RADIOLOGICAL CHARACTERISTICS

1.In bronchiolobular infiltrates in the cortical area of the pulmonary field, more often in the 1st, 2nd or 6th segments, there is a limited darkening, more often of low intensity, with blurred contours, up to 3 cm in size. the infiltrate has a polygonal shape, elongated in the towards the root of the lung. On the tomogram infiltrate often looks like a conglomerate of several more or less dense small foci united by a zone perifocal inflammation.

2.A rounded infiltrate is a circumscribed, rounded darkening shape, predominantly of medium intensity with clear but indistinct outlines.

In the supraclavicular area is localized by a classic type of infiltrate

Assmann-Redeker.

3.From the medial parts of the darkening to the root of the lung The inflammatory track is departing from the medial parts of the darkening the projection of a draining bronchus (symptom of "tennis racket"). At decay of the infiltrate in its central parts usually reveal cavities. В Inferior parts of the lung are often noticeable foci of bronchogenic insemination.

RADIOLOGICAL CHARACTERISTICS

4.A cloud-like infiltrate is an irregular darkening, limited to the limits of one or more segments and has no clear boundaries. It is characterized by The presence of several small decay cavities, limited by inflammation-compacted lung tissue, formation of large cavities.

5.Periscissuritis is an infiltrate that localizes in interlobular gap, approaches triangular shape with vague upper border and fairly clear the lower one, which runs along the interlobular gap.

6.In lobar infiltrate (lobitis), spread and the shape of the blackout depends on which proportion is affected. Sometimes it is a solid, almost uniform compaction of the lobe of the lung. In the affected lobe are found deformed and partially obturated caseosal masses of bronchi, as well as multiple cavities of decay of small and medium diameter ("bee honeycomb "or" bread crumb "). In case of progression, focal dissemination is detected in the opposite light, mainly in the 4th and 5th segments.

THREE MAIN VARIANTS PATHOLOGICAL

CHANGES:

1. combination of several polymorphic foci surrounded by more or less expressed zone perifocal interstitial infiltration;

2.isolated necrotic infiltrate or the destruction cavity without a pronounced perifocal infiltration;

3.large necrotic infiltrate or destruction cavity with extensive perifocal infiltration alveolar character.

X-RAY DIAGNOSIS

1.Shadow more than 1 cm in diameter..

2.The extent of the lesion is from 1 segment to several lobes lung.

3.Shape of the shadow - any.

4.Shade structure - heterogeneous.

5.Intensity of the shadow - small and medium.

6.The contours of the shadow are blurred.

FLOW OPTIONS:

1.The parenchymatous variant of infiltrative pulmonary tuberculosis is associated with bronchogenic spread of tuberculosis infection. On CT this form of tuberculous bronchopneumonia is formed by lobular to lobular extent. It proceeds predominantly with exudative inflammatory reaction.

2.In the interstitial variant of infiltrative of pulmonary tuberculosis in the CT picture prevails inflammatory thickening of interstitium at the level from intradolocular to large peribronchovascular structures. Characterized by predominantly productive type of inflammatory reaction and torpid course are characteristic.

Selection of variants of infiltrative tuberculosis of the lungs assumes a differentiated approach to chemotherapy..

Differential diagnosis Infiltrative tuberculosis:

1.Primary pneumonias.

2.Non-specific pneumonias.

3.Kruposic and bronchiolobular pneumonias.

4.Viral pneumonia.

5.Еosinophilic infiltrates.

6.Pulmonary abscesses.

7.Abscessive pneumonias.

8.Central cancer

9.Influenza.

10.Bronchopneumonias.

CASEOSIS PNEVMONIA is one of the the most severe form of tuberculosis, is characterized by a sharply pronounced caseosis-necrotic component of the tuberculosis inflammation, rapid progression and rapid progression and formation of multiple decay cavities formation.

CLINICAL FORMS:

1.Lobar - usually develops as a an independent clinico-anatomic form of tuberculosis.

2.lobular - more often complicates other forms of tuberculosis.

STAGES OF CASEOUS

PNEUMONIA:

1.The initial stage (acinic, acinic-lobular, confluent lobular) is characterized by mass cell death in the lesion nidus and formation of extensive zone of caseous necrosis.

2.Disseminated and irreversible stage - in adjacent lung tissue forms caseous foci and foci merging with each other. foci coalesce with each other. MBT invade into lumen of small bronchi, Lymphatic and blood vessels, in 2 - 3 weeks widespread affection of small bronchi and lymphatic vessels is observed. In 2 - 3 weeks widespread affection lungs.

MORPHOLOGICAL FEATURE OF CASEOSIS PNEUMONIA is considered a sharp predominance caseo-necrotic changes over other specific changes in pulmonary tissue.

OUTCOMES OF CASEOUS PNEUMONIA:

1.Fatal outcome. Cause of death -LSN developing on the background destruction of lung tissue and sharply severe intoxication.

2.With timely treatment → Gradual organization of fibrinous causes the appearance of areas of carnification; the cavities transform into fibrous caverns, caseous necrotic foci are encapsulated → FCTL is formed.