Lung segments on computed tomography. Segmental structure of the lungs Structure of the right lung

Peripheral lung cancer is a neoplasm in the airways, formed from epithelial cells, which is not difficult to distinguish from other oncology of the bronchi and lungs. Neoplasm can develop from the epithelium of the bronchial mucosa, pulmonary alveoli and glands of bronchioles. Most often, small bronchi and bronchioles are affected, hence the name - peripheral cancer.

Symptoms

In the initial stages, this disease is very difficult to determine. Later, when the tumor grows into the pleura, into the large bronchi, when it passes from the periphery into the central lung cancer, more vivid signs of a malignant neoplasm begin. There is shortness of breath, pain in the chest area (on the side where the tumor is localized), a strong cough interspersed with blood and mucus. Further symptoms and signs:

1. Difficulty swallowing.
2. Hoarse, hoarse voice.
3. Pancoast syndrome. It manifests itself when the tumor grows and touches the vessels of the shoulder girdle, is characterized as weakness in the muscles of the hands, with further atrophy.
4. Increased subfebrile temperature.
5. vascular insufficiency.
6. Sputum with blood.
7. neurological disorders. Manifested when metastatic cells enter the brain, affecting the phrenic, recurrent and other nerves of the chest cavity, causing paralysis.
8. Effusion in the pleural cavity. It is characterized by effusion of exudate into the chest cavity. When the fluid is removed, the exudate appears much faster.

Causes

1. Smoking comes first. The constituents of tobacco smoke contain many carcinogenic chemicals that can cause cancer.
2. "Chronicle" - chronic lung pathology. Constant damage to the lung walls by viruses and bacteria causes them to become inflamed, which increases the risk of developing abnormal cells. Also, tuberculosis, pneumonia can develop into oncology.
3. Ecology. It's no secret that in Russia the environment is the precursor of all diseases, polluted air, poor quality water, smoke, dust from the thermal power plant, which is released into the external environment - all this leaves an imprint on health.
4. A work sickness manifests itself when people work at "harmful" enterprises, constant inhalation of dust causes the development of sclerosis of the tissues of the bronchi and lungs, which can lead to oncology.
5. Heredity. Scientists have not yet proven the fact that people are able to transmit this disease to their blood relatives, but such a theory has a place to be, and statistics confirm this.
6. Pneumoconiosis (asbestosis) is a disease caused by asbestos dust.

Sometimes peripheral lung cancer can be secondary disease. This happens when a malignant tumor is already developing in the body and metastasizes to the lungs and bronchi, so to speak, "settling" on them. The metastatic cell enters the bloodstream, touching the lung, and begins the growth of a new tumor.

Stages of the disease

1. Biological. From the onset of tumor development to the appearance of the first visible symptoms, which will be officially confirmed by diagnostic studies.
2. Preclinical. During this period, there are no signs of the disease, this fact reduces the likelihood of getting to the doctor, and therefore diagnosing the disease in the early stages.
3. Clinical. From the appearance of the first symptoms and the initial visit to the doctors.

Also, the rate of development depends on the type of cancer itself.

Types of peripheral lung cancer

Non-small cell cancer grows slowly, if the patient does not go to the doctor, then the life span will be about 5-8 years, it includes:

• adenomacarcinoma;
• Large cell cancer;
• Squamous.

Small cell cancer develops aggressively and without appropriate treatment, the patient can live up to about two years. With this form of cancer, there are always clinical signs and most often a person does not pay attention to them or confuses them with other diseases.

Forms

1. cavity form- This is a tumor in the central part of the body with a cavity. During the development of a malignant formation, the central part of the tumor disintegrates, as there are not enough nutritional resources for further development. The tumor reaches at least 10 cm. Clinical symptoms of peripheral localization are practically asymptomatic. The strip form of peripheral cancer is easily confused with cysts, tuberculosis and abscesses in the lungs, since they are very similar on x-rays. This form is diagnosed late, so the survival rate is not high.
2. Cortico-pleural form is a form of squamous cell carcinoma. A tumor of a round or oval shape, located in the subpleural space and penetrating into the chest, and more precisely into adjacent ribs and into the thoracic vertebrae. With this form of the tumor, pleurisy is observed.

Peripheral cancer of the left lung

The tumor is localized in the upper and lower lobes.

1. Peripheral cancer of the upper lobe of the right lung. Cancer of the upper lobe of the left lung on X-ray, the differentiation of the contours of the neoplasm is clearly expressed, the tumor itself has a diverse shape and heterogeneous structure. The vascular trunks of the roots of the lungs are dilated. Lymph nodes are within the physiological norm.
2. Peripheral cancer of the lower lobeleft lung- the tumor is also clearly expressed, but in this case, the supraclavicular, intrathoracic and prescalene lymph nodes are enlarged.

Peripheral cancer of the right lung

The same localization as in the left lung. It occurs an order of magnitude more often than cancer of the left lung. The characteristic is exactly the same as in the left lung.

1. Nodal shape- at the beginning of formation, the site of localization is the terminal bronchioles. Symptoms appear when the tumor invades the lungs and soft tissues themselves. An X-ray shows a clearly differentiated neoplasm with a bumpy surface. If a deepening is visible on the x-ray, then this indicates the germination of the vessel into the tumor.
2. Pneumonia-like peripheral (glandular cancer) - the neoplasm originates from the bronchus, spreading throughout the lobe. The primary symptoms are subtle: dry cough, sputum is separated, but in small quantities, then it becomes liquid, abundant and foamy. When bacteria or viruses enter the lungs, symptoms are characteristic of recurrent pneumonia. For an accurate diagnosis, it is necessary to take sputum for the study of exudate.
3. Pancoast syndrome- localized in the apex of the lung, with this form, a cancerous tumor affects the nerves and blood vessels.
4. Horner's syndrome- this is a triad of symptoms, most often observed together with Pancoast syndrome, characterized by drooping or retraction of the upper eyelid, retraction of the eyeball and atypical pupillary constriction.

stages

First of all, what the doctor needs to find out is the stage of cancer in order to specifically determine the treatment of the patient. The earlier cancer was diagnosed, the better the prognosis in therapy.

1 stage

• 1A- education no more than 30 mm in diameter.
• 1B- the cancer does not reach more than 50 mm.

At this stage, the malignant formation does not metastasize and does not affect the lymphatic system. The first stage is more favorable, since the neoplasm can be removed and there are chances for a full recovery. Clinical signs are not yet manifest, which means that the patient is unlikely to turn to a specialist, and the chances of recovery are reduced. There may be symptoms such as sore throat, mild cough.

2 stage

• 2A- the size is about 50 mm, the neoplasm approaches the lymph nodes, but does not affect them.
• 2B- The cancer reaches 70 mm, the lymph nodes are not affected. Metastases are possible in nearby tissues.

Clinical symptoms are already manifesting such as fever, cough with sputum, pain syndrome, rapid weight loss. Survival in the second stage is less, but it is possible to surgically remove the mass. With proper treatment, a patient's life can be extended up to five years.

3 stage

• 3A— The size is more than 70 mm. Malignant formation affects the regional lymph nodes. Metastases affect the organs of the chest, vessels going to the heart.
• 3B- The size is also more than 70 mm. Cancer is already beginning to penetrate the lung parenchyma and affect the lymphatic system as a whole. Metastases reach the heart.

In the third stage, treatment practically does not help. Clinical signs are pronounced: sputum with blood, severe pain in the chest area, continuous cough. Doctors prescribe narcotic drugs to alleviate the suffering of the patient. The survival rate is critically low - about 9%.

4 stage

Cancer is not curable. Metastases through the bloodstream have reached all organs and tissues, and concomitant oncological processes are already appearing in other parts of the body. The exudate is constantly pumped out, but it rapidly reappears. Life expectancy is reduced to zero, no one knows how long a person with lung cancer in stage 4 will live, it all depends on the resistance of organisms and, of course, on the method of treatment.

Treatment

The method of treatment depends on the type, form and stage of the disease.

Modern methods of treatment:

1. Radiation therapy. It gives positive results at the first and second stages, is also used in combination with chemotherapy, at stages 3 and 4 and achieves the best results.
2. Chemotherapy. When using this method of treatment, complete resorption is rarely observed. Apply 5-7 courses of chemotherapy with an interval of 1 month, at the discretion of the pulmonologist. The interval may change.
3. Surgical removal - more often, the operation is done at stages 1 and 2, when it is possible to completely remove the neoplasm with a prognosis for complete recovery. At stages 3 and 4, with metastasis, it is useless to remove the tumor and it is dangerous for the patient's life.
4. Radiosurgery - a fairly recent method, which is also called the "Cyber ​​Knife". Without incisions, the tumor is burned out by radiation exposure.

There may be complications after any treatment: violation of swallowing, germination of the tumor further into neighboring organs, bleeding, tracheal stenosis.

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It is possible to detect a neoplasm in the lungs, and determine what it may be, with a detailed examination. This disease affects people of all ages. Formations arise due to a violation of the process of cell differentiation, which can be caused by internal and external factors.

Neoplasms in the lungs are a large group of various formations in the region of the lungs, which have a characteristic structure, location and nature of origin.

Neoplasms in the lungs can be benign or malignant.

Benign tumors have a different genesis, structure, location and different clinical manifestations. Benign tumors are less common than malignant ones, and make up about 10% of the total. They tend to develop slowly, do not destroy tissues, since they are not characterized by infiltrating growth. Some benign tumors tend to transform into malignant ones.

Depending on the location, there are:

1. Central - tumors from the main, segmental, lobar bronchi. They can grow inside the bronchus and surrounding tissues of the lung.
2. Peripheral - tumors from surrounding tissues and walls of small bronchi. Grow superficially or intrapulmonaryly.

Types of benign tumors

There are such benign lung tumors:

Briefly about malignant tumors

Lung cancer (bronchogenic carcinoma) is a tumor consisting of epithelial tissue. The disease tends to metastasize to other organs. It can be located in the periphery, the main bronchi, it can grow in the lumen of the bronchus, the tissues of the organ.

Malignant neoplasms include:

1. Lung cancer has the following types: epidermoid, adenocarcinoma, small cell tumor.
2. Lymphoma is a tumor that affects the lower respiratory tract. It may occur primarily in the lungs or as a result of metastases.
3. Sarcoma is a malignant formation consisting of connective tissue. Symptoms are similar to those of cancer, but develop more quickly.
4. Pleural cancer is a tumor that develops in the epithelial tissue of the pleura. It can occur initially, and as a result of metastases from other organs.

Risk factors

The causes of malignant and benign tumors are largely similar. Factors that provoke tissue proliferation:

• Smoking active and passive. 90% of men and 70% of women who have been diagnosed with malignant neoplasms in the lungs are smokers.
• Contact with hazardous chemical and radioactive substances due to professional activities and due to environmental pollution in the area of ​​​​residence. Such substances include radon, asbestos, vinyl chloride, formaldehyde, chromium, arsenic, and radioactive dust.
• Chronic diseases of the respiratory tract. The development of benign tumors is associated with such diseases: chronic bronchitis, chronic obstructive pulmonary disease, pneumonia, tuberculosis. The risk of malignant neoplasms increases if there is a history of chronic tuberculosis and fibrosis.

The peculiarity lies in the fact that benign formations can be caused not by external factors, but by gene mutations and a genetic predisposition. Also, malignancy often occurs, and the transformation of the tumor into a malignant one.

Any lung formations can be caused by viruses. Cell division can cause cytomegalovirus, human papillomavirus, multifocal leukoencephalopathy, simian virus SV-40, human polyomavirus.

Symptoms of a tumor in the lung

Benign lung formations have various signs that depend on the location of the tumor, its size, existing complications, hormone activity, the direction of tumor growth, impaired bronchial patency.

Complications include:

• abscess pneumonia;
• malignancy;
• bronchiectasis;
• atelectasis;
• bleeding;
• metastases;
• pneumofibrosis;
• compression syndrome.

Bronchial patency has three degrees of violations:

• 1 degree - partial narrowing of the bronchus.
• Grade 2 - valvular narrowing of the bronchus.
• Grade 3 - occlusion (impaired patency) of the bronchus.

For a long time, symptoms of the tumor may not be observed. The absence of symptoms is most likely with peripheral tumors. Depending on the severity of the symptoms, several stages of the course of the pathology are distinguished.

Formation stages

1 stage. Runs asymptomatic. At this stage, there is a partial narrowing of the bronchus. Patients may cough with a small amount of sputum. Hemoptysis is rare. On examination, the x-ray shows no abnormalities. The tumor can be shown by such studies as bronchography, bronchoscopy, computed tomography.

2 stage. Observed valve (valve) narrowing of the bronchus. By this time, the lumen of the bronchus is practically closed by the formation, but the elasticity of the walls is not broken. When inhaling, the lumen partially opens, and when exhaled, it closes with a tumor. In the area of ​​the lung, which is ventilated by the bronchus, expiratory emphysema develops. As a result of the presence of bloody impurities in the sputum, mucosal edema, complete obstruction (impaired patency) of the lung may occur. In the tissues of the lung, there may be the development of inflammatory processes. The second stage is characterized by cough with mucus sputum (often pus is present), hemoptysis, shortness of breath, fatigue, weakness, chest pain, fever (due to the inflammatory process). The second stage is characterized by an alternation of symptoms and their temporary disappearance (with treatment). An x-ray image shows impaired ventilation, the presence of an inflammatory process in a segment, lobe of the lung, or the whole organ.

To be able to make an accurate diagnosis, bronchography, computed tomography, and linear tomography are required.

3 stage. Complete obturation of the bronchus occurs, suppuration develops, and irreversible changes in lung tissues and their death occur. At this stage, the disease has such manifestations as impaired breathing (shortness of breath, suffocation), general weakness, excessive sweating, chest pain, fever, cough with purulent sputum (often with bloody particles). Occasionally, pulmonary bleeding may occur. During examination, an x-ray image may show atelectasis (partial or complete), inflammatory processes with purulent-destructive changes, bronchiectasis, volumetric education in the lungs. To clarify the diagnosis, a more detailed study is necessary.

Symptoms

Symptoms of malignant tumors also vary depending on the size, location of the tumor, the size of the bronchial lumen, the presence of various complications, metastases. The most common complications include atelectasis and pneumonia.

At the initial stages of development, malignant cavity formations that have arisen in the lungs show few signs. The patient may experience the following symptoms:

• general weakness, which increases with the course of the disease;
• increased body temperature;
• fast fatiguability;
• general malaise.

Symptoms of the initial stage of neoplasm development are similar to those of pneumonia, acute respiratory viral infections, bronchitis.

The progression of malignant formation is accompanied by symptoms such as cough with sputum, consisting of mucus and pus, hemoptysis, shortness of breath, suffocation. When the neoplasm grows into the vessels, pulmonary bleeding occurs.

A peripheral lung mass may not show signs until it grows into the pleura or chest wall. After that, the main symptom is pain in the lungs that occurs when inhaling.

In the later stages of malignant tumors are manifested:

• increased constant weakness;
• weight loss;
• cachexia (exhaustion of the body);
• occurrence of hemorrhagic pleurisy.

Diagnostics

To detect neoplasms, the following examination methods are used:

1. Fluorography. Preventive diagnostic method of X-ray diagnostics, which allows you to identify many pathological formations in the lungs. read this article.
2. Plain radiography of the lungs. Allows you to identify spherical formations in the lungs, which have a round contour. On the x-ray, changes in the parenchyma of the examined lungs are determined on the right, left, or both sides.
3. CT scan. Using this diagnostic method, the lung parenchyma, pathological changes in the lungs, and each intrathoracic lymph node are examined. This study is prescribed when differential diagnosis of rounded formations with metastases, vascular tumors, and peripheral cancer is necessary. Computed tomography allows you to make a more correct diagnosis than x-ray examination.
4. Bronchoscopy. This method allows you to examine the tumor, and conduct a biopsy for further cytological examination.
5. Angiopulmonography. It implies an invasive x-ray of the vessels using a contrast agent to detect vascular tumors of the lung.
6. Magnetic resonance imaging. This diagnostic method is used in severe cases for additional diagnostics.
7. Pleural puncture. A study in the pleural cavity with a peripheral location of the tumor.
8. Cytological examination of sputum. Helps to determine the presence of a primary tumor, as well as the appearance of metastases in the lungs.
9. Thoracoscopy. It is carried out to determine the operability of a malignant tumor.

Fluorography.

Bronchoscopy.

Angiopulmonography.

Magnetic resonance imaging.

Pleural puncture.

Cytological examination of sputum.

Thoracoscopy.

It is believed that benign focal lesions of the lungs are no more than 4 cm in size, larger focal changes indicate malignancy.

Treatment

All neoplasms are subject to surgical treatment. Benign tumors are subject to immediate removal after diagnosis in order to avoid an increase in the area of ​​affected tissues, trauma from surgery, the development of complications, metastases and malignancy. For malignant tumors and for benign complications, a lobectomy or bilobectomy may be required to remove a lobe of the lung. With the progression of irreversible processes, pneumonectomy is performed - removal of the lung and surrounding lymph nodes.

Central cavity formations localized in the lungs are removed by resection of the bronchus without affecting the lung tissue. With such localization, removal can be performed endoscopically. To remove neoplasms with a narrow base, a fenestrated resection of the bronchus wall is performed, and for tumors with a wide base, a circular resection of the bronchus is performed.

In peripheral tumors, such methods of surgical treatment as enucleation, marginal or segmental resection are used. With a significant size of the neoplasm, a lobectomy is used.

Lung masses are removed by thoracoscopy, thoracotomy and videothoracoscopy. During the operation, a biopsy is performed, and the resulting material is sent for histological examination.

For malignant tumors, surgery is not performed in such cases:

• when it is not possible to completely remove the neoplasm;
• metastases are at a distance;
• impaired functioning of the liver, kidneys, heart, lungs;
• the patient's age is over 75 years.

After removal of the malignant tumor, the patient undergoes chemotherapy or radiation therapy. In many cases, these methods are combined.

What do our lungs look like? In the chest, 2 pleural sacs contain lung tissue. Inside the alveoli are tiny air sacs. The apex of each lung is in the region of the supraclavicular fossa, slightly higher (2-3 cm) than the clavicle.

The lungs are supplied with an extensive network of blood vessels. Without a developed network of vessels, nerves and bronchus, the respiratory organ would not be able to fully function.

The lungs have lobes and segments. The interlobar fissures are filled by the visceral pleura. The segments of the lungs are separated from each other by a connective tissue septum, inside which the vessels pass. Some segments, if they are broken, can be removed during the operation without harming neighboring ones. Thanks to the partitions, you can see where the "section" line of the segments goes.

Lobes and segments of the lung. Scheme

The lungs are known to be a paired organ. The right lung consists of two lobes separated by furrows (Latin fissurae), and the left one consists of three. The left lung is narrower because the heart is located to the left of center. In this area, the lung leaves part of the pericardium uncovered.

The lungs are also subdivided into bronchopulmonary segments (segmenta bronchopulmonalia). According to international nomenclature, both lungs are divided into 10 segments. In the upper right section 3, in the middle lobe - 2, in the lower - 5 segments. The left side is divided differently, but contains the same number of sections. The bronchopulmonary segment is a separate section of the lung parenchyma, which is ventilated by 1 bronchus (namely, the bronchus of the 3rd order) and is supplied with blood from one artery.

Each person has an individual number of such areas. The lobes and segments of the lungs develop during the period of intrauterine growth, starting from 2 months (differentiation of the lobes into segments begins from the 20th week), and some changes in the development process are possible. For example, in 2% of people, the analog of the right middle lobe is another reed segment. Although in most people the reed segments of the lungs are only in the left upper lobe - there are two of them.

In some people, the segments of the lungs are simply “lined up” differently than in others, which does not mean that this is a pathological anomaly. The functioning of the lungs does not change from this.

The segments of the lung, the diagram confirms this, visually look like irregular cones and pyramids, with their apex facing the gates of the respiratory organ. The base of the imaginary figures is at the surface of the lungs.

Upper and middle segments of the right lung

The structural structure of the parenchyma of the left and right lung is slightly different. The segments of the lung have their own name in Latin and in Russian (with a direct relationship to the location). Let's start with a description of the anterior section of the right lung.

1. Apical (Segmentum apicale). It goes up to the scapular spine. Has the shape of a cone.
2. Posterior (Segmentum posterius). Passes from the middle of the scapula to its edge from above. The segment is adjacent to the thoracic (posterolateral) wall at the level of 2-4 ribs.
3. Anterior (Segmentum anterius). Located in front. The surface (medial) of this segment is adjacent to the right atrium and superior vena cava.

The average share is "marked" into 2 segments:

1. Lateral (laterale). It is located at the level of 4 to 6 ribs. Has a pyramidal shape.
2. Medial (mediale). The segment faces the chest wall from the front. In the middle it is adjacent to the heart, the diaphragm goes from below.

Displays these segments of the lung diagram in any modern medical encyclopedia. There may only be slightly different names. For example, the lateral segment is the outer, while the medial is often referred to as the inner.

Lower 5 segments of the right lung

There are 3 sections in the right lung, and the most recent lower section has 5 more segments. These lower segments of the lung are called:

1. Apical (apicale superius).
2. Medial basal, or cardiac, segment (basale mediale cardiacum).
3. Anterior basal (basale anterius).
4. Lateral basal (basale laterale).
5. Posterior basal (basale posterius).

These segments (the last 3 basal ones) are similar in shape and morphology to the left segments. This is how the segments of the lung are divided on the right side. The anatomy of the left lung is somewhat different. We will also consider the left side.

Upper lobe and lower left lung

The left lung, some believe, should be divided into 9 parts. Due to the fact that the 7th and 8th sectors of the parenchyma of the left lung have a common bronchus, the authors of some publications insist on combining these lobes. But for now, let's list all 10 segments:

Upper sectors:

• Apical. This segment is similar to the mirror right one.
• Rear. Sometimes the apical and posterior are combined into 1.
• Front. largest segment. It comes into contact with the left ventricle of the heart with its medial side.
• Upper reed (Segmentum lingulare superius). Adjacent at the level of 3-5 ribs to the anterior chest wall.
• Lower reed segment (lingulare interius). It is located directly under the upper reed segment, and is separated from the bottom by a gap from the lower basal segments.

And the lower sectors (which are similar to the right ones) are also given in the order of their sequence:

• Apical. The topography is very similar to the same sector on the right side.
• Medial basal (cardiac). It is located in front of the pulmonary ligament on the medial surface.
• Anterior basal.
• Lateral basal segment.
• Posterior basal.

Segments of the lung are both functional units of the parenchyma and morphological. Therefore, for any pathology, an x-ray is prescribed. When a person is given an x-ray, an experienced radiologist immediately determines in which segment the focus of the disease is.

blood supply

The smallest "details" of the respiratory organ are the alveoli. Alveolar sacs are bubbles covered with a thin network of capillaries through which our lungs breathe. It is in these lung "atoms" that all gas exchange takes place. Segments of the lung will contain several alveolar passages. There are 300 million alveoli in each lung. They are supplied with air by arterial capillaries. The carbon dioxide is taken up by the veins.

The pulmonary arteries operate on a small scale. That is, they nourish lung tissue and make up a small circle of blood circulation. The arteries are divided into lobar, and then segmented, and each feeds its own "department" of the lung. But also here are the bronchial vessels, which belong to the systemic circulation. The pulmonary veins of the right and left lungs enter the left atrial current. Each segment of the lung has its own grade 3 bronchus.

On the mediastinal surface of the lung there is a "gate" hilum pulmonis - recesses through which the main veins, lymphatic vessels, bronchi and arteries pass to the lungs. This place of "crossing" of the main vessels is called the root of the lungs.

What will the x-ray show?

On an x-ray, healthy lung tissue appears as a solid color image. By the way, fluorography is also an x-ray, but of lower quality and the cheapest. But if cancer is not always visible on it, then pneumonia or tuberculosis is easy to notice. If the picture shows spots of a darker shade, this may mean inflammation of the lung, as the density of the tissue is increased. But lighter spots mean that the organ tissue has a low density, and this also indicates problems.

Lung segments are not visible on the radiograph. Only the general picture is recognizable. But the radiologist must know all the segments, he must determine in which part of the lung parenchyma the anomaly. X-rays sometimes give false positive results. Image analysis only gives "fuzzy" information. More accurate data can be obtained on computed tomography.

Lungs on CT

Computed tomography is the most reliable way to find out what is happening inside the lung parenchyma. CT allows you to see not only the lobes and segments, but also intersegmental septa, bronchi, vessels and lymph nodes. Whereas segments of the lung on the radiograph can only be determined topographically.

For such a study, you do not need to starve in the morning and stop taking medication. The whole procedure is fast - in just 15 minutes.

Normally, the person examined with the help of CT should not have:

• enlarged lymph nodes;
• fluid in the pleura of the lungs;
• areas of excessive density;
• no formations;
• changes in the morphology of soft tissues and bones.

And also the thickness of the bronchi should correspond to the norm. Lung segments are not fully visible on CT scan. But the attending physician will compile a three-dimensional picture and write it down in the medical record when he views the entire series of images taken on his computer.

The patient himself will not be able to recognize the disease. All images after the study are written to disk or printed. And with these pictures, you need to contact a pulmonologist - a doctor who specializes in lung diseases.

How to keep your lungs healthy?

The greatest harm to the entire respiratory system is caused by an unhealthy lifestyle, poor diet and smoking.

Even if a person lives in a stuffy city and his lungs are constantly “attacked” by construction dust, this is not the worst thing. Dust can be cleared from the lungs by going to clean forests in summer. The worst thing is cigarette smoke. It is the poisonous mixtures inhaled during smoking, tar and carbon monoxide that are terrible. Therefore, smoking should be quit without regrets.

An X-ray beam lowers the entire human body at chest level and gives a summation image of all organs and tissues of the chest on a fluoroscopic screen or film. The image of the lungs is obtained with a layering of the shadow of the surrounding organs and tissues.

On an anterior plain radiograph, the lungs form lung fields intersected by shadows of the ribs. Between the lung fields is the median shadow - this is a summary image of all mediastinal organs, including the heart and large blood vessels.

In the inner parts of the lung fields, on the sides of the median shadow, at the level of the anterior ends of the 2nd and 4th ribs, an image of the roots of the lungs is projected, and against the background of the lung fields, a kind of shadow pattern, which is called a pulmonary pattern, necessarily appears in the norm. It is mainly an image of the blood vessels that branch out in the airy lung tissue.

The ribs cross the lung fields in the form of symmetrical stripes. Their posterior ends start from the articulation with the thoracic vertebrae, are directed more horizontally than the anterior ones, and are turned upwards with a bulge. The anterior sections go from top to bottom, from the outer edge of the sternum inwards. Their bulge is turned downward. The anterior ends of the ribs seem to break off, not reaching 2-5 cm to the shadow of the mediastinum. This is because the costal cartilage weakly absorbs x-rays.

The areas of the lung fields located above the clavicles are called the tops of the lungs. The rest of the lung fields are divided into sections by horizontal lines drawn on each side at the level of the lower edges of the anterior ends of the 2nd and 4th ribs. The upper section extends from the apex to the 2nd rib, the middle section from the 2nd to the 4th rib, and the lower section from the 4th rib to the diaphragm.

Projection of the lobes of the lungs in direct projection: the upper border of the lower lobe runs along the posterior part of the body of the 4th rib, and the lower border is projected along the anterior part of the body of the 6th rib. The border between the upper and middle lobes of the right lung runs along the anterior part of the body 4 ribs. In the lateral projection: first, the top point of the diaphragm contour is found in the picture. A straight line is drawn from it through the shadow of the middle of the root until it intersects with the image of the spine. This line approximately corresponds to the oblique interlobar fissure separating the lower lobe from the upper lobe in the left lung and from the upper and middle lobe in the right lung. A horizontal line from the middle of the root towards the sternum indicates the position of the interlobar fissure in the right lung, delimiting the upper and middle lobes.

In the picture in direct projection, each half of the diaphragm forms a clear arc going from the shadow of the mediastinum to the image of the walls of the chest cavity.

In a healthy person, 1/3 of the shadow of the heart is located to the right of the midline of the chest, drawn through the spinous processes of the vertebrae, and 2/3 to the left. The gastric air bladder is located on the left under the diaphragm.

Three vertical lines serve as reference points for determining the position of the mediastinal organs. One of them is carried out along the right edge of the shadow of the spine, the second through the spinous processes of the vertebrae, the third - the left mid-clavicular. Normally, the left edge of the shadow of the heart is 1.5-2 cm medially from the left mid-clavicular line. The right edge of the shadow of the heart protrudes into the right lung field 1-1.5 cm outward from the right edge of the spine

Lung segments

S1 segment (apical or apical) of the right lung. Refers to the upper lobe of the right lung. It is topographically projected onto the chest along the anterior surface of the 2nd rib, through the apex of the lung to the spine of the scapula.

S2 segment (posterior) of the right lung. Refers to the upper lobe of the right lung. It is topographically projected onto the chest along the posterior surface paravertebral from the upper edge of the scapula to its middle.

S3 segment (anterior) of the right lung. Refers to the upper lobe of the right lung. Topographically projected onto the chest in front of 2 to 4 ribs.

S4 segment (lateral) of the right lung. Refers to the middle lobe of the right lung. It is topographically projected onto the chest in the anterior axillary region between the 4th and 6th ribs.

S5 segment (medial) of the right lung. Refers to the middle lobe of the right lung. It is topographically projected onto the chest between the 4th and 6th ribs closer to the sternum.

S6 segment (superior basal) of the right lung. Refers to the lower lobe of the right lung. It is topographically projected onto the chest in the paravertebral region from the middle of the scapula to its lower angle.

S7 segment (medial basal) of the right lung. Refers to the lower lobe of the right lung. Topographically localized from the inner surface of the right lung, located below the root of the right lung. It is projected onto the chest from the 6th rib to the diaphragm between the sternal and midclavicular lines.

S8 segment (anterior basal) of the right lung. Refers to the lower lobe of the right lung. It is topographically delimited in front by the main interlobar sulcus, below by the diaphragm, and behind by the posterior axillary line.

S9 segment (lateral basal) of the right lung. Refers to the lower lobe of the right lung. It is topographically projected onto the chest between the scapular and posterior axillary lines from the middle of the scapula to the diaphragm.

Segment S10 (posterior basal) of the right lung. Refers to the lower lobe of the right lung. It is topographically projected onto the chest from the lower angle of the scapula to the diaphragm, delimited on the sides by the paravertebral and scapular lines.

S1+2 segment (apical-posterior) of the left lung. Represents a combination of C1 and C2 segments, due to the presence of a common bronchus. Refers to the upper lobe of the left lung. It is topographically projected onto the chest along the anterior surface from the 2nd rib and up, through the apex to the middle of the scapula.

S3 segment (anterior) of the left lung. Refers to the upper lobe of the left lung. Topographically projected onto the chest in front from 2 to 4 ribs.

S4 segment (superior lingual) of the left lung. Refers to the upper lobe of the left lung. It is topographically projected onto the chest along the anterior surface from 4 to 5 ribs.

S5 segment (lower lingual) of the left lung. Refers to the upper lobe of the left lung. It is topographically projected onto the chest along the anterior surface from the 5th rib to the diaphragm.

S6 segment (superior basal) of the left lung. Refers to the lower lobe of the left lung. It is topographically projected onto the chest in the paravertebral region from the middle of the scapula to its lower angle.

S8 segment (anterior basal) of the left lung. Refers to the lower lobe of the left lung. It is topographically delimited in front by the main interlobar sulcus, below by the diaphragm, and behind by the posterior axillary line.

S9 segment (lateral basal) of the left lung. Refers to the lower lobe of the left lung. It is topographically projected onto the chest between the scapular and posterior axillary lines from the middle of the scapula to the diaphragm.

S10 segment (posterior basal) of the left lung. Refers to the lower lobe of the left lung. It is topographically projected onto the chest from the lower angle of the scapula to the diaphragm, delimited on the sides by the paravertebral and scapular lines.

The radiograph of the right lung in the lateral projection is shown, indicating the topography of the interlobar fissures.

The lungs are located in the chest, occupying most of it, and are separated from each other by the mediastinum. The dimensions of the lungs are not the same due to the higher position of the right dome of the diaphragm and the position of the heart, shifted to the left.

In each lung, lobes are distinguished, separated by deep fissures. The right lung has three lobes, the left has two. The right upper lobe accounts for 20% of the lung tissue, the middle - 8%, the lower right - 25%, the upper left - 23%, the lower left - 24%.

The main interlobar fissures are projected to the right and left in the same way - from the level of the spinous process of the 3rd thoracic vertebrae, they go obliquely down and forward and cross the 6th rib at the point of transition of its bone part into the cartilage.

An additional interlobar fissure of the right lung is projected onto the chest along the 4th rib from the midaxillary line to the sternum.

The figure indicates: Upper Lobe - upper lobe, Middle Lobe - middle lobe, Lower Lobe - lower lobe

Right lung

Upper lobe:

• apical (S1);
• rear (S2);
• front (S3).

Average share :

• lateral (S4);
• medial (S5).

lower lobe :

• top (S6);
• mediobasal, or cardiac (S7);
• anterobasal (S8);
• posterobasal (S10).

Left lung

Upper lobe:

• apical-posterior (S1+2);
• front (S3);
• upper reed (S4);
• lower reed (S5).

lower lobe :

• top (S6);
• anterobasal (S8);
• laterobasal, or laterobasal (S9);
• posterobasal (S10).

4. The main radiological syndromes of lung diseases:

Radiological symptoms are divided into two large groups. The first group occurs when the air tissue is replaced by a pathological substrate (atelectasis, edema, inflammatory exudate, tuberculoma, tumor). The airless area absorbs X-rays more strongly. On the x-ray, an area of ​​blackout is determined. The position, size and shape of the darkening depends on which part of the lung is affected. The second group is due to a decrease in the volume of soft tissues, an increase in the amount of air (swelling, cavity). In the area of ​​rarefaction or absence of lung tissue, X-ray radiation is delayed more weakly. On the radiograph, an area of ​​enlightenment is found. The accumulation of air or fluid in the pleural cavity, gives a darkening or enlightenment. If changes are formed in the interstitial tissue, these are changes in the lung pattern. X-ray examination distinguishes the following syndromes:

• a) extensive darkening of the lung field. In this syndrome, it is important to determine the presence or absence of mediastinal displacement. If the darkening is on the right, then the left contour of the median shadow is studied, if on the left, then the right contour.

Mediastinal displacement in the opposite direction: effusion pleurisy (homogeneous shadow), diaphragmatic hernia (non-uniform shadow)

No mediastinal displacement: inflammation in lung tissue (pneumonia, tuberculosis)

Shift to the healthy side: obstructive atelectasis (uniform shadow), cirrhosis of the lung (non-uniform shadow), pulmonectomy.

• b) limited dimming. This syndrome can be caused by a disease of the pleura, ribs, mediastinal organs, intrapulmonary lesions. To clarify the topography, you need to take a side shot. If the shadow is inside the lung and is not adjacent to the chest wall, diaphragm, mediastinum, then it is of pulmonary origin.

The size corresponds to the lobe, segment (infiltration, edema)

Reducing the size of a lobe or segment (cirrhosis - heterogeneous with enlightenment, atelectasis - homogeneous)

The dimensions of the compacted area are not reduced, but there are rounded enlightenments (cavities) in it. If there is a liquid level in the cavity, then an abscess, if the cavity is without liquid, then tuberculosis, multiple cavities can be with staphylococcal pneumonia.

• c) round shadow.

Shadows with a diameter of more than 1 cm, shadows with a diameter of less than 1 cm are called a focus. To decipher this syndrome, I evaluate the following features: the shape of the shadow, the ratio of the shadow to the surrounding tissues, the contours of the shadow, the structure of the shadow. The shape of the shadow can determine the intrapulmonary or extrapulmonary location of the focus. An oval or rounded shadow, more often with an intrapulmonary location, more often it is a cavity filled with fluid (cyst). If the shadow is surrounded on all sides by lung tissue, then it comes from the lung. If the formation is parietal, then it comes from the lung, if the largest diameter is in the lung field and vice versa. Fuzzy contours are usually a symptom of an inflammatory process. Clear contours are characteristic of a tumor, cyst filled with fluid, tuberculoma. The structure of the shadow can be homogeneous and heterogeneous. Heterogeneity may be due to areas of enlightenment (more dense areas - lime salts, calcination)

• d) ring-shaped shadow

If the annular shadow in different projections is within the pulmonary field, this is an absolute criterion for the intrapulmonary cavity. If the shadow has the shape of a semicircle and is adjacent to the chest with a wide base, this is an encysted pneumothorax. Wall thickness is important: thin walls (air cyst, tuberculous cavity, bronchiectasis), evenly thick walls (tuberculous cavity, abscess if there is a fluid level). Multiple annular shadows can be due to various reasons: polycystic lung disease (spread throughout the lung, diameter more than 2 cm), tuberculosis with several caverns (various in diameter), bronchiectasis (mostly below, diameter 1-2 cm).

• e) foci and limited dissemination

These are shadows with a diameter of 0.1-1cm. A group of foci close to each other, spread over two intercostal spaces is limited dissemination, scattered in both lungs is diffuse.

Distribution and location of focal shadows: apices, subclavian zones - tuberculosis, bronchogenic dissemination occurs in focal pneumonia, tuberculosis.

The contours of the foci: sharp contours, if the localization is at the apex, then tuberculosis, if in other departments, then peripheral cancer in the presence of a single lesion in another part of the lung.

Shadow structure. Uniformity speaks of focal tuberculosis, heterogeneity of tuberculoma.

The intensity is assessed by comparing with the shadow of the blood vessels of the lungs. Low-intensity shadows, in density approaching the longitudinal section of the vessels, of medium intensity, like the axial section of the vessel, dense focus, more intense than the axial section of the vessels

• e) widespread dissemination of foci. A syndrome in which lesions are scattered over a large part of one or both lungs. Many diseases (tuberculosis, pneumonia, nodular silicosis, nodular tumors, metastases, etc.) can give a picture of pulmonary dissemination. The following criteria are used for diagnosis:

The sizes of the foci: miliary (1-2mm), small (3-4mm), medium (5-8mm), large (9-12mm).

Clinical manifestations (cough, shortness of breath, fever, hemoptysis), onset of the disease.

Preferential localization of foci: unilateral, bilateral, in the upper, middle, lower sections of the lung fields.

The dynamics of the foci: stability, merging into infiltrates, subsequent disintegration and cavity formation.

• g) pathological changes in the lung pattern. This syndrome includes all deviations from the radiological picture of the normal pulmonary pattern, which is characterized by a gradual decrease in the caliber of the shadows from the root to the periphery. Changes in the lung pattern occur with congenital and acquired disorders of blood and lymph circulation in the lungs, bronchial diseases, inflammatory and degenerative-dystrophic lesions of the lungs.

Strengthening of the lung pattern (an increase in the number of pattern elements per unit area of ​​the lung field) occurs with arterial plethora of the lungs (with heart defects), thickening of the interlobular and interalveolar septa (pneumosclerosis).

Deformation of the roots of the lungs (in addition to vascular shadows, the image of the lumen of the bronchi, stripes from fibrous cords in the lung tissue appears on the pictures). Associated with proliferation and sclerosis of the interstitial tissue of the lung.

Impoverishment of the lung pattern (decrease in the number of pattern elements per unit area of ​​the lung field)

• h) pathological changes in the root of the lung. The following processes can be an anatomical substrate for root damage: infiltration of the hilum of the lung, sclerosis of the hilum, and enlarged lymph nodes in the root. Unilateral lesion - tuberculous bronchoadenitis, central cancer, which leads to atelectasis, bilateral lesion - lymphocytic leukemia, lymphogranulomatosis, metastases to the lymph nodes from a tumor of any localization. If there is a lung pathology, then root changes are secondary. The conclusion is made, taking into account the clinical manifestations, the age of the patient.
• i) extensive enlightenment of the lung field (increased transparency of a significant part or the entire lung field). These changes are found in pneumothorax, chronic emphysema, large air cavity. For pneumothorax, the absence of a pulmonary pattern is characteristic, for emphysema, an increase in both lung fields, an increase in their transparency, a low position and flattening of the diaphragm.

Bronchoscopy

Bronchoscopy is a method of examining the trachea and bronchi from the inside using flexible and rigid (rigid) devices (endoscopes), used for diagnostic and therapeutic purposes.

There is flexible and rigid bronchoscopy.

Flexible bronchoscopy technique.

A flexible bronchoscope resembles a gastroscope, only the endoscope for examining the trachea and bronchi is more miniature: the length of the tube inserted into the patient's body does not exceed 60 cm, and the diameter is 5-6 mm. A similar diameter of the inserted tube does not lead to respiratory failure during the procedure. The doctor sees the image of the respiratory tract in the eyepiece or it is fed to the monitor.

A flexible bronchoscope is inserted into one of the nasal passages and passed through the vocal cords into the trachea and bronchi. With narrow nasal passages or a deviated septum, the endoscope is passed through the mouth (as in gastroscopy).

Before the introduction of a flexible bronchoscope, local anesthesia of the nasal mucosa and oral cavity with lidocaine is performed. In case of intolerance to lidocaine, bronchoscopy is performed in intensive care under general anesthesia (anesthesia) while maintaining spontaneous breathing. During the study, the patient is under the continuous supervision of the doctor performing the procedure and the nurse who assists him, who has undergone special training and has work experience. Bronchoscopy is a painless procedure, does not lead to respiratory failure due to the small diameter of the bronchoscope, and is well tolerated by patients.

Rigid bronchoscopy technique.

A rigid bronchoscope is a set of hollow tubes of different diameters from 9 mm to 13 mm, which are connected to a light source and a device for forced breathing (artificial ventilation of the lungs). (endoscope slide) A rigid bronchoscope is inserted into the mouth and then through the vocal cords into the trachea and large bronchi.

Rigid bronchoscopy is performed in the operating room under general anesthesia. At the time of the procedure, monitoring equipment is connected to the patient and the vital signs of the body are reflected on the monitor, which allows timely prevention of negative reactions of the body and increases the safety of the procedure.

Currently, rigid bronchoscopy is exclusively therapeutic, while flexible bronchoscopy is performed for both therapeutic and diagnostic purposes.

Indications for bronchoscopy

In patients over 45 years of age with a long history of smoking for the timely diagnosis of tumor diseases;

For the diagnosis of neoplastic diseases in the early stages, when there are still no radiographic signs of the tumor;

Suspicion of a tumor (malignant or benign) in the trachea, bronchi, lung;

To determine the prevalence of the tumor process and resolve the issue of surgery or chemotherapy, radiation treatment, photodynamic and laser therapy;

The appearance of hemoptysis (the presence of blood in the sputum when coughing);

Suspicion of trauma to the respiratory tract (trachea and bronchi);

Protracted pneumonia, lack of dynamics in the treatment of pneumonia, recurring (recurrent) pneumonia;

Prolonged cough, change in the nature of the cough;

Suspicion of a foreign body in the respiratory tract or detection of a foreign body during an X-ray examination;

Suspicion of tuberculosis of the lungs and bronchi;

With formations in the mediastinum and an increase in the lymph nodes of the mediastinum (lymphadenopathy);

Diffuse (interstitial) lung diseases: fibrosing alveolitis, granulomatosis, vasculitis with collagenoses, diseases with alveolar accumulation (proteinosis), multiple foci of a tumor nature (pulmonary dissemination);

Inflammatory lung diseases (abscesses, bronchiectasis);

Chronic bronchitis, bronchial asthma, accompanied by difficult discharge of bronchial secretions, outside the exacerbation phase;

Narrowing of the lumen of the airways (trachea, bronchi) due to tumors (tumor stenosis), scars (cicatricial stenosis) or due to compression from the outside (compression stenosis)

The presence of a defect in the bronchus that communicates with the pleural cavity (bronchopleural communication or fistula

Contraindications for bronchoscopy:

1) Asthmatic status;

2) Chronic obstructive bronchitis or bronchial asthma in the acute period;

3) Acute myocardial infarction and acute cerebrovascular accident;

4) Acute or for the first time a violation of the heart rhythm; unstable angina;

5) Severe degree of heart failure (III degree);

6) Severe degree of pulmonary insufficiency (III degree): with a forced expiratory volume in 1 sec. less than 1 liter according to respiratory function; when the content of carbon dioxide in the blood is over 50 mm Hg and the oxygen content in the blood is below 70 mm Hg. according to the determination of blood gases;

7) Mental disorders, epilepsy, loss of consciousness after a brain injury or due to apparent reasons without prior treatment and the conclusion of a neuropathologist and psychiatrist;

8) Aneurysm of the thoracic aorta;

Segmental structure of the lungs (human anatomy)

In the lungs, 10 broncho-pulmonary segments are isolated, which have their own segmental bronchus, a branch of the pulmonary artery, a bronchial artery and vein, nerves and lymphatic vessels. The segments are separated from each other by layers of connective tissue, in which intersegmental pulmonary veins pass (Fig. 127)

Rice. 127. Segmental structure of the lungs. a, b - segments of the right lung, external and internal view; c, d - segments of the left lung, external and internal view. 1 - apical segment; 2 - posterior segment; 3 - anterior segment; 4 - lateral segment (right lung) and upper reed segment (left lung); 5 - medial segment (right lung) and lower reed segment (left lung); 6 - apical segment of the lower lobe; 7 - basal medial segment; 8 - basal anterior segment; 9 - basal lateral segment; 10 - basal posterior segment

Segments of the right lung

Segments of the left lung

Segmental bronchi have similar names.

Topography of the lungs . The lungs are located in the pleural cavities (see the Genitourinary System section of this publication) of the chest. The projection of the lungs on the ribs makes up the boundaries of the lungs, which on a living person are determined by percussion (percussion) and radiologically. Distinguish between the border of the tops of the lungs, the anterior, posterior and lower borders.

The tops of the lungs are 3-4 cm above the clavicle. The anterior border of the right lung goes from the apex to the II rib along the linea parasternalis and further along it to the VI rib, where it passes into the lower border. The anterior border of the left lung passes to the III rib, as well as the right one, and in the IV intercostal space deviates horizontally to the left to the linea medioclavicularis, from where it follows down to the VI rib, where the lower border begins.

The lower border of the right lung runs in a gentle line in front of the cartilage of the 6th rib back and down to the spinous process of the 11th thoracic vertebra, crossing the upper edge of the 7th rib along the linea medioclavicularis, along the linea axillaris media - the upper edge of the 8th rib, along the linea axillaris posterior - the IX rib, along linea scapularis - the upper edge of the X rib and along linea paravertebralis - the XI rib. The lower border of the left lung is 1 - 1.5 cm below the right.

The costal surface of the lungs is in contact throughout with the chest wall, the diaphragmatic one is adjacent to the diaphragm, the medial one is to the mediastinal pleura and through it to the mediastinal organs (the right one is to the esophagus, the unpaired and superior vena cava, the right subclavian artery, the heart, the left one is to left subclavian artery, thoracic aorta, heart).

The topography of the elements of the root of the right and left lungs is not the same. At the root of the right lung, the right main bronchus is located above, below is the pulmonary artery, in front and below which are the pulmonary veins. At the root of the left lung on top lies the pulmonary artery, posterior and below which the main bronchus passes, below and anterior to the bronchus are the pulmonary veins.

X-ray anatomy of the lungs (human anatomy)

On a chest x-ray, the lungs appear as light lung fields intersected by oblique cord-like shadows. Intense shadow coincides with the root of the lung.

Vessels and nerves of the lungs (human anatomy)

The vessels of the lung belong to two systems: 1) vessels of a small circle, related to gas exchange and transport of gases absorbed by the blood; 2) vessels of the systemic circulation, supplying lung tissue.

The pulmonary arteries, which carry venous blood from the right ventricle, branch in the lungs into lobar and segmental arteries and then, according to the division of the bronchial tree. The resulting capillary network braids the alveoli, which ensures the diffusion of gases into the blood, as well as out of it. The veins that form from the capillaries carry arterial blood through the pulmonary veins to the left atrium.