X-ray pattern with exudative pleurisy on the radiograph
In the human body there are several serous cavities. They contain two sheets, between which is the liquid needed to perform the movements of bodies of prisoners in these formations. Lungs located in the pleural bag. The liquid, which is called the pleura. In composition it resembles blood plasma. Inflammatory and neoplastic diseases are accompanied by the formation of effusion. He fills the pleural cavity, depending on the relationship between the processes of secretion and resorption of pleural fluid. X-ray helps to detect pathology only in the development of the second phase of the disease – the phase of exudation.
How does the accumulation of fluid in the pleura?
It is known that the intact (undamaged) leaves without serous inflammation when carrying out radiographic examinations are not visualized. Exudative pleural effusion can be seen with a sufficient accumulation of fluid. As with ultrasound, x-ray lets you find fluid in the pleura with its volume exceeding 200 ml.
If the darker costal-diaphragmatic sinus, it indicates involvement of the pleura in the inflammation process. Or has another disease, accompanied by increased synthesis of the fluid.
The following potential radiological sign of the appearance of pleural fluid in the crevices plusiinae darkening. This term reflects the appearance of the shadow that covers the entire lung surface like a Cape. Darkening can be seen from the lateral side of the chest, and in the course of interlobar pleural furrows (she shares easy-share).
Radiologists know well that with the increase in the accumulation of fluid is smoothed by the upper border of darker area on the radiograph. The level of this boundary on the edges determine the degree of hydrothorax is a condition characterized by massive pleural effusion in the gap of different etiology and pathogenesis. But pericardial effusion rarely reaches such a scale and is limited to the sinuses.
Additional x-ray signs
The accumulation of pleural fluid, regardless of the cause, leads to the phenomenon of the shift of the mediastinum (the middle shade) in the direction opposite to the affected (this applies to unilateral pleurisy). The extent of this bias depends on several factors:
- The volume of exudate.
- Standing of the diaphragm.
- The degree of mobility of the mediastinal structures.
- The functional state of the pulmonary structures.
When the patient is examined in a horizontal position, the more intense the shadow appears in the lateral areas of the chest. This symptom is the author’s name – Lena phenomenon. It is played in the horizontal position or in the Trendelenburg position. Also typical of this situation, the reduction of such indicator, as the transparency of the lung tissue. It is homogeneous and diffuse.
Pleurisy with mediastinal involvement (mediastinal) pleura is detected not so often. Its characteristics are:
- Additional darkening of the area median shade.
- The clarity of the contours of these formations.
- A variety of forms shadows: triangular, resembling a spindle or strips (ribbon-like).
When the effusion is located in the interlobar pleura, x-ray picture has its own peculiarity. It is that of darkening located along the boundaries between the lobes of the lung. The shade at the same time remind lenses: they have the form of symmetric formations with a biconcave or biconvex shape. The mediastinum is usually in this form of pleurisy is intact and not displaced.
A special variant of exudative inflammation of pleural sheets – summany pleurisy. The term means that the fluid is not subjected to final resorption and partially separated from the rest of the cavity. Depending on where it was initially localized inflammation, and how it was resolved, there are the following options somawansa pleurisy:
- Costal (rib).
- Apical (apical).
- Nudepregnancy (costal-diaphragmatic sinus).
Delayed resorption of exudate increases the risk of such an outcome, as pleural adhesions, synechia, fibrotic folds that would limit respiratory excursion of the lungs.
The differential diagnosis
As described earlier, the physician imaging techniques is not entitled to make a clinical diagnosis in its conclusion. It can specify which radiographic manifestations seen in the photo.
When the conclusion States that a fluid in the pleural cavity, it is necessary to keep in mind which type of diseases should be excluded or confirmed.
After all, not always fluid in the pleura of inflammatory Genesis. What diseases may be accompanied by hydrothorax?
- Congestion violation of systolic or diastolic function of the heart.
- Inflammation is pleurisy.
- Tuberculous lesions of the pleural membranes.
- Traumatic defeat.
- The complication of pneumonia.
- Metastases to the pleural sheets.
In order to clearly determine the cause of the identified symptoms on x-ray, you need to have at least two projections. For imaging small objects using naturography.
Tomography or the application of ultrasound for the diagnosis of controversial issues is very valuable. These methods can determine the nature of the liquid, its relation to neighboring structures.
Puncture of the pleural cavity is usually required for cytological and biochemical studies. This allows to exclude inflammatory Genesis of the disease. Cellular structure can help in the further search for the causative agent, if discussed infectious origin of the pleuritis. If lymphocytes predominate, we are talking about viral defeat. When there is predominance of neutrophils in most cases of inflammation caused by bacterial flora.
X-ray picture is very valuable, coupled with clinical manifestations. Therefore, if a patient says that a week ago he was troubled with severe pain in the chest, especially in the projection of the sternum, aggravated by coughing, movement and weakening when tilted forward, and then disappeared, you should think about pleurisy and take the picture. It is desirable to implement it in two projections for diagnostic quality. The research is complemented by clinical and biochemical tests.