What is the lung threshold. Lung diseases and their symptoms: possible pathologies and their manifestations. What are the lesions and how to identify them

The lungs are a paired organ located in the chest cavity and performing a number of functions.

The main task of the lungs is gas exchange. In the alveoli, carbon dioxide and oxygen are exchanged between the inhaled air and venous blood.

This is a vital function, when violated, acute or chronic hypoxia occurs, and when breathing stops, clinical and then biological death develops rapidly.

Also, the lungs are a place that directly contacts the external environment, and therefore all pathogenic agents transmitted by airborne droplets.

Given the importance for the body as a whole, lung diseases and their symptoms are extremely important points that require the fastest and most effective treatment.

All pulmonary pathologies are divided into several groups:

1. Congenital diseases.
   • Dysplasias are malformations. These include: the absence or underdevelopment of the lung or bronchial tree, malformations of the pulmonary vessels, cystic degeneration, etc.
   • Pulmonary symptoms of systemic diseases. Bruton's syndrome, cystic fibrosis.
2. Acquired pathologies.
   • Sharp forms
   • With the defeat of the bronchial tree. Bronchitis of bacterial, viral, toxic or thermal origin.
   • With damage to lung tissue. Abscess, gangrene of the lungs. Pneumonia of various etiology.
   • Chronic forms
   • With the defeat of the bronchial tree. Chronic bronchitis, bronchial asthma, bronchiectasis, COPD.
   • With damage to the lung tissue. Emphysema of the lungs, pneumoconiosis, tuberculosis.

A distinction is made between benign and malignant diseases. To a greater extent, this applies to tumor processes in the lungs. Benign tumors include: fibroma, lipoma, adenoma. Malignant neoplasms include lymphoma, sarcoma, squamous cell carcinoma.

Consequences for the human body. Lung diseases and their symptoms can have a wide variety of consequences for a person. With timely treatment, acute inflammatory pathologies most often have a favorable prognosis, both for life and for health. Chronic diseases, with proper treatment, for the most part do not pose a threat to human life, but significantly reduce the quality of life.

Benign and malignant diseases, as well as massive purulent processes (abscess, gangrene), require surgical intervention for health reasons. Malignant lung diseases and their symptoms are often subtle, which is why they are diagnosed late. Therefore, they often metastasize and have a dubious or poor prognosis. Lung cancer is the most common cause of death in lung diseases, followed by pneumonia.

Can the lungs hurt: the most common symptoms of lung disease

Can lungs hurt? By itself, the lung tissue does not have pain receptors. This means that with the development of local pathological changes, the feeling of pain does not arise.

But many can say that they definitely felt the feeling of pain in the chest. The bottom line is that the chest cavity is lined by the pleura, which has two sheets - visceral (covering organs, including the lungs) and parietal or parietal - lining the chest from the inside.

The visceral pleura, like the lungs, does not have pain receptors, and cannot hurt. However, the parietal pleura has painful endings, and when it is drawn into the pathological process, pain occurs. Therefore, answering the question, "can the lungs hurt?" the answer is no, but with the allowance for the fact that pain can occur when the pleura is damaged.

Signs that you have a lung problem. Almost all pulmonary pathologies have fairly characteristic clinical manifestations. These include cough (dry and wet), shortness of breath, feeling of heaviness and chest pain, hemoptysis, etc. Often these symptoms are accompanied by non-specific manifestations - fever, general weakness, drowsiness, decreased appetite.

In what cases should you urgently go to the doctor? Any lung disease is the reason for visiting a general practitioner or family doctor. Almost all diseases of the respiratory system are prone to progression. This means that delaying the consultation aggravates the patient's condition and complicates the treatment process. But there are also signs in which you need to seek medical help immediately. First of all, it is the secretion of sputum with streaks of blood.

In all cases, this is a symptom of serious disorders, and often the first manifestations of pulmonary hemorrhage. Severe shortness of breath is also an alarming sign in which you need to immediately consult a doctor. Diseases such as bronchial asthma or COPD lead to narrowing of the bronchial lumen and chronic hypoxia, which has a detrimental effect on the entire body. And an acute attack of bronchial asthma is a life-threatening condition. To avoid it, you need to regularly take drugs that only a doctor can properly prescribe.

Lung diseases and their symptoms: the clinical picture of the most common pathologies

All lung diseases and their symptoms in the initial stages are very similar. For all pathologies without exception, an increase in the respiratory rate, an increase in the heart rate and a violation of the act of inhalation or exit are characteristic.

A specific disease can be identified only by the results of a physical examination (palpation, percussion and auscultation) and laboratory test data (general blood and urine analysis, EKG) and instrumental research methods (X-ray, computed tomography, bronchoscopy). It is impossible to establish an accurate diagnosis without additional research. The main lung diseases and their symptoms are presented below.

Bronchitis- This is an inflammation of the walls of the bronchial tree with a narrowing of their lumen. Bronchitis can be acute or chronic. They appear or worsen, as a rule, in the cold season. The clinical picture includes a general malaise, a dry cough, which turns into a wet one, to which light or yellowish sputum joins. With a background weakening of immunity, body temperature can rise to maximum figures of 38.5-39 degrees. Without proper treatment, bronchitis can progress to pneumonia.

Alveolitis- a disease characterized by massive inflammation of the alveoli and interstitium of the lungs. These lung diseases and their symptoms depend on the specific form - idiopathic, allergic or toxic. Symptoms common to all forms are progressive shortness of breath (mostly with physical exertion), dry cough without phlegm, cyanosis, general malaise, a temperature rise of up to 38 degrees is possible.

- inflammation of the lung tissue is more often of an infectious origin. At the same time, the alveoli are more involved in the pathological process, into which the inflammatory exudate is released. Depending on the degree of damage, pneumonia can be focal, segmental, lobar, confluent and total. The prevalence of these forms of lung disease and their symptoms also differ in severity and difficulty in treatment. The main symptoms are an increase in body temperature over 39 degrees, a strong cough with the release of a large amount of purulent sputum, when the pleura is drawn into the process, chest pain joins. Breathing becomes short, quickened, and audible wheezing may occur.

Lung abscess- This is a limited area of ​​the purulent-destructive process in the tissues of the lungs. It develops with a decrease in immunity or the form of complications of other diseases. The most common causative agent is staphylococci. An abscess can be acute or chronic. With acute development, there is a sharp increase in body temperature over 39.5 degrees, increased sweating, severe malaise, dry cough and chest pain. In chronic abscess, chronic hypoxia with cyanosis and purulent sputum, which is released when coughing, comes out on top.

Emphysema of the lungs- This is a pathology that is manifested by an increased air content in the lung tissue and destruction of the alveoli. With it, normal gas exchange does not occur. Most often it develops against the background of chronic obstructive bronchitis and long-term smoking. Clinically, emphysema is manifested by severe shortness of breath, cyanosis, expansion of the chest and bulging of the intercostal spaces and supraclavicular fossa. The rib cage takes on a characteristic "barrel shape".

Pulmonary tuberculosis Is an infectious disease caused by Mycobacterium tuberculosis or Koch's bacillus. It can have various forms: disseminated, miliary, infiltrative, limited, cirrhotic, cavernous, etc. This lung disease and its symptoms are not detected for a certain time, only occasionally an unrelated cough may occur. With prolonged development, nonspecific symptoms appear first: general malaise, pallor, apathy, fever up to 37.5 degrees, increased sweating. Regional lymph nodes are very often enlarged. After some time, there is a cough with the discharge of clear or yellowish sputum, hemoptysis.

Lung cancer or bronchogenic carcinoma- malignant neoplasm of lung tissue, which develops from the epithelium of the walls of the bronchi. It can be central or peripheral, depending on the localization. Common manifestations are rapid weight loss, general malaise, low-grade fever. This lung disease and its symptoms do not appear immediately. Central cancer gives the clinic much earlier than peripheral.

The first manifestations are progressive shortness of breath, lung collapse, hypoxia. Immediately there is a cough, to which sputum streaked with blood quickly joins. Pain often occurs as the process quickly affects the pleura. Peripheral cancer clinically manifests itself only in the late stages and has similar symptoms, but to a lesser degree.

Covers the spectrum of cystic and adenomatous formations in the lobes, which are hamartomas with a cystic structure.

Exclude concomitant organ defects (up to 20%): kidneys, small intestine, diaphragmatic hernia, hydrocephalus, skeletal anomalies.

Prenatal diagnosis: polyhydramnios (compression of the esophagus or direct communication of the cyst with the airways) or dropsy (heart failure due to impaired venous return).

Diagnosis: chest x-ray - multiple discrete blisters are visible, often with fluid levels within one lobe.

First aid: consultation with a surgeon, planning an operation. With a prenatally established diagnosis - as early as possible.

Beware pulmonary hypertension of a healthy lung.

Congenital lobar emphysema

Congenital lobar emphysema: almost always a medical emergency with over-inflation of one lobe of the lung (without emphysematous destruction of lung tissue).

Causes: malformations of cartilage, bronchial tree, stenosis or external compression (vascular anomaly or tumor), polyalveolar lobe.

Caution: Always exclude a mucous (meconium) plug as the cause (bronchoscopy).

Complications / problems: displacement, compression and excess blood flow in healthy lung tissue.

First aid: observation → operation. Emergency surgery (lobectomy) is rarely required.

Lung sequestration

Lung sequestration: cystic or homogeneous area, mostly in the lower lobes, more often on the left. It is a non-functional tissue that is not associated with the bronchial system. Blood is supplied most often from the aorta. Venous outflow can be carried out into the systemic or pulmonary veins. They develop from the accessory rudiment of the lungs from the anterior intestine. The earlier the defect is formed, the more often the lung and sequestration have a common pleura.

The likelihood of concomitant defects is increased.

Complications: an enlarged left-right shunt and, as a result, heart failure (> 80% of anastomoses - with the vessels of the esophagus or the fundus of the stomach).

Prenatal diagnostics: ultrasound.

Diagnostics, postnatal X-ray, CT if necessary, angiography (MRI angiography) and methylene diphosphonate scintigraphy (accumulation in sequestration).

Treatment: the method of choice is surgery even in the absence of a clinic due to the risk of infection. Before surgery - treatment according to the clinical picture.

Agenesis and aplasia of the lungs

Bilateral agenesis is an extremely rare defect incompatible with life. Sometimes the trachea is also missing. Bronchial arteries and veins are usually absent. It can be combined with malformations of the esophagus, face and asplenia. A unilateral process occurs much more often, in 50-60% of patients other congenital malformations are observed: heart, genitourinary system, vertebrae and ribs, diaphragmatic hernia, etc. The only lung is compensatory enlarged. Bronchiectasis is often found in it.

Lung hypoplasia (small lung)

Lung hypoplasia occurs in 10% of pediatric autopsies and is associated with other congenital malformations in 85% of cases. Clinically characterized by the development of SDR, the severity of which depends on the degree of hypoplasia. Congenital hypoplasia of the lungs can be primary, or idiopathic, and secondary (much more often), unilateral and bilateral. Primary lung hypoplasia is due to genetic factors. It is described in trisomies 13, 18 and 21, some genetic syndromes, in twins, familial cases are known.

Causes of secondary hypoplasia:

1. anomalies of the vessels supplying the lung (stenosis of the pulmonary artery, tetralogy of Fallot, etc.);
2. lack of water;
3. compression of the lungs with intrathoracic masses (congenital diaphragmatic hernia, congenital dropsy of the fetus);
4. compression of the lungs with deformities of the chest (asphytic thoracic dystrophy, severe scoliosis);
5. lack of respiratory movement in the uterus due to neuromuscular diseases.

The diagnosis of idiopathic pulmonary hypoplasia is made in the absence of all of the above causes. The pathological anatomy of both forms of hypoplasia is of the same type. Macroscopically: both lungs can be evenly reduced, or there is a pronounced asymmetry (for example, with a diaphragmatic hernia). In cases where hypoplasia is the immediate cause of death, the lung mass is reduced by more than 40% and is often only 20-30% of the normal mass for a given gestational age. Normally, in full-term fetuses and newborns, the lung mass is -50 g. Of greater importance for determining hypoplasia is the indicator of the relative lung mass, i.e. the ratio of lung mass to fetal mass. Normally, in fetuses and newborns 28 weeks of gestation and older, this indicator is 0.012, in premature infants up to 28 weeks old - 0.015 aspiration syndromes, etc., the relative weight will be higher). Depending on the microscopic picture, two main forms of lung hypoplasia are distinguished. In the first case, the lungs are small, but in terms of maturity they correspond to gestational age, although the number of alveoli is reduced, in the second, pronounced immaturity of the lung tissue is observed. This form is combined with oligohydramnios. Special staining reveals the absence of elastic tissue in the interlobar septa. Immunohistochemically determined a significant decrease in the amount of type IV collagen. Morphometric studies show that, regardless of the cause, the alveolar radial count is decreased in the hypoplastic lung. Alveolar radial counting is easily determined on histological specimens by the number of alveolar septa located in a straight line drawn perpendicularly from the terminal bronchiole to the pleura or lobular septum. In full-term infants, the normal radial alveolar count is 4.1-5.3. Another method for determining hypoplasia is by measuring the amount of lung DNA as an indicator of the total cell population of the lungs.

Hyperplasia of the lungs

More often it is a secondary defect. Lung enlargement is observed in cystic adenomatous lung disease, congenital emphysema, as a compensatory process in unilateral agenesis or hypoplasia. True hyperplasia is always a bilateral process due to obstruction in the upper respiratory tract. Lung hyperplasia in combination with laryngeal atresia is observed in autosomal recessive Fraser's syndrome, characterized by cryptophthalmos, ear, kidney anomalies, syndactyly, and cryptorchidism. Macroscopically: with a pronounced increase in the lungs, the diaphragm is displaced downward, the lungs are with rib prints, the relative mass is increased. Microscopically: more mature lung tissue with an increase in alveolar surface compared to the weight of the newborn and the gestational age. Hyperplasia of the lung with atresia of the larynx is due to the lack of outflow of fluid from the lungs into the amnion cavity due to obstruction.

Accessory lung (tracheal accessory lung)

This extremely rare defect is caused by a violation of the division of the primary bronchial kidneys. It is necessary to differentiate with pulmonary sequestration and with "tracheal bronchus".

Horseshoe lung

Refers to rare defects in which the lungs are partially connected by their bases behind the heart and in front of the esophagus. In the absence of other defects, it is asymptomatic, but it is described in combination with various vascular anomalies of the lungs and other defects, such as hypoplasia of the right or left lung and scimitar syndrome.

Ectopic lung tissue

There may be ectopia of lung tissue in the neck, abdominal cavity and chest wall, often combined with skeletal anomalies and diaphragmatic hernia. Sometimes ectopic lung tissue in the abdomen is referred to as extralobar sequestration. Ectopia on the neck is observed in inioncephaly, Klippel-Feil anomaly, and feline cry syndrome. The causes of lung ectopia are not known.

Heterotopia in the lungs

Heterotopias are described in the form of islets of tissue of the adrenal glands, pancreas, thyroid gland (without C cells), liver, striated muscles, which are also found in pulmonary sequesters and a hypoplastic lung. Their significance is not great, since such heterotopies are observed only in children with other severe defects, mainly of the heart. With anencephaly with blood flow or when swallowed, foci of glial tissue may enter the lung. As a result of birth trauma, emboli from cerebellar tissue can be observed in the vessels, which are sometimes mistaken for hamartomas or heterotopic tissue.

Cystic lung disease

The existing classification of cystic lung disease is far from ideal. Currently, congenital and acquired cysts are distinguished. Acquired cysts in infants can be the result of infection, compression of the bronchus by an enlarged pulmonary artery, the presence of a foreign body in the bronchus, bronchial hypoplasia. We do not consider them in this section. Congenital cysts include: bronchogenic cysts, pulmonary sequestration, cystic adenomatous lung disease, polyalveolar lobe, congenital lobar emphysema, lymphangiomatous cysts, and enterogenic cysts.

Congenital cysts of the lung.

A rare vice

Single or multiple cysts, always associated with the bronchial tree (postnatally often filled with fluid), limited to one lobe.

Differential diagnosis: pneumothorax.

Treatment: surgery is the method of choice. For strained cysts, puncture can be made as an emergency measure. The increase in size and tension can come very quickly.

Bronchogenic cysts are congenital cystic formations. caused by a violation of the development of the primary intestine. They are usually localized in the mediastinum near the tracheal keel (51%), but can be located in the right paratracheal region, along the esophagus, at the hilum of the lung, or in various other places. Bronchogenic cysts rarely connect to the tracheobronchial tree or are located in the lung tissue. In newborns, they are asymptomatic or can cause SDR. Macroscopically: a round cyst with a smooth or rough inner surface, 1-4 cm in diameter, attached to the tracheobronchial tree, but not associated with it. Contents - clear serous fluid, in cases of infection - cloudy or bloody. Microscopically: the cyst is lined with ciliated cubic or columnar epithelium, sometimes squamous metaplasia is observed. The wall consists of a small amount of connective tissue, smooth muscles, foci of cartilage and, rarely, bronchial glands. Bronchogenic cysts are combined with pulmonary sequestration, an accessory lobe of the lung, described in Down syndrome.

Extralobar sequestration diagnosed in infants under 1 month of age. The ratio of boys: girls-4: 1. Macroscopically: an isolated area of ​​the lung with its own pleura, often cystic changes. It is located anywhere - from the neck to the diaphragm, more often behind the left lower lobe, while a diaphragm defect is often detected. It can be located in the thickness of the diaphragm or pericardium. About 15% of extralobar sequesters are localized in the abdominal cavity, sometimes connected to the esophagus or stomach. Microscopically: among the foci of normally formed alveoli, there are small, but dilated and cartilage-containing bronchi, in some cases the expansion of the bronchi is more pronounced, and the alveoli are underdeveloped. Bronchioles and alveolar passages of irregular shape. The bronchi are not connected to the tracheobronchial tree. Lymphatic vessels are dilated, which resembles congenital lymphangiectasias. Arterial vessels are of normal structure, but thin-walled vessels can also be found. Due to the lack of normal drainage of the bronchi, a secret stagnates in them, which contributes to infection, the formation of cysts and fibrosis. Extralobar sequestration can be combined with cystic adenomatous lung disease, types II and III. In 65% of cases, defects of other organs are observed, of which diaphragmatic hernia, pulmonary hypoplasia, congenital heart disease and funnel chest are most characteristic. TTP defect - up to the 6th week of embryonic development.

At intralobar sequestration the abnormal area is usually located in the posterior-internal parts of the lower lobe of the left lung among normal lung tissue and is not delimited from the surrounding parenchyma. Rarely combined with other PR. It is extremely rarely diagnosed in newborns. It occurs with the same frequency in boys and girls. Macroscopically: the abnormal area looks like an atelectatic segment or polycystic tissue, cysts are filled with a yellowish-whitish transparent liquid or jelly-like masses. Microscopically: cysts are lined with cylindrical or cubic epithelium, lung tissue is underdeveloped. In older children and adults, chronic inflammation with bronchiectasis, fibrosis, cysts is noted in this area, on the basis of which many authors believe that at an older age it is, as a rule, an acquired process, and rarely congenital.

Infantile (congenital) lobar emphysema (congenital large super-transparent lobe) characterized by stretching of a segment or lobe of the lung due to internal or external obstruction of the bronchi. Boys are more often sick. It is clinically diagnosed in newborns with SDS and infants, extremely rarely in older children (acquired emphysema must be excluded), can cause death. The upper lobes are mainly affected, rarely two lobes. The causes of the defect are: stenosis, atresia, abnormal discharge of the bronchi, defects in the development of bronchial cartilage, mucous folds, mucous plugs and aspirated meconium in the lumen of the bronchi, obstruction of the bronchi by aberrant vessels or bronchogenic cysts, etc. These changes contribute to overstretching of the lung site distal to the obstruction site. the fact that when you exhale, less air is removed than it enters (valve mechanism). Macroscopically: the affected lobe is enlarged, with a sharp swelling, it prolapses through the anterior mediastinum towards the healthy lung, squeezing the adjacent areas. Microscopically: uniformly overstretched acini with alveolar sacs and alveoli 3-10 times larger than the norm are visible, there are focal ruptures in the alveolar septa. In some cases, this type of emphysema is caused by an increase in the number of alveoli (3-5 times more than normal) in the affected lobe (polyalveolar lobe), the size of the alveoli does not change. Infantile lobar emphysema is often associated with other defects, especially of the heart. Acquired infantile emphysema is observed in premature infants on mechanical ventilation.

Congenital cystic-adenomatous lung disease (cystic-adenomatous dysplasia of the lungs, cystic-adenomatous hamartoma of the lungs)- quite frequent (25% of all congenital malformations of the lungs) hamartomatous lung disease, characterized by the presence of adenomatous proliferating cysts resembling bronchioles in structure. Cysts usually connect to the tracheobronchial tree, blood supply and venous outflow are carried out by normal pulmonary vessels, except in cases of combination with extralobar sequestration. The defect was first described by Ch "in and Tang in 1949. The frequency is 1 case per 25 000-35 000 births. In most cases it is diagnosed in the first 6 months of life, in 70% - from birth or in the 1st month of life, rarely later Almost 90% of all observations described in the literature were clinically manifested in children under the age of 2. In newborns, in 80% of cases, varying degrees of severity of SDD are clinically observed, in older children - persistent or recurrent pneumonia. predominantly in fetuses of 22.6 ± 3 weeks of gestation, however, observations are described in 5-8-week-old fetuses.When antenatal diagnosis, this defect must be differentiated from diaphragmatic hernia, bronchogenic cysts, pulmonary sequestration and congenital lobar emphysema.

The etiology and pathogenesis of this defect are not known. It is assumed that a violation of the normal maturation of the lungs may be due to bronchial atresia or abnormal division. This leads to dysplasia of the lung tissue distal to the affected segment. The formation of dysplastic lung tissue in the fetus can cause lung hypoplasia or even its aplasia. Unlike a normally developing lung, with cystic-adenomatous dysplasia, an increase in cell proliferation and a decrease in the process of apoptosis are observed in it. In the affected tissue, both in the fetus and in newborns, the expression of some growth factors is increased, in particular, platelet growth factor (TGF-BB, TFR-BB), glial neurotropic factor (GNTP-GDNF), which are known to be among of factors that stimulate the growth and development of the lungs, and the expression of GDNF in the affected tissue correlates with the degree of proliferation. Disintegration in the embryonic period between paracrine factors is also noted.

Depending on the clinical manifestations, prognosis and morphology, five types of defect are distinguished.

• Type 0 - acinar dysplasia - a defect incompatible with life. Combines with heart defects and dermal dysplasia. Macroscopically: the lungs are small, dense, on the cut, the cysts resemble somewhat dilated small bronchi. Microscopically: among the abundant mesenchyme, there are small (0.5 cm in diameter) bronchiole-like structures lined with high cylindrical epithelium with goblet mucus-producing cells (mucous differentiation is unique for this type of defect), in the fibromuscular wall there are cartilage and glands.
• Type I - cystic dysplasia is the most common type (50-75%). It is diagnosed in the 1st week or month of life, but can occur in older children and even in adults. Macroscopically: one or more multilocular large cysts (3-10 cm in diameter) filled with air and fluid, surrounded by smaller cysts and compressed normal pulmonary parenchyma. Microscopically: the larger cysts are lined with ciliated, pseudo-row cylindrical, and the smaller ones are lined with cubic or cylindrical epithelium. In 1/3 of cases, there are mucus-producing cells in the epithelial lining of large cysts or in bronchiolo-, alveol-like structures near the largest cysts. Sometimes inside the cysts and in the adjacent bronchiole-like structures, papillary epithelial proliferation is observed, which resembles bronchogenic cancer. The cyst wall consists of elastic, smooth muscle and collagen tissues, in 5-10% of cases cartilage is detected. It is usually treated surgically with a favorable prognosis.
• Type II - intermediate - the second most frequent type (about 20-25%). It is observed only in the 1st year of life, has a poorer prognosis and a more frequent combination with other congenital malformations of the heart, central nervous system, urinary, musculoskeletal systems, diaphragmatic hernia, some of them are not compatible with life (for example, arenia, sirenomelia). This type of defect is observed with extralobar sequestration. Macroscopically: the affected part or the entire lung on the cut has a spongy appearance and consists of closely adjacent small cysts with a diameter of 0.5 to 2 cm, connecting with the bronchi and filled with air if the child was breathing. The inner surface of the cysts is smooth, shiny or rough. They are evenly distributed among the lung tissue, merging with it. Microscopically: cysts resemble dilated terminal bronchioles, lined with respiratory cube or columnar epithelium, there are fibrous, elastic and smooth muscle fibers in the wall. Mucinous cells and cartilage are absent, but in 5-10% of cases there may be foci of striated muscles (rhabdomyomatous subvariant).
• Type III - solid - occurs infrequently (5%) and practically only in boys. Pregnancy is complicated by polyhydramnios due to compression of the esophagus by enlarged lobes or lungs. With prolonged compression of the inferior vena cava, fetal dropsy occurs. In the mother's blood in the 2nd trimester of pregnancy, an increase in the amount of α-feto-protein is observed. Macroscopically: large, dense, tumor-like masses occupy the entire lobe or the entire lung, the mediastinum is always displaced and the affected lung is often hypoplastic (cystic hypoplasia of the lungs). The section shows small cavities resembling cysts, rarely more than 0.2 cm in diameter (except for scattered, larger bronchiole-like structures). The pulmonary parenchyma outside the cysts is underdeveloped. Microscopically: the affected tissue resembles an immature, bronchial-free lung. Irregularly shaped stellate bronchiolo-like structures are lined with cubic epithelium and surrounded by alveolar ducts and alveoli, also lined with cubic epithelium. Mucous cells and cartilage are absent. The cysts observed in the types described above are absent. The prognosis depends on the prevalence of the process and the amount of preserved lung tissue, the degree of mediastinal displacement and the presence of congenital malformations. The lethality is high.
• Type IV - peripheral cystic, distal acinar - occurs in 2-10% of cases. Boys and girls are affected equally often. It is observed in newborns and young children in the first 4 years of life. Macroscopically: large, multilocular, thin-walled, air-containing cysts are localized in the periphery of the lung and can compress other organs of the chest, sometimes complicated by pneumothorax. Microscopically, the cysts are lined with flattened alveolar epithelium (type I alveolocytes). The wall consists of dense mesenchymal tissue with clearly visible arteries and arterioles. Mucous cells, cartilage and muscles are absent. The prognosis for surgical treatment is favorable.

Congenital pulmonary lymphangiectasias (lymphangiomatous cysts) are primary and secondary. Secondary due to obstruction of lymphatic or venous drainage of the lungs, primary - an extremely rare defect. Boys are affected 2 times more often. The reasons are heterogeneous. Can be inherited in an autosomal recessive manner, but in most cases the defect is sporadic. Often combined with other congenital malformations, especially asplenia and heart defects, are described in Noonan, Turner and Down syndromes. Primary pulmonary lymphangiectasias are isolated (only the lung is affected) or a manifestation of generalized lymphangiectasias. Clinically pronounced SDR is observed in newborns. In most cases, death occurs within the first hours or days of life, but occasionally it can only be clinically diagnosed for the first time in adults. Macroscopically: the lungs are enlarged, dense, tuberous. In the wide interlobar septa and under the pleura, multiple cysts up to 5 mm in diameter are visible, emphasizing the lobar structure of the lungs. Near the gate of the lungs, cysts are oblong in shape. The content of the cysts is lymph, or when connected to the bronchi, air and lymph. Microscopically: cysts are localized in the connective tissue under the pleura, in the interlobar septa, near the bronchioles and arteries. Serial sections show that they are part of a complex network of interconnecting lymphatic channels, widely varying in size and devoid of valves. The cysts are lined with a flattened endothelium (antigens CD 31 and factor 8 are a marker of the endothelium of lymphatic vessels). In the thin wall, elastic, collagen fibers and, rarely, smooth muscle cells are detected. The absence of giant cells of foreign bodies in the cyst wall distinguishes this pathology from persistent interstitial emphysema, which is usually a complication of mechanical ventilation in premature infants.

Enterogenic cysts- This is a form of single-chamber duplication cysts of the gastrointestinal tract. In the chest cavity, they are localized in the posterior mediastinum on the right, attached to the esophagus, rarely connected to the bronchus. Microscopically: the cyst wall is lined with multilayer flat, occasionally gastric or small intestinal epithelium. The gastric epithelium may ulcerate, leading to perforation of the cyst. Enterogenic cysts can be combined with anomalies of the lower cervical and upper thoracic vertebrae.

Capillary alveolar dysplasia- violation of the structure of the pulmonary vessels. A rare lethal pathology that is the cause of congenital pulmonary hypertension, persistence of fetal circulation and SDR in newborns. Microscopically: the proliferation of connective tissue in the interlobar and interalveolar septa, in which the number of capillaries is reduced, there is no contact between the alveolar epithelium and the capillary. Pulmonary lobules are small, the radial count is reduced. The walls of small arteries are thickened due to hypertrophy of smooth muscle tissue. In addition, there is an abnormal arrangement of the pulmonary veins that accompany the pulmonary arteries in the center of the acinus, and not in the interlobar septa, as is observed in normal lung tissue. The walls of abnormally located veins are thickened. The causes of the defect are not known. Sibs are rarely affected. It can be combined with gastrointestinal and urinary tract defects.

Pulmonary arteriovenous fistulas- abnormal communication between arteries and veins. The process is more often localized in the lower lobe. It is observed in 25% of patients with Randu - Weber - Osler disease (familial hemorrhagic telangiectasia), an autosomal dominant hereditary disease with high penetrance. Homozygous forms are sometimes lethal in early childhood.

Congenital surfactant deficiency (congenital alveolar proteinosis)

This is an autosomal recessive hereditary deficiency of one of the surfactant proteins, surfactant protein B (SP-B), caused by a mutation in codon 121 of the SP-B gene and its RNA, SP-B mRNA. Clinically characterized by rapidly progressive respiratory failure immediately after birth. Macroscopically: lungs are dense, more than 2 times enlarged, airless. Microscopically: the alveoli are dilated, lined with cubic epithelium and filled with eosinophilic, granular, PIC positive masses with desquamated alveolocytes and an abundance of macrophages. In the final stage, there is a thickening of the alveolar septa due to the proliferation of fibroblasts. Immunohistochemically determined by the absence or decrease of surfactant protein with a normal amount of proteins A and C. The prognosis is poor. In all cases described in the literature, death occurred within 1 year of life.

Primary pulmonary hypertension

Hypertension of the pulmonary circulation in newborns can be associated with persistence of fetal arteries of the lungs, hypertrophy of their muscle layer, proliferation and fibrosis of the intima, sometimes fibrinoid necrosis and arteritis, which leads to precapillary obstruction of the branches of the pulmonary artery and the formation of secondary glomus anastomoses. With this option, the disease proceeds according to the lightning-fast type, children die in the first months of life. Sudden death is often observed. Hypertrophy of the muscular membrane of the pulmonary vessels (mainly small intraacinar arteries) is also observed with intrauterine asphyxia, pulmonary hypoplasia, premature closure of the ductus arteriosus, hernia of the diaphragm.

Benign familial pneumothorax

It is extremely rare in newborns, mainly observed in male adolescents. Families with both autosomal dominant and autosomal recessive types of inheritance have been described.

Lung disease is a common diagnosis in recent years. Due to the large number of varieties and similar symptoms, it is very difficult for a layman to determine what may be associated with feeling unwell and pain.

Only an experienced doctor knows exactly what lung diseases are, and how to properly treat them.

A huge number of types of diseases

The list of the most common lung diseases in humans is as follows:

All these diseases associated with the lungs manifest themselves in a rather acute form, and if not treated promptly, they can lead to serious consequences concerning both the health condition and the life of the sick person.

The forms of manifestation of chronic lung diseases are very dangerous. Such diseases include:

• Tracheobronchial dyskinesia;
• Forms of pneumonia;
• Chronic cor pulmonale;
• Polycystic;
• Asthma;
• Bruton's disease;
• Cartagena syndrome.

Pneumonia, also called pneumonia, develops due to the inflammatory process due to the ingress of various kinds of infection, from fungal to viral. In addition, one of the possible pathogens can be a chemical that has entered the body during inhalation. The disease spreads throughout the body, or is able to "hide" only in a certain part.

Other common abnormalities in the lungs are diseases, the names of which are pleurisy and bronchitis.

The first is associated with pleural edema or an inflammatory process in it (the outer membrane that "envelops" the lungs). Pleurisy can occur due to infection or injury that affects the chest area. This disease can be the beginning of the development of a malignant tumor.

Bronchitis is diagnosed in 2 types: chronic and acute forms of manifestation. The reason for the appearance of the latter is inflammation of the bronchial mucosa. The disease is especially common among the elderly and young children. The respiratory tract becomes infected due to allergies, when chemically contaminated air is inhaled.

Bronchial asthma most often manifests itself in the form of coughing fits or painful suffocation of a periodic nature. While an attack occurs, the bronchi and the entire chest are sharply narrowed, which makes breathing difficult. In this case, the mucous membrane swells, the epithelial cilia do not fulfill their main functions, which leads to malfunctioning of the lungs.

Asphyxia and silicosis are common dangerous lung diseases.

The first is called oxygen starvation, which occurs due to negative external influences that directly affect the respiratory process. Disease appears with squeezing, various injuries of the neck or chest, pathological abnormalities in the larynx, with disturbances in the work of the muscles responsible for breathing.

Silicosis is defined as a disease that is common among people in certain professions associated with working in an environment where there is a lot of dust, the particles of which contain silicon dioxide. Hazardous areas - facilities under construction, mines, metallurgical industry,

The causative agent of a disease such as tuberculosis is mycobacterium. It is transmitted by the host through the air and saliva. The main manifestations are directly related to the general state of health of the patient, as well as to how many pathogens have got in. Emphysema is characterized by the separation of the walls located between the alveoli due to which they significantly increase in volume.

The consequence of this is that the lungs grow, all the passages narrow, and the structure of the organ becomes loose and flabby. Such damage reduces the level of oxygen and carbon dioxide exchange to critical levels. It becomes difficult for the patient to breathe.

The most dangerous of lung diseases is cancer, which ends, in most cases, death. There is a chance for a cure in those people who started the course of therapy even before the main manifestation of symptoms. The problem, however, is that cancer is the most difficult disease to recognize.

In medicine, no symptoms have yet been identified that would definitely indicate a terrible diagnosis. It is generally accepted that you should immediately go to the hospital if you have a strong cough, pain in the chest and the presence of blood in the expectorant discharge.

Consequences for the human body

The lungs are a rather complex organ, consisting of important elements of the respiratory tract. The bronchi as well as the trachea can be vulnerable if a person suffers from any of the possible diseases associated with the lungs.

The list of diseases associated with the occurrence of an inflammatory process and purulent discharge can be combined into a whole category of purulent lung diseases:

Suppurative lung diseases are represented by the following list:

• Empyema of the outer membrane of the lungs;
• Infectious destruction in acute form;
• Gangrenous organ abscess (acute form);
• Gangrene is widespread;
• Chronic abscess;
• Purulent abscess in acute form.

The list of lung diseases is quite extensive, there is currently no clear classification. All violations are differentiated by the sign of impact on certain organs or tissues, as well as by the source of occurrence.

Non-specific lung diseases include:

1. Chronical bronchitis;
2. Some experts include bronchial asthma in this group;
3. Chronic abscess;
4. Pneumonia;
5. Obstructive emphysema;
6. Pneumofibrosis.

If we talk about the effect on the respiratory tract and the negative effect on them, then we can distinguish a lot of dangerous diseases. First of all, this is asthma, which is characterized by frequent spasms, causing severe shortness of breath and difficulty breathing.

The disease can be in a person from birth, and also as a complication after an allergy, the possibility of occurrence from the negative effects of the environment is not excluded.

A persistent tormenting cough is characterized by chronic obstructive pulmonary disease. From birth, a child may develop cystic fibrosis, in which infections in the body periodically recur due to excessive accumulation of mucus in the bronchi. Acute bronchitis and emphysema have a negative effect on the respiratory tract.

Diseases that negatively affect the alveoli are pneumonia, tuberculosis, emphysema, cancer. Plus, pulmonary edema, characteristic of the loss of pulmonary fluid from the smallest blood vessels. This category also includes acute respiratory distress syndrome, which causes irreparable damage to the main respiratory organ.

It is imperative to ventilate the lungs until the patient can recover. Another disease in this group is pneumoconiosis, which appears as a result of inhalation of hazardous substances that can cause any kind of organ damage. It can be cement dust or coal, asbestos, and more. dr.

Lung diseases that have a negative effect on blood vessels - pulmonary embolism and hypertension. The first is the result of venous thrombosis of the lower extremities. Blood clots present in the pulmonary arteries can cause a lack of oxygen and shortness of breath. Hypertension is increased pressure in the arteries of the lung. Most often, the patient feels severe chest pain and shortness of breath.

Lung diseases and their symptoms

Diseases of the lungs in humans are combined, in most cases, by common symptoms, which are manifested in frequent coughing, shortness of breath, pain in the chest and discharge of blood, in addition, respiratory failure is noted.

Fungal lung diseases are often diagnosed, the symptoms of which are as follows:

• A cough markedly different from that of colds;
• A large amount of sputum, the discharge of which delivers acute pain in the lungs;
• Great weakness;
• Decreased activity;
• Strong cravings for sleep.

Signs of lung disease such as pneumonia are pronounced and are accompanied by temperature changes, coughing and shortness of breath. The patient feels exhausted, anxious, complains of pain in the chest area.

Signs of emphysema appear already in the late stages, when the lungs are severely damaged. Body weight decreases, the skin turns red, exhalation requires significant effort, and the chest becomes like a "barrel".

Cancer is almost impossible to diagnose in its early stages. Therefore, for any deviations from the norm, it is required not to postpone the visit to the hospital. The symptoms of this lung disease in women are similar, in the early stages, to the common cold. Therefore, many do not pay attention to their malaise and the gradual deterioration of the state of the body.

The following symptoms are distinguished:

• Blood in sputum;
• Unexplained weight loss;
• "Whistle" from the chest when exhaling;
• Pain when coughing;
• Dyspnea.

Signs of lung disease - cancer - in men are fever, frequent viral illnesses, severe cough and heart rhythm disorders.

Lung diseases and their symptoms are similar to each other in initial manifestations, but the effect is on completely opposite parts of the respiratory tract. Asthma can damage lung tissue.

The disease can be identified by noisy breathing, cough, "bluish" skin, frequent sneezing. Acute bronchitis is manifested by a violent nocturnal cough that causes acute pain. In the chronic stage, the symptom becomes more frequent, mucus is secreted, the body swells, the skin tone approaches blue.

Pleurisy is characterized by severe pain during breathing and chest movements.

Tuberculosis is considered dangerous in terms of the manifestation of signs, since the patient usually does not complain of any pain or cough. Only over time it becomes noticeable that a person is dramatically losing weight, sweating, he is constantly drawn to sleep, and the body temperature rises.

More about lung diseases

Diseases of the lungs and bronchi are common. In recent years, there has been a steady trend towards an increase in the percentage of patients suffering from diseases of the bronchopulmonary system.

Symptomatically, such pathologies are expressed in two ways: either in the form of an acute severe process, or in the form of sluggish progressive forms. Neglect, improper treatment and the principle of "somehow it will pass by itself" leads to tragic consequences.

It is impossible to establish the cause of the disease at home. Only a qualified pulmonologist can diagnose the pathological process.

A distinctive feature of many pulmonary diseases is complex diagnostics. The causes of a specific pathology may be subjective. But there are a number of common factors that provoke the onset and development of the inflammatory process:

• unfavorable ecological situation in the region; the presence of harmful industries;
• exacerbation of other chronic diseases;
• pathology of the cardiovascular system;
• violation of the electrolyte balance in the body, increased sugar levels;
• nerve diseases;
• the presence of bad habits.

Each pathological process in the lungs has specific signs that appear as it develops. In the initial stages, the manifestations of all lung diseases are very similar.

1. The presence of a cough. A cough is the first sign of a possible lung disease. The pathological process provokes inflammation, irritation of receptors and reflexive contraction of the muscles of the respiratory tract.
   Coughing is the body's natural attempt to rid itself of accumulated phlegm. Already by the timbre of the cough, one can judge whether the patient has any pathology: croup, laryngotracheobronchitis, bronchiectasis.

With bouts of coughing, the patient experiences:

• the discomfort;
• pain and burning sensation in the sternum;
• lack of air;
• oppressive sensation in the chest.

1. Sputum production... As a consequence of the pathological process, sputum saturated with pathogenic microbes is considered. With inflammation, the amount of discharge increases significantly. The patient's illness is determined by the color of the sputum, its smell and consistency. An unpleasant smell indicates putrefactive processes in the lungs, white, frothy discharge is a sign of pulmonary edema.
2. Presencebloodin sputum orsaliva... Often serves as a sign of a dangerous illness. The cause may be damage to a small vessel, and malignant neoplasms, and lung abscess. In any case, the presence of blood in sputum or saliva requires immediate education to specialists.
3. Labored breathing... A symptom of almost all diseases of the bronchi and lungs. In addition to lung problems, it can be caused by dysfunction of the cardiovascular system.
4. Painful sensations in the sternum. Chest pain is a characteristic sign of pleural involvement. Most often found in various forms of pleurisy, cancer, foci of metastases in the tissues of the pleura. Chronic pulmonary pathologies are considered as one of the prerequisites for pleurisy.

With infectious lesions of the lungs, the symptoms appear suddenly and vividly. Fever appears almost immediately, there is a sharp rise in temperature, chills and profuse sweating.

Classification

A characteristic feature of lung diseases is their effect not only on various parts of the lungs, but also on other organs.

According to the lesions, broncho-pulmonary pathologies are classified by the following criteria:

• lung diseases affecting the respiratory tract;
• diseases affecting the alveoli;
• pathological lesions of the pleura;
• hereditary lung pathologies;
• diseases of the broncho-pulmonary system;
• purulent processes in the lungs;
• congenital and acquired lung defects.

Lung diseases affecting the airways

1. COPD(chronic obstructive pulmonary disease). In COPD, the bronchi and lungs are affected at the same time. The main indicators are persistent cough, sputum production, shortness of breath. Currently, there are no therapeutic methods that completely cure pathology. Risk groups - smokers and patients associated with hazardous production. At the third stage, the patient's life expectancy is about 8 years, at the last - less than a year.
2. Emphysema... Pathology is considered as a type of COPD. The disease is characterized by impaired ventilation, blood circulation and destruction of lung tissue. The emission of carbon dioxide is characterized by significant and sometimes critical indicators. It arises both as an independent disease and as a complication of tuberculosis, obstructive bronchitis, silicosis. As a consequence of the pathology, pulmonary and right ventricular heart failure, myocardial dystrophy develop. The main symptoms in all types of emphysema are skin discoloration, sudden weight loss, and shortness of breath.
3. Asphyxia- oxygen starvation. It is characterized by a lack of oxygen and an excessive amount of carbon dioxide. There are two groups of asphyxia. Nonviolent is considered as a severe consequence of broncho-pulmonary and other diseases. Violent - occurs with mechanical, toxic, barometric lesions of the bronchi and lungs. With complete suffocation, irreversible changes and death occur in less than five minutes.
4. Acute bronchitis. With the disease, the patency of the bronchi is impaired. Acute bronchitis is characterized by symptoms of both acute respiratory illness and intoxication. It can have both the form of primary pathology and be the result of complications of other processes. Two common causes are bronchial infections or viruses. Acute bronchitis of an allergic nature is less common.

Symptomatically expressed by incessant cough, sputum production, profuse sweating. Self-medication, improper intake of medications, untimely access to specialists threatens the transition of the disease into a chronic form.

A typical manifestation of chronic bronchitis is a cough that occurs with any slight decrease in immune activity.

Alveolar pathology

Alveoli - air sacs, the smallest particle of the lung. They look like bubbles, the walls of which are at the same time their partitions.

Lung pathologies are also typified by alveolar lesions.

1. Pneumonia. An infectious disease caused by viruses or bacteria. With neglect of the disease, with untimely referral to specialists, it turns into pneumonia.

A characteristic feature is the rapid, sometimes reactive development of pathology. At the first sign, immediate medical attention is required. Clinically expressed as follows:

• heavy, crunchy breathing;
• a sharp and strong increase in temperature, sometimes up to critical indicators;
• separation of sputum in the form of mucous lumps;
• shortness of breath and chills;
• with severe courses of the disease, a change in the color of the skin is observed.

1. Tuberculosis. It causes severe processes in the lungs and, if immediate assistance is not provided, leads to the death of the patient. The causative agent of pathology is Koch's wand. The risk of disease in a long incubation period is from three weeks to a year. To exclude infection, an annual survey is indicated. The initial stages of the disease are characterized by:

• persistent cough;
• low, but not dropping temperature;
• the appearance of blood streaks in saliva and sputum.

Important. In children, the clinical picture is more pronounced, the disease is more severe, develops much faster and leads to the most sad consequences. Parents, first of all, should pay attention to the following signs:

• the child has been coughing for more than 20 days;
• loss of appetite;
• decreased attention, fatigue and apathy;
• signs of intoxication.

1. Pulmonary edema... It is not an independent disease and is considered a serious complication of other diseases. There are several types of pulmonary edema. The most common causes of occurrence are either the ingress of fluid into the pulmonary space, or the destruction of the outer walls of the alveoli by toxins produced by the human body itself.

Pulmonary edema is a dangerous disease that requires quick and accurate diagnosis and immediate treatment.

1. Lungs' cancer... Aggressive, rapidly developing oncological process. The last, terminal stage leads to the death of the patient.

A cure is possible at the very beginning of the disease, but few people pay attention to persistent cough - the main and main symptom of early stage lung cancer. To detect the disease at the earliest stages, computed tomography is necessary.

The main symptoms of pathology are:

• cough;
• blood streaks and whole blood clots in the sputum;
• dyspnea;
• constantly elevated temperature;
• sharp and significant weight loss.

Additional Information... The longest life expectancy is observed in patients with peripheral lung cancer. Cases were officially registered when patients lived for 8 or more years. A feature of pathologists is its slow development in the complete absence of pain. Only in the terminal stage of the disease, with total metastasis, the patients developed pain syndrome.

1. Silicosis. Occupational disease of miners, miners, grinders. In light years, grains of dust settle, the smallest fragments of a flog and stone. Silicosis is insidious - the symptoms of the disease may either not appear at all for many years, or be mild.

The disease is always accompanied by a decrease in lung mobility and a violation of the respiratory process.

Tuberculosis, emphysema, pneumothorax are considered as serious complications. In the last stages, a person suffers from constant shortness of breath, cough, fever.

1. Acute Respiratory Syndrome - SARS... Other names are SARS and purple death. The causative agent is coronavirus. It multiplies rapidly and in the process of development destroys the pulmonary alveoli.

The disease develops within 2-10 days, accompanied by renal failure. Already after discharge, the patients showed an increase in connective tissue in the lungs. Recent studies indicate the possibility of the virus to block all links of the body's immune response.

Pathological lesions of the pleura and chest

The pleura is a thin sac that surrounds the lungs and the inside of the chest. Like any other organ, it can be affected by disease.

With inflammation, mechanical or physical damage to the pleura, there are:

1. Pleurisy. Inflammation of the pleura can be considered both as an independent pathology, and as a consequence of other diseases. About 70% of pleurisy is caused by the invasion of bacteria: Legionella, Staphylococcus aureus and others. With the penetration of infection, with physical and mechanical damage, the visceral and parietal layers of the pleura become inflamed.

The characteristic manifestations of the disease are stabbing or dull pain in the sternum, severe sweating, in severe forms of pleurisy, hemoptysis.

1. Pneumothorax... It occurs as a result of the penetration and accumulation of air in the pleural cavity. There are three types of pneumothorax: iatrogenic (resulting from medical procedures); traumatic (as a result of internal damage or injury), spontaneous (due to heredity, lung defect or other disease).

Pneumothorax is fraught with lung collapse and requires immediate medical attention.

Diseases of the chest are associated with pathological processes in the blood vessels:

1. Pulmonary hypertension... The first signs of the disease are associated with a violation and change in pressure in the main vessels of the lungs.

Important. The forecast is disappointing. 20 people out of a hundred die. The timing of the development of the disease is difficult to predict, they depend on many factors, and, first of all, on the stability of blood pressure and the condition of the lungs. The most alarming sign is frequent fainting. In any case, the survival rate of patients, even with the use of all possible methods of treatment, does not cross the five-year threshold.

1. Lung embolism... One of the main reasons is venous thrombosis. The blood clot enters the lungs and blocks oxygen flow to the heart. A disease that threatens sudden, unpredictable hemorrhage and death of the patient.

Permanent chest pain can be a manifestation of such diseases:

1. Hyperventilation when overweight... Excess body weight puts pressure on the chest. As a result, breathing is out of rhythm, shortness of breath occurs.
2. Nervous stress. A classic example is myasthenia gravis, and muscle flaccidity is an autoimmune disease. Considered as a pathological disorder of nerve fibers in the lungs.

Diseases of the bronchopulmonary system as a hereditary factor

The hereditary factor plays an important role in the occurrence of pathologies of the bronchopulmonary system. In diseases transmitted from parents to children, gene mutations provoke the development of pathological processes, regardless of external influences. The main hereditary diseases are:

1. Bronchial asthma. The nature of the occurrence is the effect of allergens on the body. It is characterized by shallow breathing, shortness of breath, spastic symptoms.
2. Primary dyskinesia... Congenital pathology of the bronchi of a hereditary nature. The cause of the disease is purulent bronchitis. Treatment is individual.
3. Fibrosis. There is an overgrowth of connective tissue and its replacement of alveolar tissue. As a result, shortness of breath, weakness, apathy in the early stages. In the later stages of the disease, the skin changes color, a bluish tint appears, drumstick syndrome is observed - a change in the shape of the fingers.

The aggressive form of chronic fibrosis shortens the patient's life to one year.

1. Hemosiderosis. The reason is an excess of hemosiderin pigment, a massive release of red blood cells into body tissues and their decay. Indicative symptoms are hemoptysis and dyspnea at rest.

Important. Acute respiratory infection is the root cause of pathological processes in the bronchopulmonary system. The first symptoms of the disease do not inspire anxiety and fear in patients, they are treated at home using traditional means. The disease progresses into a chronic phase or acute inflammation in both lungs.

Bronchopulmonary diseases are the result of viruses entering the body. The mucous membranes and the entire respiratory system are affected. Self-medication leads to serious consequences, including death.

The primary manifestations of diseases of the bronchi and lungs practically do not differ from the symptoms of a common cold. Infectious diseases of the lungs are bacterial in nature. The development of inflammatory processes occurs rapidly - sometimes it takes several hours.

Diseases caused by bacteria include:

• pneumonia;
• bronchitis;
• asthma;
• tuberculosis;
• respiratory allergies;
• pleurisy;
• respiratory failure.

The development of infection is reactive. To prevent life-threatening consequences, full complexes of preventive and therapeutic measures are carried out.

Many bronchial and pulmonary pathologies are accompanied by sharp and severe pain, causing interruptions in breathing. Here, a patient-specific treatment regimen is applied.

Diseases of the lungs of a suppurative nature

All suppurative lung diseases are classified as serious pathologies. The set of symptoms includes necrosis, putrefactive or purulent decay of lung tissue. Pulmonary purulent infection can be total and affect the organ completely, or be focal and affect individual segments of the lung.

All purulent pathologies of the lungs lead to complications. There are three main types of pathologies:

1. Lung abscess... A pathogenic process in which lung tissue is melted and destroyed. As a result, purulent cavities are formed, surrounded by necrotic pulmonary parenchyma. Pathogens - Staphylococcus aureus, aerobic bacteria, aerobic microorganisms. With an abscess of the lung, fever, pain in the inflamed segment, sputum with pus, and coughing up of blood are observed.

Treatment includes lymphatic drainage, antibiotic therapy.

If there is no improvement within two months, the disease becomes chronic. The gravest complication of a lung abscess is gangrene.

1. Lung gangrene... Total decay of tissues, putrefactive pathogenic processes in the lungs. As a mandatory accompanying symptom - the separation of sputum with an unpleasant odor. The fulminant form of the disease is the cause of the patient's death on the first day.

Symptoms of the disease are a rise in temperature to critical values, pouring sweat, sleep disturbances, and a persistent cough. At severe stages of the disease, the patients experienced a change in consciousness.

It is impossible to save the patient at home. And with all the success of thoracic medicine, the mortality rate of patients with lung gangrene is 40-80%.

1. Purulent pleurisy... It is an acute purulent inflammation of the parietal and pulmonary membranes, while the process also affects all surrounding tissues. Distinguish between infectious and non-infectious forms of pleurisy. The development of the disease is often reactive, and immediate treatment can save the patient. The main symptoms of pathology are:

• shortness of breath and weakness;
• pain on the side of the affected organ;
• chills;
• cough.

Congenital lung defects

It is necessary to distinguish between congenital pathologies and congenital anomalies of the lungs.

Anomalies of the lungs do not manifest themselves clinically, the modified organ functions normally.

Malformations are a complete anatomical violation of the structure of an organ. Such disorders occur during the formation of the bronchopulmonary system in the embryo. The main lung defects include:

1. Aplasia- a serious malformation in which either the entire organ or part of it is absent.
2. Agenesis- a rare pathology, there is a complete absence of the lung and main bronchus.
3. Hypoplasia- underdevelopment of the lungs, bronchi, lung tissue, blood vessels. The organs are in their infancy. If hypoplasia affects one or more segments, it does not manifest itself in any way and is discovered by chance. If everything is underdeveloped, hypoplasia manifests itself in signs of respiratory failure.
4. Tracheobronchomegaly, Munier-Kuhn syndrome. It occurs when the elastic and muscular structures of the bronchi and lungs are underdeveloped, as a result, there is a giant expansion of these organs.
5. Tracheobronchomalacia- a consequence of defects in the cartilaginous tissue of the trachea and bronchi. When inhaling, the lumen of the airways narrows, while exhaling, it expands greatly. The consequence of pathology is constant apnea.
6. Stenosis- reduction of the lumen of the larynx and trachea. There is a serious impairment of the respiratory function and the swallowing process. The defect significantly reduces the patient's quality of life.
7. Additional lobe of the lung... In addition to the main pair of lungs, there are additional lungs. They practically do not manifest themselves in any way, clinical symptoms occur only with inflammation.
8. Sequencing... A section of lung tissue is separated from the main organ, which has its own blood flow, but does not take part in the process of gas exchange.
9. Unpaired vein... The right side of the lung is divided by the azygos vein.

Congenital malformations are easily noticed on ultrasound, and modern courses of therapy make it possible to stop their further development.

Diagnostic methods and preventive measures

The more accurately the diagnosis is made, the faster the patient's path to recovery. At the first examination, the pulmonologist must take into account all the external manifestations of the disease, the patient's complaints.

Based on the initial examination and conversation with the patient, a list of necessary examinations is drawn up, for example:

• x-ray;
• fluorography;
• blood test,
• tomography;
• bronchography;
• testing for infections.

Based on the data obtained, an individual treatment regimen is determined, procedures and antibiotic therapy are prescribed.

But no, the most modern methods of treatment, no, the most effective drugs will be beneficial if you do not follow all the prescriptions and recommendations of a specialist.

Preventive measures will significantly reduce the risk of pulmonary pathologies. The rules are simple, everyone can follow them:

• exclusion of smoking and excessive alcohol consumption;
• physical education and small physical activity;
• hardening;
• rest on the seaside (and if there is no such opportunity - walks in a pine forest);
• annual visits to the pulmonologist.

The symptoms of lung disease described above are easy to remember. Everyone should know them. Know and seek the help of doctors at the first warning signs.

- gross changes in the normal anatomical structure of the lungs, arising at the stage of embryonic formation and development of the bronchopulmonary system and causing a violation or loss of its functions. Lung malformations can manifest in childhood or adulthood, accompanied by cyanosis, shortness of breath, cough with purulent sputum, hemoptysis, chest deformity, etc. In order to diagnose lung malformations, X-ray, CT, bronchoscopy and bronchography, APG are performed. Treatment of malformations of the lungs can be surgical (lung resection, pulmonectomy) or conservative (medications, FTL, massage, debridement of the bronchial tree).

ICD-10

Q33 Congenital anomalies [malformations] of the lung

General information

Lung malformations are congenital anatomical abnormalities and defects in the functioning of the lungs, bronchi and pulmonary vessels. The incidence of lung malformations in children varies from 10 to 20%. Among the congenital defects of the lungs and bronchi, there are anomalies of their development, which, unlike defects, do not manifest themselves clinically and do not affect the function of the altered organ (for example, anomalies in the division of large and medium bronchi). Malformations of the lungs, accompanied by respiratory failure, appear already in early childhood and are accompanied by a delay in the physical development of the child.

Against the background of malformations of the lungs, inflammatory and suppurative processes often develop, causing a clinic of acute or chronic nonspecific diseases, which can take on a very severe course. More than half of chronic nonspecific lung diseases are pathogenetically associated with the existing malformations of the lungs.

Causes

The formation of anomalies and malformations of the lungs in the prenatal period can occur under the influence of a number of exogenous and endogenous teratogenic (damaging the fetus) factors. Exogenous factors that have a teratogenic effect on the embryo include physical (mechanical or thermal injury, electromagnetic or radioactive radiation), chemical (any poisons), biological (viral or other infections, bacterial toxins) damaging mechanisms.

Endogenous teratogenic factors include heredity, gene and chromosome abnormalities, endocrine pathologies, biologically defective germ cells (in late pregnancy in women or in older men in men). The type of developing lung defect depends not so much on the nature of the teratogenic factor as on the duration of pregnancy, at which the woman's body is affected by it.

If the effect of a teratogenic factor occurs in the first 3-4 weeks of pregnancy, when the trachea and the main bronchi are laid, it is possible that these structures develop defects up to the disruption of the formation of the whole lung. Teratogenic effects on the embryo in the period from 6 to 10 weeks of pregnancy can cause defects in the formation of segmental and subsegmental bronchi, such as cystic or simple hypoplasia, as well as the development of congenital bronchiectasis. Late malformations of the lungs in the fetus can form at 6-8 months of pregnancy, when the alveolar tissue is laid.

Classification

According to the degree of underdevelopment of the lung or its individual anatomical, tissue, structural elements in pulmonology are distinguished:

• Agenesis is a developmental defect characterized by the complete absence of the lung and the corresponding main bronchus.
• Aplasia is a developmental defect in which a lung or part of it is absent in the presence of a stump of a rudimentary main bronchus.
• Hypoplasia is a simultaneous underdevelopment of the elements of the lung (bronchi, pulmonary parenchyma, vessels), occurring at the level of a segment, lobe, or the entire lung. Simple hypoplasia is characterized by a uniform decrease in the size of the lung without significant disruption of its structure, while maintaining a distinct reduction in the bronchial tree. Cystic hypoplasia (cystic or cellular lung, polycystic) occurs among all lung malformations most often (in 60-80% of cases) and is accompanied by simultaneous underdevelopment of the bronchi, pulmonary parenchyma and blood vessels with the formation of bronchogenic cavities in the distal subsegmental bronchi, where chronic inflammatory and suppurative process.

Among the malformations of the walls of the trachea and bronchi, there are:

• Tracheobrochomegaly (tracheocele, megatrachea, Mounier-Kuhn syndrome) is an expansion of the lumen of the trachea and large bronchi due to congenital underdevelopment of muscle and elastic fibers of their walls. The presence of tracheobronchomegaly is accompanied by a persistent course of tracheobronchitis.
• Tracheobronchomalacia is a failure of the cartilage of the trachea and bronchi, causing them to abnormally collapse during breathing. Manifested by stridor breathing, rough cough, apnea attacks.
• Williams-Campbell syndrome is hypoplasia of cartilage and elastic tissues of the bronchi of the III-VI orders, manifested by the generalized development of bronchiectasis at the level of the middle bronchi and broncho-obstructive syndrome.
• Leschke's bronchioectatic emphysema is a congenital weakness of the walls of the bronchioles, accompanied by bronchioectasias and centrilobular emphysema.

Limited (localized) defects in the structure of the walls of the bronchi and trachea include:

• Stenosis of the trachea and bronchi - a sharp narrowing of the bronchi and trachea, resulting from a violation of the development of cartilaginous rings or external compression of the tracheobronchial tree by vessels. Clinically manifested by stridor breathing, attacks of cyanosis, impaired swallowing, recurrent atelectasis.
• Congenital lobar (lobar) emphysema is a violation of bronchial patency at the level of the bronchi of the III-V orders with the formation of a valve (valve) mechanism, causing a sharp swelling of the corresponding lobe. Narrowing of the lumen of the bronchus can develop as a result of a defect in cartilage, folds of the mucous membrane, compression by a tumor or abnormally located vessels, etc. Lobar emphysema is manifested by respiratory failure of varying degrees, which develops in the first hours after birth.
• Tracheo- and bronchoesophageal fistulas are an open communication between the trachea (or bronchi) and the esophagus. Diagnosed shortly after birth, accompanied by aspiration of food, cough, cyanosis, attacks of suffocation during feeding, the development of aspiration pneumonia.
• Diverticula of the bronchi and trachea are formed due to hypoplasia of the muscular and elastic frame of the bronchi.

Congenital malformations of the lungs associated with the presence of additional (excess) dysembryogenetic structures include:

• An additional lobe (or lung) is the presence of an additional accumulation of lung tissue, independent of a normally formed lung.
• Lung sequestration - the presence of an abnormal area of ​​lung tissue that develops independently of the main lung and is supplied with blood by its own arteries of the great circle. Sequestration can be located outside the lobe (non-lobe) and inside it (intralobe). For many years, a sequestration clinic may be absent, manifestations in the form of recurrent pneumonia occur when sequestration is infected.
• Lung cysts are parabronchial cavities associated with impaired embryogenesis of small bronchi. There are draining and non-draining cysts based on the presence or absence of communication with the bronchial tree. Cysts can grow to gigantic sizes, while compressing the surrounding lung parenchyma.
• Hamartomas are dysembryonic formations consisting of bronchial walls and pulmonary parenchyma; progressive growth and malignancy are not typical.

Among the malformations of the lungs, characterized by an abnormal arrangement of anatomical structures, the most common are:

• Kartagener's syndrome is a reverse arrangement of internal organs, including the lungs. Usually combined with chronic bronchitis, bronchiectasis and chronic sinusitis, occurs with frequent exacerbations of a purulent bronchopulmonary process. Modifications of the terminal phalanges and nails are possible according to the type of "watch glasses", "drum sticks".
• Tracheal bronchus - the presence of an abnormal bronchus extending from the trachea above the upper lobe bronchus.
• Lobe of the azygos vein - the part of the upper lobe of the right lung, separated by the azygos vein.

The most common blood vessel malformations in the lungs include:

• Pulmonary artery stenosis - isolated are extremely rare, usually found together with heart defects.
• Arteriovenous aneurysms - the presence of pathological messages between the venous and arterial beds, accompanied by mixing of venous blood with arterial and leading to the occurrence of hypoxemia. The presence of multiple arteriovenous messages is characteristic of Randu-Osler disease. The defeat of large and medium arteries proceeds with the formation of arteriovenous fistulas - extensions of the type of aneurysm. Patients develop severe hypoxemia and respiratory failure, hemoptysis.
• Pulmonary hypoplasia and agenesis - underdevelopment or absence of branches of the pulmonary artery is often found in combination with heart defects and lung hypoplasia.

Symptoms of lung malformations

The variety of types of malformations of the lungs corresponds to the polymorphism of their possible clinical manifestations. The latent course of many lung defects determines the variability of the timing of their detection. In the first decade of life, 3.8% of all lung malformations are found, in the second decade - 18.2%, in the third - 26.6%, in the fourth - 37.9%, in people over 40 years old - 14%.

The asymptomatic course of lung malformations occurs in 21.7% of patients, symptoms of suppuration are manifested in 74.1% of defects, complications of other diseases - 4.2%.

The earliest, in the first days of a child's life, there are malformations of the lungs, accompanied by signs of respiratory failure: lobar emphysema, pronounced stenosis of the main bronchi and trachea, broncho- and tracheoesophageal fistulas, agenesis, aplasia and severe hypoplasia of the lung. They are characterized by stridor breathing, attacks of asphyxia, cyanosis.

Diagnosis of lung malformations

Diagnosis of malformations of the lungs requires a comprehensive specialized examination. Lung malformations should be suspected in patients suffering from persistent chronic bronchopulmonary processes since childhood. Radiological and bronchological examinations are of decisive importance in the diagnosis of lung defects.

X-ray examination allows you to identify malformations of the lungs, even with their asymptomatic course. According to X-ray and CT of the lungs, it is possible to determine changes in the vascular and bronchial pattern (with hypoplasia), increased transparency (with lobar emphysema), displacement of the mediastinal organs (with hypoplasia or agenesis), shadow contours (with hamartoma or sequencing), reverse topography of the lungs (with Kartagener's syndrome), etc. During bronchoscopy and bronchography, the anatomical structure of the trachea and bronchi is assessed, deformities (stenosis, fistulas, etc.) and changes in the bronchial tree are revealed. In case of malformations of the lung vessels, it is advisable to conduct an angiopulmonography.

Treatment of malformations of the lungs

The choice of adequate tactics for the treatment of lung malformations is carried out by pulmonologists and thoracic surgeons. It is dictated by the assessment of the patient's condition, the severity of the existing disorders and the possible prognosis. Emergency surgery is indicated for severe respiratory failure in cases of lobar emphysema, aplasia and agenesis of the lungs, with tracheoesophageal fistula and stenosis of the trachea and bronchi.

In bronchiectasis and cystic hypoplasia, the choice of surgical or conservative treatment is determined by the number of altered segments in both lungs, the frequency of relapses and the nature of changes in the lung tissue. As a rule, with such malformations of the lungs, the altered part of the lung is resected.

With widespread changes in the lungs, conservative therapy is carried out, aimed at preventing exacerbations of the purulent process. It includes annual courses of anti-inflammatory therapy, improving the drainage of the bronchial tree (bronchoalveolar lavage, expectorant, mucolytic drugs, massage, inhalation, exercise therapy), spa rehabilitation.

Forecast and prevention of lung malformations

With malformations of the lungs that are not associated with the development of respiratory failure and are not accompanied by purulent-inflammatory complications, the prognosis is satisfactory. Frequent exacerbations of the bronchopulmonary process can cause limitation of the patients' ability to work. Measures for the prevention of congenital lung malformations include: exclusion of adverse teratogenic effects during pregnancy, medical genetic counseling and examination of couples planning to have a baby.