of 1-3 ribs, and often the transverse processes of the lower cervical and upper thoracic vertebrae, deformation bone skeleton. In far advanced cases, a doctor’s examination reveals unilateral dilatation of the saphenous veins. Another symptom is a dry cough.

Horner and Pancoast syndromes are often combined in one patient. With this syndrome, due to tumor damage to the lower cervical sympathetic nerve ganglia, hoarseness of the voice and unilateral prolapse are quite often observed. upper eyelid, constriction of the pupil, retraction eyeball, injection (vasodilatation) of the conjunctiva, dyshidrosis (impaired sweating) and hyperemia of the facial skin on the affected side.

In addition to the primary peripheral and metastatic cancer lung syndrome(triad) Pancosta can also occur with a number of other diseases:

• hydatid cyst in the lung;
• mediastinal tumor;
• tuberculosis.

What all these processes have in common is their apical localization. With a thorough X-ray examination of the lungs, the true nature of Pancoast syndrome can be recognized.

How long does it take for lung cancer to develop?

There are three courses of development of lung cancer:

• biological - from the onset of the tumor to the appearance of the first clinical signs, which will be confirmed by the data of the diagnostic procedures performed;
• preclinical - a period in which there are completely no signs of the disease, which is the exception of visiting a doctor, and therefore the chances of early diagnosis diseases are reduced to a minimum;
• clinical - the period of manifestation of the first symptoms and initial visits of patients to a specialist.

Tumor development depends on the type and location of cancer cells. develops more slowly. It includes: squamous cell and large cell lung cancer. The prognosis for this type of cancer is up to 5 years without appropriate treatment. Patients rarely survive more than two years. The tumor is rapidly developing and appears clinical symptoms diseases. Peripheral cancer develops in small bronchi, does not produce pronounced symptoms for a long time and often manifests itself during routine medical examinations.

Symptoms and signs of peripheral lung cancer

In the later stages of the disease, when the tumor spreads to a large bronchus and narrows its lumen, clinical picture peripheral cancer becomes similar to the central form. At this stage of the disease, the results of physical examination are the same in both forms of lung cancer. At the same time, in contrast to X-ray examination, against the background of atelectasis, a shadow of the peripheral tumor itself is revealed. In peripheral cancer, the tumor often spreads throughout the pleura with the formation of pleural effusion.
Transition of the peripheral form into central shape Lung cancer occurs due to the involvement of large bronchi in the process, while remaining invisible for a long time. Manifestations of a growing tumor may include increased cough, sputum production, hemoptysis, shortness of breath, pleural carcinomatosis with effusion into the pleural cavity.

With bronchial cancer, similar first symptoms appear with the addition of inflammatory complications from the lungs and pleura. That is why it is important to regularly conduct fluorography, which shows lung cancer.

Symptoms of peripheral lung cancer:

• shortness of breath - may be due to tumor metastasis to the lymph nodes;
• pain in the chest, which can change its character along with movement;
• cough, prolonged, without any reason;
• sputum separation;
• swollen lymph nodes;
• if the tumor develops in the area of ​​the apex of the lung, then compression of the superior vena cava may occur and the neoplasm may impact the structures of the cervical plexus, with the development of corresponding neurological symptoms.

Signs of peripheral lung cancer:

• temperature increase;
• malaise;
• weakness, lethargy;
• rapid fatigue;
• decreased ability to work;
• loss of appetite;
• weight loss;
• in some cases, pain in the bones and joints is even felt.

Causes of development of peripheral lung cancer:

1. - one of the most important reasons incidence of lung cancer. Tobacco smoke contains hundreds of substances that can have a carcinogenic effect on the human body;
2. conditions environment: air pollution that penetrates the lungs (dust, soot, fuel combustion products, etc.);
3. harmful working conditions – the presence of large amounts of dust can cause the development of sclerosis lung tissue, which has a risk of becoming malignant;
4. asbestosis – a condition caused by inhalation of asbestos particles;
5. hereditary predisposition;
6. Chronic lung diseases - cause constant inflammation, which increases the likelihood of developing cancer; viruses can invade cells and increase the likelihood of developing cancer.

Stages of peripheral lung cancer

depending on the clinical manifestation degrees:

• Stage 1 peripheral lung cancer. The tumor is quite small in size. There is no spread of the tumor to the chest organs and lymph nodes;

1. 1A - tumor size does not exceed 3 cm;
2. 1B - tumor size from 3 to 5 cm;

• Stage 2 peripheral lung cancer. The tumor grows;

1. 2A - tumor size 5-7 cm;
2. 2B - dimensions remain unchanged, but cancer cells located close to the lymph nodes;

• Stage 3 peripheral lung cancer;

1. 3A - the tumor affects adjacent organs and lymph nodes, the tumor size exceeds 7 cm;
2. 3B - cancer cells penetrate the diaphragm and lymph nodes on the opposite side of the chest;

• Stage 4 peripheral lung cancer. At this stage, the tumor spreads throughout the body.

Diagnosis of lung cancer

Important! Peripheral lung cancer is a malignant neoplasm that tends to rapid growth and distribution. When the first suspicious symptoms appear, you should not hesitate to visit a doctor, as you may waste precious time.

It is complex due to the similarity of its radiological symptoms with many other diseases.

How to recognize peripheral lung cancer?

• X-ray examination is the main method in diagnosis malignant neoplasms. More often this study patients perform it for a completely different reason, and in the end they may encounter lung cancer. The tumor appears as a small lesion on the peripheral part of the lung.
• Computed tomography and MRI are the most precise methods diagnostics that allow you to obtain a clear image of the patient’s lungs and accurately examine all of his neoplasms. With the help of special programs, doctors have the opportunity to examine the received images in different projections and extract maximum information for themselves.
• - is carried out by removing a section of tissue followed by histological examination. Only by examining the tissue under high magnification can doctors say that the neoplasm is malignant.
• Bronchoscopy is an examination of the patient’s respiratory tract and bronchi from the inside using special equipment. Since the tumor is located in parts more distant from the center, the information this method gives less than if the patient has central lung cancer.
• Cytological examination of sputum - allows you to detect atypical cells and other elements that suggest a diagnosis.

Differential diagnosis

On a chest x-ray, the shadow of peripheral cancer must be differentiated from several diseases unrelated to the tumor in the right lung.

• Pneumonia is an inflammation of the lungs, which gives a shadow on the X-ray image; the accumulation of exudate provokes a violation of ventilation in the lungs, since it is not always possible to make out the pattern accurately. Accurate diagnosis placed only after a thorough examination of the bronchi.
• Tuberculosis – chronic illness, which can provoke the development of an encapsular formation - tuberculoma. The size of the shadow on the radiograph will not exceed 2 cm. The diagnosis is made only after laboratory research exudate to identify mycobacteria.
• Retention cyst - the image will show a formation with clear edges.
• A benign tumor of the right lung - there will be no tuberosity in the image, the tumor is clearly localized and does not disintegrate. Distinguish benign tumor based on the patient’s history and complaints – there are no symptoms of intoxication, stable health, no hemoptysis.

Having excluded all similar diseases, the main stage begins - selecting the most effective techniques treatment for a specific patient, depending on the form, stage and location of the malignant focus.

Informative video: Endobronchial ultrasound in the diagnosis of peripheral lung cancer

Peripheral lung cancer and its treatment

To date, the most modern methods are:

• surgical intervention;
• radiation therapy;
• chemotherapy;
• radiosurgery.

In world practice, surgery and radiation therapy are gradually giving way to advanced methods of treating lung cancer, but despite the advent of new treatment methods, surgery patients with resectable forms of lung cancer are still considered radical method, in which there are prospects for a complete cure.

When chemotherapy is combined with radiation treatment(simultaneous or sequential use is possible) achieve best results. Chemoradiation treatment is based on the possibility of both an additive effect and synergism, without the addition of toxic side effects.

Combined treatment is a type of treatment that includes, in addition to radical surgery, other types of effects on the tumor process in the local-regional affected area (remote or other methods radiation therapy). Hence, combined method involves the use of two heterogeneous, different in nature, impacts aimed at local-regional foci.

For example:

• surgical + radiation;
• radiation + surgical;
• radiation + surgical + radiation, etc..

The combination of unidirectional methods makes up for the limitations of each of them separately. At the same time, it must be emphasized that combination treatment can only be said when it is applied according to the plan developed at the very beginning of treatment.

Peripheral lung cancer: prognosis

It is very difficult to predict the treatment of peripheral lung cancer, since it can be expressed in various structures, be in different stages and is being treated different methods. This disease is curable with both radiosurgery and surgery. According to statistics, among patients who underwent surgery, the 5-year or more survival rate is 35%. When treating the initial forms of the disease, a more favorable outcome is possible.

Prevention of peripheral lung cancer

To minimize lung cancer you need to:

• treatment and prevention inflammatory diseases lungs;
• annual medical examinations and fluorography;
• complete cessation of smoking;
• treatment benign formations in the lungs;
• neutralization harmful factors in production, and in particular: contacts with nickel compounds, arsenic, radon and its decay products, resins;
• avoiding exposure to carcinogenic factors in everyday life.

Informative video: Peripheral cancer of the upper lobe of the right lung

The lungs are the respiratory organs in which gas exchange occurs between air and circulatory system living organisms. Mammals (including humans), reptiles, birds, most species of amphibians and some species of fish have lungs.

The unusual name of these organs came about as follows. When people cut up animal carcasses and put the entrails taken out of them into a basin of water, all the organs turned out to be heavier than the water and sank to the bottom. Only the respiratory organs located in the chest were lighter than water and floated on the surface. This is how the name “lungs” stuck to them.

And after we have briefly understood what the lungs are, let's look at what the human lungs are and how they work.

The structure of the human lungs

Lungs are paired organ. Every person has two lungs - right and left. The lungs are located in the chest and occupy 4/5 of its volume. Each lung is covered with pleura, the outer edge of which is tightly fused with the chest. Initially (in newborns), the lungs are pale pink. Over the course of life, the lungs gradually darken due to the accumulation of coal and dust particles in them.

Each lung consists of lobes, the right lung has three lobes, the left lung has two. The lobes of the lung are divided into segments (the right lung has 10, the left lung has 8), the segments consist of lobules (there are about 80 of them in each segment), and the lobules are divided into acini.

Air enters the lungs through windpipe(trachea). The trachea divides into two bronchi, each of which enters the lung. Next, each bronchus is divided according to a tree-like principle into bronchi of smaller diameter in order to supply air to each lobe, each segment, each lobe of the lung. The bronchus included in the lobule is divided into 18 - 20 bronchioles, each of which ends in an acini.

Inside the acini, the bronchioles are divided into alveolar ducts, dotted with alveoli. The alveoli are entwined with a network of the finest blood vessels- capillaries separated from the alveoli the thinnest wall. It is inside the alveoli that gas exchange occurs between blood and air.

How the lungs work

During inhalation, air from the trachea enters the alveoli through a network of bronchi and bronchioles. On the other hand, blood supersaturated with carbon dioxide enters the alveoli through capillaries. Here human blood is purified from carbon dioxide and is enriched with oxygen necessary for the body’s cells. When you exhale, carbon dioxide is released from the lungs into the atmosphere. This cycle is repeated countless times as long as the organism continues to live.

The lungs are the organs that provide human breathing. These paired organs are located in chest cavity, adjacent to the left and right to the heart. The lungs have the shape of semi-cones, the base adjacent to the diaphragm, the apex protruding 2-3 cm above the collarbone. The right lung has three lobes, the left - two. The skeleton of the lungs consists of tree-like branching bronchi. Each lung is covered on the outside by a serous membrane - the pulmonary pleura. The lungs lie in the pleural sac, formed by the pulmonary pleura (visceral) and the parietal pleura (parietal) lining the inside of the chest cavity. Each pleura contains glandular cells on the outside that produce fluid into the cavity between the layers of the pleura (pleural cavity). On the inner (cardial) surface of each lung there is a depression - the hilum of the lungs. The pulmonary artery and bronchi enter the gates of the lungs, and two exit pulmonary veins. Pulmonary arteries branch parallel to the bronchi.

Lung tissue consists of pyramidal lobules, with their bases facing the surface. The apex of each lobule includes a bronchus, which sequentially divides to form terminal bronchioles (18-20). Each bronchiole ends with an acinus, a structural and functional element of the lungs. The acini consist of alveolar bronchioles, which are divided into alveolar ducts. Each alveolar duct ends in two alveolar sacs.

Alveoli are hemispherical protrusions consisting of connective tissue fibers. They are lined with a layer epithelial cells and are abundantly intertwined with blood capillaries. It is in the alveoli that the main function lungs – gas exchange processes between atmospheric air and blood. In this case, as a result of diffusion, oxygen and carbon dioxide, overcoming the diffusion barrier (alveolar epithelium, basement membrane, blood capillary wall), penetrate from the erythrocyte to the alveoli and vice versa.

Lung functions

The most important function of the lungs is gas exchange - supplying hemoglobin with oxygen and removing carbon dioxide. The intake of oxygen-enriched air and the removal of carbon dioxide-saturated air is carried out thanks to the active movements of the chest and diaphragm, as well as the contractility of the lungs themselves. But there are other functions of the lungs. The lungs take an active part in maintaining the required concentration of ions in the body (acid-base balance), and are capable of removing many substances (aromatic substances, esters, and others). The lungs also regulate water balance body: approximately 0.5 liters of water per day evaporates through the lungs. At extreme situations(for example, hyperthermia), this figure can reach up to 10 liters per day.

Ventilation of the lungs is carried out due to the pressure difference. During inhalation, pulmonary pressure is much lower than atmospheric pressure, allowing air to enter the lungs. When you exhale, the pressure in the lungs is higher than atmospheric pressure.

There are two types of breathing: costal (chest) and diaphragmatic (abdominal).

• Costal breathing

At the points where the ribs are attached to the spinal column, there are pairs of muscles that are attached at one end to the vertebra and at the other to the rib. There are external and internal intercostal muscles. The external intercostal muscles provide the process of inhalation. Exhalation is normally passive, but in case of pathology, the act of exhalation is assisted by the internal intercostal muscles.

• Diaphragmatic breathing

Diaphragmatic breathing is carried out with the participation of the diaphragm. When relaxed, the diaphragm has a dome shape. When its muscles contract, the dome flattens, the volume of the chest cavity increases, the pressure in the lungs decreases compared to atmospheric pressure, and inhalation occurs. When the diaphragmatic muscles relax as a result of the pressure difference, the diaphragm returns to its original position.

Regulation of the breathing process

Breathing is regulated by the centers of inhalation and exhalation. The respiratory center is located in medulla oblongata. Receptors that regulate breathing are located in the walls of blood vessels (chemoreceptors sensitive to the concentration of carbon dioxide and oxygen) and on the walls of the bronchi (receptors sensitive to changes in pressure in the bronchi - baroreceptors). There are also receptive fields in the carotid sinus (the divergence of the internal and external carotid arteries).

Lungs of a smoker

In the process of smoking, the lungs are subjected to severe shock. Tobacco smoke penetrating into the lungs smoking man, contains tobacco tar (tar), hydrogen cyanide, nicotine. All these substances settle in the lung tissue, as a result the epithelium of the lungs simply begins to die. The lungs of a smoker are a dirty gray or even just a black mass of dying cells. Naturally, functionality such lungs are significantly reduced. In the lungs of a smoking person, ciliary dyskinesia develops, spasm of the bronchi occurs, as a result of which bronchial secretions accumulate and develop chronic inflammation lungs, bronchiectasis forms. All this leads to the development of COPD - chronic obstructive pulmonary disease.

Pneumonia

One of the common severe pulmonary diseases is pneumonia. The term “pneumonia” includes a group of diseases with different etiologies, pathogenesis, and clinical features. Classic bacterial pneumonia is characterized by hyperthermia, cough with purulent sputum, in some cases (when the visceral pleura is involved in the process) – pleural pain. With the development of pneumonia, the lumen of the alveoli expands, exudative fluid accumulates in them, red blood cells penetrate into them, and the alveoli are filled with fibrin and leukocytes. For diagnostics bacterial pneumonia are used X-ray methods, microbiological examination sputum, lab tests, study of blood gas composition. The basis of treatment is antibacterial therapy.