Focal pneumonia

What is pneumonia focal

It is often diagnosed such a disease of the lower respiratory tract as pneumonia focal. Pneumonia is an inflammatory disease in which the lung tissue is affected. This pathology often infects young children. There are different varieties of this disease. In this case, a whole part of the organ, lobule or segment can become inflamed. Often diagnosed as total inflammation of the lungs.

Very often, focal pneumonia occurs. The lungs of a person are a paired organ. They are located in the chest cavity. Each lung is divided into segments, segments and segments. In the focal form of pneumonia, small infiltrates are observed within the lobule of the organ. What is the etiology, clinic and treatment of this disease?

Features of the disease

For this form of pneumonia is characterized by an acute course with severe intoxication. This form of pneumonia occurs in 2 patients out of 3. Often the terminal bronchi are initially affected, after which the process affects the lung tissue. The disease has an infectious nature. At the heart of the development of the disease lie the same pathogenetic mechanisms that are inherent to the share (croupous pneumonia).

In the development of inflammation, four phases are distinguished: tidal flow, red curing, gray curing and resolution. The foci can be large and small. The focus can be one, or multiple foci are observed. In most cases, the lower segments of the organ are affected. Very rarely, the upper ones.

This is the difference between focal pneumonia and pulmonary tuberculosis. When tuberculosis infection in most cases, the tops of the organ become inflamed. The peculiarity of this form of the disease is that when studying X-rays, alternating dark and light areas is found. The dark areas correspond to atelectasis, and the lighter ones correspond to emphysema. The affected area of ​​the lung has a mottled appearance.

In most cases, the prognosis for this pulmonary pathology is favorable. With inadequate therapy or self-treatment, focal pneumonia may cause the formation of a pulmonary abscess, gangrene. Sometimes the disease becomes chronic.

Etiological factors

The development of focal pneumonia is due to various external and internal factors. The disease has an infectious nature. In children, focal pneumonia is most often caused by the following microorganisms: streptococci, pneumococci, microscopic fungi, viruses, E. coli.

In children immunity is imperfect. Activation of pathogenic microflora quickly causes edema and impaired function of the organ. At first, bronchitis may occur. Against this background, sputum accumulation takes place, which is a favorable factor for the reproduction of microorganisms. In the absence of proper treatment, pneumonia develops. In childhood, the most common single site of inflammation is more than 1 cm.

In adults, focal pneumonia is most often secondary, that is, it is formed in the complicated course of another disease. Predisposing factors are:

• flu;
• adenovirus infection;
• rhinovirus infection;
• measles;
• whooping cough;
• scarlet fever;
• chlamydia.

More rarely the cause of specific inflammation of the lungs is purulent otitis, dysentery, purulent diseases of soft tissues and bones (osteomyelitis, furunculosis), meningitis. Stagnant and aspiration pneumonia is singled out separately. Aspiration form is observed in case of penetration into the lungs of various substances (toxic gases, food particles, vomit, small solid objects). Aspiration is possible with a loss of consciousness during severe vomiting, as well as with severe alcohol intoxication.

As for congestive pneumonia, it develops in seriously ill people who have been in bed for a long time. Hypodinamy leads to stagnation of blood in the pulmonary circulation, which leads to a violation of the ventilation of the lungs. Against the background, sputum is accumulated, which is the cause of activation and reproduction of pathogenic microorganisms. Often, congestive pneumonia is diagnosed in the elderly.

This form of pneumonia can be formed against the background of the following diseases: heart defects, ischemic disease, asthma, diabetes, stroke, skull injuries, fractures of bones and spine. Of important importance in the development of focal pneumonia are the following provoking factors: smoking, frequent colds, abuse alcohol, hypodynamia, decreased immunity, hypovitaminosis, irrational nutrition, fluctuations in pressure and humidity.

Clinical manifestations

Right-sided focal pneumonia or left-sided leaking with a variety of clinical manifestations.

The most common signs are:

• febrile fever;
• pain in the chest;
• coughing;
• increased sweating;
• weakness;
• pain in the head;
• dyspnea.

The severity of symptoms depends on the size of the foci and their number. Fever usually lasts from 3 to 5 days. Cough can be dry or productive with the discharge of mucous sputum. With multiple foci and their fusion, dyspnea and cyanosis may occur. In children, the disease often begins with prodromal phenomena. These include agitation or apathy, a decrease in appetite, an increase in heart rate, frequent breathing. In severe cases, vomiting is possible.

Inflammation of the lungs can be suspected by the following objective signs: tachycardia, tachypnea, muffled heart sounds, listening to wet rales, hard pulmonary respiration.

In most cases, clinical symptoms are observed for 1.5-2 weeks, then the disease regresses. Possible complications of focal pneumonia include:

• formation of an abscess;
• gangrene of the lung;
• inflammation of the pleura;
• development of obstructive syndrome;
• acute respiratory failure;
• pulmonary hemorrhage;
• empyema of the pleura;
• pyopneumovorax (accumulation of air and pus in the pleural cavity);
• acute infection of blood (sepsis);
• purulent pericarditis;
• amyloidosis.

Heart failure is often formed against the backdrop of postoperative pneumonia. With the drainage pneumonia of the viral etiology, complications such as hemoptysis, various bleedings are possible. The most difficult is bilateral pneumonia. Treatment of it should be carried out within the walls of a medical institution

Diagnostic measures

You need to know not only the symptoms of focal pneumonia, but also a set of diagnostic procedures that will help to make an accurate diagnosis. Diagnosis of the disease includes:

• collection of anamnesis of life and anamnesis of the disease;
• visual inspection;
• physical examination (percussion, auscultation);
• measurement of pressure and body temperature;
• X-ray examination;
• bronchoscopy;
• CT or MRI of the lungs;
• sputum examination;
• general and biochemical blood test;
• Analysis of urine.

In the blood there is leukocytosis, acceleration of ESR, increased concentration of fibrinogen and sialic acid, the presence of C-reactive protein. Often, a study is made of the gas composition of the lungs and spirometry. At the X-ray examination, small focal shadows are found. With drainage pneumonia, these foci are larger, and they can alternate with microabscesses and areas of emphysema.

Therapeutic tactics

Treatment of focal pneumonia should be complex.

Treatment involves the use of antibiotics (protected penicillins, fluoroquinolones, cephalosporins, macrolides), infusion therapy, mucolytics, expectorants, antihistamines, physiotherapy.

To treat children, often used "Augmentin" and "Timentin." Treatment lasts 1-2 weeks. Antibiotics should be injected. Mucolytics are prescribed in case of cough with phlegm. Do not overcool and smoke during treatment.

A good effect is given by inhalation. With severe respiratory failure, oxygen therapy is performed. From physiotherapy methods UHF-therapy, electrophoresis is used. Treatment includes chest massage, respiratory gymnastics. With congestive pneumonia, patients, if possible, need to move more. Thus, focal pneumonia is a serious disease requiring antibiotic therapy and medical supervision.

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Focal pneumonia in children and adults. Symptoms and Treatment of Focal Pneumonia

Focal pneumonia is one of the most common lung diseases. Both adults and children suffer from this ailment. That is why many readers are interested in additional information about the disease. What are the causes of this form of pneumonia? What symptoms are accompanied by the disease? What complications can be encountered? What does treatment look like?

What is the disease?

Focal pneumonia is a disease that often occurs in modern medical practice. This acute inflammation, which is accompanied by the defeat of limited areas of lung tissue, in particular, lobules of the lung.

According to statistical data, about 65% of cases of pneumonia are just this form of disease. In modern pulmonology, some other terms are used for this disease - "lobular pneumonia" or "bronchopneumonia". Inflammation in this case usually begins with small terminal bronchi, and the process captures one or more lobules of the lung. Small foci of inflammation can be either single or multiple. By the way, bronchopneumonia is often diagnosed in children, and infants are also susceptible to the disease.

The main causes of focal pneumonia

Focal pneumonia can be both secondary and primary. Primary forms of the disease, as a rule, arise when a viral or bacterial pathogen penetrates into the respiratory system. In particular, the cause of the disease can be rhinovirus, parainfluenza virus, respiratory syncytial viruses. As for bacterial microorganisms, in about 70-80% of cases, the ailment develops against the background of activity of various types of pneumococci. But focal pneumonia in children is often manifested with the activation of opportunistic microflora - streptococci, Escherichia coli, staphylococci. In addition, rickettsia, mycoplasma, chlamydia may act as causative agents.

By the way, it is noted that the body becomes more susceptible to such a disease against the background of influenza and other acute respiratory infections.

Secondary pneumonia develops as a complication of some other disease. For example, often an ailment appears against the background of whooping cough, scarlet fever, measles, purulent otitis, dysentery, meningococcal meningitis, peritonitis, furunculosis, osteomyelitis and some other diseases.

Pathomorphology

Focal pneumonia is characterized by the appearance of single or multiple foci within the pulmonary lobe. In this case, the pathological process, as a rule, develops in the longitudinal direction - first the bronchi are involved, then the bronchioles and the alveoli. For this form of inflammation, three stages are characteristic: it is the stage of serous effusion, followed by curation and resolution.

Exudate in the alveoli, as a rule, serous with impurities of alveolar epithelium and leukocytes. Most often the disease affects the posterior segments of the lungs.

Case history: focal pneumonia and its symptoms

To begin with it is worth noting that the clinical picture in this case largely depends on the characteristics of the inflammatory process. Nevertheless, we can identify some common features. How does focal pneumonia occur? Symptoms of the first stage are an increase in body temperature, as well as general weakness, headaches, increased sweating. Some patients complain of chest pain that occurs during a cough.

As a rule, the body temperature comes back to normal after the beginning of antibacterial therapy. Separately it is necessary to talk about a cough. At first it can be dry, and as the disease develops it becomes wet. During coughing, serous or serous-purulent sputum may be isolated.

When examining the patient, you can notice a rapid increase in respiratory movements. In addition, the inflammatory process affects the work of the cardiovascular system - for example, tachycardia is often observed.

Focal pneumonia can also be accompanied by shortness of breath. Most often this symptom is present in children - difficulty with breathing occurs with physical stress or at rest. In any case, the insufficiency of the respiratory system can lead to hypoxia, which is accompanied by cyanosis and severe weakness.

On the other hand, in some patients the disease is hidden - there is no fever, no pain in the chest, no breathlessness. Such forms of ailment are considered quite dangerous, because sick people turn to the doctor too late.

Bronchopneumonia and its forms

As already mentioned, bronchopneumonia in children is more common. And during the diagnosis it is extremely important to find out its shape and degree of severity, since it depends on this depends on the doctor's chosen technique of treatment. In modern medicine, there are several classification systems for such a disease. For example, depending on the localization of the inflammatory process, the following forms can be distinguished:

• The most commonly diagnosed right-sided focal pneumonia in a child or adult, which is associated with some anatomical features. The fact is that the right main bronchus is shorter and wider, which facilitates the progression of the infection in the lung tissue. By the way, right-sided inflammation is much more common with lubricated symptoms, which greatly complicates the diagnostic process. However, this form of the disease is well suited to standard therapy.
• Left-sided inflammation also has some features. In particular, the diagnostic process can be difficult. That's why to identify small foci of inflammation it is recommended to conduct a computer tomography.
• The more severe is bilateral pneumonia. Such inflammation, as a rule, occurs on the background of depletion of the body or after carrying out artificial ventilation of the lungs. Symptoms in this case are more pronounced - there is a strong chill and weakness, a sharp and persistent increase in body temperature, as well as severe pain in the chest. Treatment of this form is carried out exclusively in a hospital.
• The most dangerous is the focal-drain pneumonia. With such a disease, the inflammatory process covers several segments at once or even a whole fraction of the lung. At the same time there is a change in pulmonary tissues and the type of emphysema and the appearance of microabscesses. In patients, such symptoms of respiratory failure as cyanosis and severe dyspnea appear.

Modern diagnostic methods

Of course, in the presence of the above symptoms it is necessary to immediately seek help from a specialist - it is impossible to determine the presence of the disease. The diagnostic process in this case includes a set of several activities. Only a specialist knows what constitutes a focal pneumonia, the symptoms and treatment of which we are considering today.

Naturally, at first the patient will be assigned standard examinations. When analyzing blood, one can notice an increase in ESR, as well as an increase in the number of neutrophils. In the most severe cases, a blood test is performed on the blood culture.

The sick person must be sent to the X-ray of the lungs. The results of such a study may be different, since everything here depends on the stage and form of the disease, the localization of the inflammatory process, and so on. If the radiography does not allow you to get enough information, additional studies are carried out, including bronchoscopy, MRI and CT of the lungs.

To determine the causative agent, mucus, sputum and flushing from the bronchi are examined. The samples obtained are analyzed by various techniques, including PCR and bacterial culture. Only after receiving the maximum amount of information the doctor will be able to make an effective treatment regimen.

How is focal pneumonia treated?

What therapy requires bronchopneumonia? Treatment in this case is selected by the doctor individually for each patient and includes a whole range of recreational activities.

Therapy primarily depends on the nature of the pathogen. Inflammation of a viral origin is treated with antiviral drugs and immunomodulators. If the cause of the inflammatory process are bacteria, then the administration of antibacterial drugs is indicated. As a rule, cephalosporins ("Cefazolin", "Cephepim", "Ceftriaxone"), penicillins ("Ampicillin", "Ampiox," " "Carbenicillin"), fluoroquinolones ("Levofloxacil", "Moxifloxacil", "Gatifloxacil") and combinations of these drugs. The course of admission lasts at least 10-14 days. In most cases, drugs are administered intramuscularly or intravenously, but in more severe cases, endobronchial and intrapleural administration is possible.

Naturally, detoxification is also carried out, which helps to alleviate the condition of patients (intravenous infusions of glucose, saline, etc.). It is necessary to take anti-inflammatory drugs - in the most severe cases, hormonal corticosteroids are used.

In order to facilitate the departure of phlegm, patients are prescribed mucolytic and bronchodilator agents. Quite effective are "Bromgexin", "Euphylin" and "Teopek", which dilute sputum, facilitate its withdrawal and expectoration. As an auxiliary therapy are various inhalations - they can be medicinal, enzymatic, alkaline, oil, etc. Patients also take multivitamin complexes, which accelerate the process of recovery of the body.

After the inflammatory process subsides, the course of therapy includes various physiotherapy techniques that help restore the normal function of the respiratory system. Quite effective is chest massage, DMV therapy, as well as UHF, electrophoresis.

With the development of respiratory failure (it happens rarely) oxygen therapy is indicated. After completion of the course, the patient is again examined to confirm the results of treatment.

Focal pneumonia in children: treatment and its characteristics

As already mentioned, this form of the disease is often found in babies. So what kind of therapy in this case requires bronchopneumonia? Treatment of mild forms is done at home. Preparations and dosage are determined by the attending physician - parents only have to follow his recommendations.

It is extremely important to create suitable conditions for the recovery of the baby. For example, do not forget about the full nutrition, despite the lack of appetite in the child. Make sure that bed linens and clothes are always clean and dry, because patients sweat profusely. The room needs to be ventilated regularly, but there should not be drafts. In the first few days it is extremely important to observe strict bed rest, even if the child remains active.

Hospitalization of children is carried out only in severe cases, namely:

• in the presence of chronic diseases of the respiratory system;
• in the presence of encephalopathies of any origin;
• if the child is less than two months old;
• in the presence of congenital malformations of the cardiovascular system;
• Children from disadvantaged families are also hospitalized, or if the child lives in unsuitable conditions for treatment, including orphanages.

Are complications possible?

In most cases, focal pneumonia results in complete recovery of the patient. However, in the absence of treatment, improperly administered therapy, or in extremely difficult conditions, dangerous complications are possible.

For example, against the background of such a disease, obstructive syndrome may develop. In more severe cases, this form of pneumonia results in the formation of an abscess or gangrene in the lung tissue. There are some other consequences of the disease, in particular, acute respiratory failure and inflammation of the pleura.

On the other hand, extrapulmonary complication of focal pneumonia is also common. The patient may develop a toxic shock in a serious condition. Sometimes, against the background of the disease, cardiovascular diseases, including endocarditis and myocarditis, also appear. On the other hand, the infection can spread to the tissues of the nervous system, which leads to the development of meningitis or meningoencephalitis.

Basic preventive precautions

Certainly, focal pneumonia can be an extremely dangerous disease. Unfortunately, there are no vaccines or other drugs that can protect a person from such a disease. Therefore, the only way to prevent disease is to strengthen the immune system.

A healthy lifestyle will have a great effect on the condition of the body. Proper nutrition, physical activity, breathing exercises, hardening, wiping with cold water, taking multivitamin complexes - these measures reduce the likelihood of developing inflammatory infectious diseases. And since pneumonia often develops precisely against the background of influenza, it is necessary to treat all ARVI in time and correctly.

After the inflammation of the lungs, a person needs time to restore the body. Therefore, the epicrisis is given only 10 days after the disappearance of the symptoms, and only if the blood tests and the results of other studies are within normal limits.

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Focal pneumonia and its consequences

It is an inflammatory process that takes place in the lungs and that captures small areas of lung tissue. Focal pneumonia and its consequences is one of the types of acute pneumonia. Most often the inflammatory process begins in the bronchi, the focal form still has the name - bronchopneumonia. In medical practice, there are three types of focal pneumonia: small-focal, large-focal and draining.

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Focal pneumonia - a characteristic of the disease

Focal pneumonia can begin sharply: with fever, chills, coughing, headache, weakness. Sputum can be mucous, purulent, mucopurulent. The temperature of focal pneumonia may increase to 39 degrees, and in older people it can be quite normal or increase to subfebrile digits. Fever lasts with antibacterial therapy for no more than 5 days.

In patients with large focal pneumonia, dyspnoea and cyanosis are often observed. The results of the physical examination are very diverse. When the inflammatory focus with focal pneumonia is located in the center, the physical data are scant. In the peripheral location of inflammation, the areas that are blunt with percussion sound are identified, which alternate with normal pulmonary sound. When auscultation against a background of hard breathing, moist wheezes are heard on separate sites. When draining in focal pneumonia, when the inflammatory process captures most of the lobe, when carried out physical examination, identify changes that are usually observed in croupous pneumonia. When focal pneumonia is detected, absent-minded dry rales are often listened to, and when dry pleurisy joins the disease, then a pleural friction noise is heard.

Focal pneumonia and its consequences

With focal pneumonia, there are changes in the cardiovascular system: tachycardia, muffled I tone at the apex, widening of the percutaneous boundaries. In most patients with X-ray examination, such effects of focal pneumonia as moderate or low intensity darkening with uneven contours are observed. Such changes can be observed against peribronchial or perivascular infiltration, but when they are affected acini, small foci of inflammation can not always be detected by X-ray examination.

When focal pneumonia has a croupiform shape, it is often possible to observe an increase in the shadow of the roots of the lung. In the patient's blood leucocytosis is found, the number of leukocytes is not changed, but sometimes there is leukopenia, ESR is increased. To date, the effects of focal pneumonia are much less common, the use of antibiotic therapy produces positive results and leads to the localization of symptoms.

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Symptoms of bronchopneumonia

Symptoms and outcomes of focal pneumonia differ from the described bitterness of clinical manifestations of lobar (croupous) inflammation of the lung, which is largely due to the peculiarities of pathogenesis and morphological changes in both clinical and morphological variants of pneumonia.

First, with focal pneumonia, the inflammatory process is usually limited to the lobe or segment of the lung. Often, pneumonic foci can merge, capturing a larger proportion of the lobe of the lung or even the entire lobe. In these cases, they speak of discharge focal pneumonia. It is characteristic that, unlike the lobular inflammation of the lungs, the pleura is involved in the inflammatory process only with superficial localization or focal pustular pneumonia.

Secondly, in contrast to lobar (croupier) pneumonia, focal pneumonia, as a rule, is not accompanied by hypersensitivity immediate type; more characteristic are the normal and hyperergic reactions of the body. This feature probably determines not so rapid, gradual formation of an inflammatory focus and significantly less vascular permeability than with croupous inflammation.

Thirdly, in connection with the less pronounced violations of vascular permeability in the focus of inflammation, exudate in focal pneumonia contains only a small amount of fibrin and in most cases has the character of serous or mucopurulent exudate. For the same reason, there are no conditions for a massive yield of red blood cells in the lumen of the alveoli.

Fourth, focal pneumonia almost always has the character of bronchopneumonia, in which the inflammatory process is first involved bronchial mucosa (bronchitis), only after that the inflammation as it passes to the parenchyma of the lung and pneumonia is formed. Hence another important feature: in focal pneumonia, a significant amount of serous or mucopurulent exudate is contained directly in the airway lumen pathways, which contributes to more or less pronounced violations of bronchial patency both at the level of respiratory bronchioles and at the level of larger bronchi.

Finally, fifthly, the relatively slow spread of inflammation within the affected segment leads to the fact that some of its areas are at different stages of the inflammatory process. While in one group of alveoli only hyperemia and edema of the interalveolar walls (stage of hyperemia) are revealed, the other groups of the alveoli are already completely filled with exudate (the stage of curation). Such a variegated morphological picture of the inflammation focus with uneven compaction of the lung tissue, which is very characteristic for bronchopneumonia, is supplemented by the presence of sites of micro-teleclases, caused by violation of patency of mainly small bronchi. Thus, for focal pneumonia as a whole, the staging of inflammation, which is detected in some patients with lobar (croupous) pneumonia, is not typical.

The clinical-morphological variant of focal pneumonia is characterized by the following pathogenetic and morphological features:

1. Relatively small length of the inflammatory focus, which captures 1 or more lobules or segment of the lung. An exception is the discharge pneumonia, which seizes significant parts of the lobe of the lung or even the entire lobe.
2. Focal pneumonia is accompanied by a normal or hyperergic reaction of the body, which determines a slower formation of an inflammatory focus and a moderate violation of vascular permeability.
3. Serous or muco-purulent exudate.
4. Involvement in the inflammatory process of bronchial tubes (bronchitis), which is accompanied by violations of patency of both small and (rarely) larger bronchi.
5. Absence of a clear staging of the inflammatory process, characteristic of croupous pneumonia.

These features of pathogenesis largely determine the clinical manifestations of focal pneumonia (bronchopneumonia). Nevertheless, it should be remembered that the biological properties of the causative agents of pneumonia and some other factors also have a significant effect on the clinical picture of this disease.

Resolve

In contrast to lobar (croupous) pneumonia, the onset of bronchopneumonia is more gradual and prolonged in time. Often focal pneumonia occurs as a complication of acute respiratory viral infection, acute or exacerbation of chronic bronchitis. Within a few days the patient notes an increase in body temperature to 38.0-38.5 ° C, a runny nose, a lacrimation, a cough with a mucous membrane or mucopurulent sputum, malaise and general weakness, which is regarded as a manifestation of acute tracheobronchitis or acute respiratory viral infection.

Against this background, it is very difficult to establish the onset of bronchopneumonia. Nevertheless, the ineffectiveness of the therapy conducted for several days, the increase in intoxication, the appearance of dyspnoea and tachycardia or a new "wave" of fever increases suggest that focal pneumonia occurs.

The patient is coughing up and secreting mucopurulent or purulent sputum, body temperature increases to 38.0-39.0 ° C (rarely higher), weakness is increased, the headache worsens appetite.

Pain in the chest, associated with involvement in the inflammatory process of the pleura (dry pleurisy), appear only in a part of patients with a superficial location of the focus or the presence of a drainage focal pneumonia. However, even in these cases, pleural pain usually does not reach the same intensity as observed with lobar pneumonia. Pain increases or appears with deep breathing; its localization corresponds to the defeat of various parietal pleura sites. In some cases (with lesions of the diaphragmatic pleura), there may be abdominal pain associated with breathing.

Physical examination

When examined, the hyperemia of the cheeks is determined, perhaps a small cyanosis of the lips, an increased moisture of the skin. Sometimes there is a significant pallor of the skin, which is explained by pronounced intoxication and reflex increase in the tone of peripheral vessels.

When examining the chest, the lag in the act of breathing on the side of the lesion is revealed only in a part of the patients, mainly in individuals with discharge focal pneumonia.

When percussion over the focus of the lesion, a blunt percussion sound is detected, although for a short duration inflammatory focus or deep location of his lung percussion is not informative.

The greatest diagnostic value is the auscultation of the lungs. Most often, over the area of ​​the lesion, a pronounced weakening of the respiration is determined due to impaired bronchial patency and the presence of a multitude of micro-teleclases in the inflammatory focus. As a result, the sound oscillations formed when air passes through the vocal chord, along the trachea and (partially) the main bronchi, do not reach the surface of the chest, creating the effect of weakening the breath. The presence of violations of bronchial patency explains the fact that even with draining focal bronchopneumonia, the pathological Bronchial respiration is not listened to as often as with lobar inflammation of the lungs.

In rare cases, when bronchopneumonia developed against a background of chronic obstructive bronchitis, and the focus of inflammation is deep, at auscultation, you can listen to hard breathing due to the narrowing of the bronchi located outside the pneumonic focus.

The most vivid and reliable auscultative sign of focal bronchopneumonia is the definition of small bubble moist sonorous (consonant) wheezing. They are heard locally on the area of ​​inflammation and are caused by the presence of inflammatory exudate in the airways. Small-bubbly moist sonorous rales are heard most of the time throughout the inhalation.

Finally, in some cases with the involvement of the pleural pleura in the inflammatory process, you can listen to the noise of friction of the pleura.

The most significant differences between the two clinical and morphological variants of pneumonia are: lobar (croupous) and focal inflammation of the lungs (bronchopneumonia).

Comparative characteristics of lobar (croupous) and focal pneumonia

Symptoms	Fractional pneumonia	Focal bronchopneumonia
Features of pathogenesis
The amount of damage	Share, segment	One or more lobules, segment; multiple foci of inflammation possible
Spread of inflammation	Immediately along the alveolar tissue (Kohn's pores)	Inflammation of the bronchi "passes" to the parenchyma of the lung
The immediate-type hypersensitivity reaction in the respiratory zone of the lungs	Typical	Not typical
Involvement of bronchial inflammation	Not typical	Characteristically
Airway transmission	Not violated	Disrupted, possibly the occurrence of micro-teleclactases
Involvement in the inflammatory process of the pleura	Always	Only with superficial localization of the focus of inflammation or with a drain pneumonia
Stages of development of morphological changes	Typical	Not typical
The nature of the exudate	Fibrinous	Muco-purulent, serous
Clinical Features
Onset of disease	Acute, sudden with chills, fever and chest pain	Gradual, after the period of acute respiratory infections, acute tracheobronchitis or exacerbation of chronic bronchitis
Chest pain ("pleural")	Typical	Rarely, only with superficial localization of the focus of inflammation or with drainage pneumonia
Cough	At first dry, then with the separation of "rusty" sputum	From the very beginning productive, with the separation of muco-purulent sputum
Symptoms of intoxication	Expressed	Less common and less pronounced
Dyspnea	Typical	Possible, but less often
Dullness of percussion sound	In the stage of curing, pronounced blunting of sound	Less pronounced, sometimes absent
Type of breathing during auscultation	In the stage of the tide and the stage of resolution - a weakened vesicular, in the stage of curation - bronchial	Mostly weakened breathing throughout the disease
Adverse respiratory noises	In the stage of the tide and the stage of resolution - crepitation, in the stage of curing - the noise of friction of the pleura	Wet, finely bubbly sonorous rales
The appearance of bronhofonii	Characteristically	Not typical

The most significant clinical signs that allow differences, focal bronchopneumonia from lobar pneumonia, are:

• gradual onset of the disease, which develops, as a rule, against the background of acute respiratory viral infection, acute tracheobronchitis, or exacerbation of chronic bronchitis;
• the absence in most cases of acute "pleural" pain in the chest;
• cough with separation of mucopurulent sputum;
• absence in most cases of bronchial respiration;
• presence of moist small-bubbly sonorous rales.

It should be added that the signs listed in the table, which make it possible to distinguish two clinico-morphological variants of pneumonia, belong to the typical classical course of these diseases, which is currently not always observed. This is particularly true for cases of severe hospital pneumonia or pneumonia that have developed in weakened patients and elderly and senile patients

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