How does pneumonia look on X-rays?
Pneumonia on X-rays is characterized by areas of darkening. They indicate the presence of an infiltrate (a swollen inflamed focus) in the lung tissue.
An x-ray photograph can show how much the darkening, its shapes, contours, quantity and location have spread.
Dimensions can be of different sizes. They are divided into
- Small-focal ones, the size of which reaches 3 mm;
- mid-elevation - from 3 to 7 mm;
- Large-focal, reaching 7-12 mm.
Also, blackouts can be total, subtotal, common. Thus, lung X-ray in pneumonia is an integral part of therapy.
Prevalence of pneumonia
Inflammation of the lungs can occur in both adults and children. In children, it is more common, since the respiratory system and immunity are in their developmental stage.
- hypothermia of the body;
- frequent regurgitation of babies;
- lack of vitamin D;
- prematurity of the child;
- poor nutrition;
- beriberi and anemia;
- decreased immunity;
- bad ecology;
- poor living conditions;
- smoking or smoking parents;
- various congenital malformations and diseases associated with the pulmonary system;
- nervous disorders.
The importance of lung X-rays in pneumonia
An important role in the diagnosis is given to the X-ray, since no other tests can provide reliable information. Before the chest X-ray, the task is not only to determine the lesion focus, but also to create a picture of the morphological variety of pathology. It can be focal, croup, fractional, mixed, draining, etc. The darkening areas on the x-ray are painted in a light color, and the areas of enlightenment in the dark.
What is the stage of resolution of pneumonia on the radiograph?
With the resolution of pneumonia, the following signs will be revealed on the roentgenogram:
- At the site of inflammation, the pulmonary structure is enriched with small elements.
- The root expands.
- Dimensions of the shadow are reduced.
- Darkening is reduced.
How do the complications of pneumonia look on the pictures? Complications after pneumonia also have their characteristics on the roentgenogram. For example, an abscess is detected by the appearance of cavities of the disintegration of lung tissue, which merge with each other. Exudative pleurisy is determined in the pictures due to the dimming of the lower pulmonary field. X-ray diagnosis of pneumonia can give the most accurate results of the disease.
Pneumonia in children
Most often the disease affects the child's body. The etiology of pneumonia is divided into:
- caused by invasion of helminths.
Symptoms of pneumonia in children are associated with the form of the disease and the course of the disease. The main ones are:
- Increased body temperature.
- Fast fatiguability.
- Discomfort in the lungs or under the shoulder blades.
- General intoxication of the body.
When listening, bronchophonia, mild breathing, crepitation are noted.
The pulmonary structure on the X-ray appears enhanced. A blood test can show an increase in white blood cells and ESR.
Complications of pneumonia include purulent formations that can be outside the lungs and cause otitis media, pyelonephritis, pericarditis, inflammation in the heart, which is rare, meningitis and other
Possible complications in the lungs:
- Abscess of the lung.
- Inflammation of the outer shell of the organ - pleurisy.
- The accumulation of gases or air in the pleura - pneumothorax.
To prevent such complications, it is necessary to start treatment with antibiotics in time.
Treatment of pneumonia in childrenIf the disease is severe, treatment is carried out in a hospital. Children under one year of age are subject to immediate hospitalization.
The treatment is of a complex nature and includes the following procedures:
- prescribes etiotropic drugs;
- if there is a respiratory insufficiency, oxygenotherapy is carried out;
- prescribe drugs to improve bronchial conductivity;
- means are used to improve the transport of blood;
- therapy aimed at improving tissue respiration;
- the appointment of funds to improve metabolic processes in the body.
During illness the child should eat due to the age, however the food should be sparing and saturated with vitamins and minerals. In view of the fact that the child constantly coughs, foods that irritate the pharynx should be excluded from the diet. The child should drink a lot of fluids. These can be broths of dogrose, currant currants, jelly and compotes. In the period of treatment, antibiotic therapy is mandatory.
Prognosis of recovery
If treatment was started in a timely manner, then the prognosis for recovery is favorable. In general, complete recovery comes a month after the disease.
If antibiotics are started on time, which lasts from 7 to 14 days, the inflammation resolves in 2-4 weeks. This can be confirmed by X-rays.In severe pneumonia, antibiotics are prescribed for two weeks or more. Degeneration of the focus of inflammation in this case can last for 1-2 months.
If you do not seek medical help on time, there may be complications that have been described above. In childhood, when there is insufficient treatment, the likelihood of a lethal outcome is high.
After discharge from the hospital, children are registered in a polyclinic, where a regular examination by a pulmonologist and an otolaryngologist is performed.
In addition, the doctor prescribes physiotherapy and exercise therapy with respiratory gymnastics. This contributes to the rapid recovery of the body. If there is such a possibility, then it is recommended to undergo a recovery period in specialized sanatoriums. Well helps herbal medicine using medicinal plants such as altea root, chamomile, sage, elephant, mother-and-stepmother. At home, treatment with mustard plasters, foot baths, inhalations with alkalis and herbs, compresses and iodine mesh on the chest area is applied. A chest massage is also prescribed.
Prevention of disease
The primary prevention of pneumonia is the healthy lifestyle of parents, especially the mother who is carrying the child.After the birth of the baby should be its timely and full-fledged feeding, in the future - tempering activities.
Secondary prevention is aimed at the following actions:
- Prevent and treat respiratory diseases.
- At the initial stage of the disease it is desirable to immediately hospitalize the child.
- Timely should be treated with hypotrophy, rickets and improve immunity.
- Do not let chronic inflammation occur.
With the correct treatment of uncomplicated pneumonia, a favorable outcome of the disease is possible. If the child is ill, do not self-medicate, immediately seek medical attention. X-ray diagnosis of pneumonia will accurately determine the diagnosis of the child, which will help in the future in his treatment. X-ray picture can indicate the exact area of inflammation, the extent of lung damage and its degree.
Diagnosis of pneumonia
Diagnosis of pneumonia is based on the identification of the five most simple and sufficiently informative clinical and laboratory and instrumental signs, called the "gold standard" of diagnosis:
- An acute onset of the disease, accompanied by an increase in body temperature above 38 ° C.
- Sudden appearance or marked increase in cough with separation of sputum mainly purulent and / and hemorrhagic nature.
- The appearance of previously missing local blunting (shortening) of percussion sound and the auscultatory phenomena described above, characteristic for lobular (croupous) or focal pneumonia (weakening of breathing, bronchial breathing, crepitation, wet fine bubbling sonorous rattles, noise of friction pleura).
- Leukocytosis or (less often) leukopenia in combination with neutrophil shift.
- X-ray signs of pneumonia - focal inflammatory infiltrates in the lungs, which had not previously been detected.
Differential diagnosis of pneumonia
Nevertheless, modern approaches to etiotropic treatment of patients with pneumonia require a number of additional laboratory and instrumental tests with a view to the possible identification of the pathogen, differential diagnosis of pulmonary disease, assessment of the functional state of the respiratory system and timely diagnosis of complications disease. To this end, in addition to chest X-ray, general and biochemical blood analysis, the following additional studies are envisaged:
- sputum examination (microscopy of the colored preparation and sowing to identify the pathogen);
- evaluation of the function of external respiration;
- The study of blood gases and oxygen saturation of arterial blood (in cases
- pneumonia of severe course to be treated in the ICU;
- repeated blood tests "for sterility" (with suspicion of bacteremia and sepsis);
- X-ray computed tomography (with insufficient informativeness of the traditional X-ray study);
- Pleural puncture (in the presence of effusion) and some others.
The choice of each of these methods is individual and should be based on an analysis of the clinical picture of the disease and the effectiveness of the diagnosis, differential diagnosis and treatment.
Radiographic diagnosis of pneumonia
X-ray methods of investigation are crucial in the diagnosis of pneumonia. Currently, the clinic is widely used methods such as X-ray and chest X-ray, tomography, computed tomography. The practitioner should be well aware of the possibilities of these methods, so that in each case diseases correctly choose the most informative ones and, if possible, reduce the radiation load on the patient.
It should be borne in mind that one of the most accessible and common methods of X-ray studies - fluoroscopy of the chest - has a number of significant deficiencies, and exactly:
- differs in the well-known subjectivity of the interpretation of the radiographic picture,
- does not provide an opportunity to objectively compare the radiographic data obtained during repeated studies and
- accompanied by a large radiation burden on the patient and the medical staff.
Therefore, the field of application of fluoroscopy in clinical practice, apparently, should be limited to the study of chest organs in the process of their movement (for example, the study of the mobility of the diaphragm, the nature of the movements of the heart when it is contracted, etc.) and clarifying the topography of pathological changes in the lungs using different positions patient.
The main method of radiographic examination of the respiratory system is radiography in two projections - direct and lateral, allowing to receive objective and documented information on the state of the thoracic organs cells. In this case, it is necessary, as far as possible, to encircle not only the nature of the pathological process, but also to accurately determine its localization, corresponding to the projection of a particular proportion of the lung and pulmonary segments.
X-ray diagnosis of pneumonia is based on the results of a study of pulmonary fields, including the evaluation of:
- features of the pulmonary pattern;
- condition of the roots of the lungs;
- presence of widespread or limited darkening of pulmonary fields (compaction of lung tissue);
- the presence of limited or diffuse bleaching of lung tissue (increased airiness).
Of great importance is also the evaluation of the state of the skeleton of the chest and the determination of the position of the diaphragm.
The roots of the lungs located in the middle zone of the pulmonary fields between the anterior ends of the II and IV ribs are formed by shadows of the branches of the pulmonary artery and pulmonary veins, as well as of the large bronchi. Depending on their location in relation to the plane of the screen, they are represented on the X-ray in the form of branching strips or clear round or oval formations. The shadows of the vessels forming the root of the lung continue and beyond its limits in the pulmonary fields, forming a pulmonary pattern. Normally, it is well marked in the central basal zone, and on the periphery is represented by only a few, very small, vascular branches.
The following is a brief description of the radiographic pattern characteristic of the two clinical and morphological variants pneumonia (croup and focal), as well as some features of radiological changes in pneumonia of various etiology.
Tomography is an additional method of "layer-by-layer" radiological examination of organs, which is used in patients with pneumonia for a more detailed the study of the pulmonary pattern, the nature of the pathological process in the pulmonary parenchyma and interstitium, the state of the tracheobronchial tree, the roots of the lungs, the mediastinum etc.
The principle of the method is that as a result of the synchronous movement of the X-ray tube and the film cassette in the opposite direction on the film a fairly clear image is obtained only of those parts of the organ (its "layers") that are located at the center level or the axis of rotation of the tube and cassette. All the other details ("elephant") that are outside this plane are, as it were, "smeared their image becomes blurred.
To obtain a multi-layered image, special cassettes are used, in which several films are placed at a suitable distance from each other. More commonly used is the so-called longitudinal tomography, where the separated layers are in the longitudinal direction. The "swing angle" of the tube (and cassette) is usually 30-45 °. This method is used to study pulmonary vessels. To evaluate the aorta, pulmonary artery, lower and upper hollow, it is better to use a transverse tomography.
In all cases, the choice of the depth of tomographic examination, exposure value, swing angle and other technical parameters of the study is carried out only after the analysis of the pre-made x-ray snapshot.
With diseases of the respiratory system, the method of tomography is used to clarify the nature and individual details of the pathological process in the lungs, as well as to assess the morphological changes in the trachea, bronchus, lymph nodes, vessels, etc. This method is particularly important in the study of patients who are suspected of having a tumor in the lungs, bronchi and pleura.
The program of examination for suspected pneumonia
According to the consensus of the Russian Congress of Pulmonology (1995), the following research is recommended for pneumonia.
- Research, mandatory for all patients
- clinical examination of patients;
- a clinical blood test;
- X-ray of the lungs in two projections;
- bacterioscopy of sputum stained by Gram;
- sputum culture with a quantitative assessment of the flora and the definition of its sensitivity to antibiotics;
- general urine analysis.
- Studies conducted according to the indications
- study of the function of external respiration in case of ventilation disorders;
- study of blood gases and acid-base balance in severe patients with respiratory failure;
- pleural puncture followed by a pleural fluid study in patients with fluid in the pleural cavity;
- tomography of the lungs with suspected destruction of lung tissue or lung neoplasm;
- serological tests (detection of antibodies to the pathogen) - with atypical pneumonia;
- biochemical analysis of blood in severe pneumonia in persons over 60;
- fibrobronchoscopy - if suspected of swelling, hemoptysis, with prolonged pneumonia;
- the study of the immunological status - with a prolonged course of pneumonia and in persons with signs of immunodeficiency;
- scintigraphy of the lungs - with suspected PE.
X-ray signs of croupous pneumonia
Stage of the tide
The earliest radiologic change that occurs on the first day of croupous pneumonia (tidal stage) is an increase pulmonary pattern in the affected lobe, due to increased blood filling of the vessels of the lungs, as well as inflammatory pulmonary edema tissue. Thus, in the tidal stage, both vascular and interstitial components of the pulmonary pattern are intensified.
There is also a slight expansion of the lung root on the side of the lesion, its structure becomes less distinct. In this case, the transparency of the pulmonary field is practically unchanged or slightly reduced.
If the focus of the forming croupous pneumonia is located in the lower lobe, a decrease in the mobility of the corresponding dome of the diaphragm is observed.
The stage of custody
The stage of curation is characterized by the appearance on the 2nd-3rd day of the onset of the disease of intense homogeneous darkening, corresponding to the projection of the affected lobe of the lung. The intensity of the shadow is more pronounced on the periphery. The size of the affected lobe is slightly enlarged or not changed; a decrease in the volume of the share is observed comparatively rarely. There is an expansion of the lung root on the side of the lesion, the root becomes unstructured. The pleura is compacted. The lumen of large bronchi with croupous pneumonia remains free.
Stage of resolution
The resolution stage is characterized by a gradual decrease in the intensity of the shadow and its fragmentation. In uncomplicated pneumonia, after -3 weeks, complete resolution of the infiltrate occurs. In other cases, the reinforcement of the pulmonary pattern with areas of its deformation is preserved on the site of the affected part, which is the radiographic evidence of pneumofibrosis. At the same time, a small seal of the pleura remains.
X-ray signs of focal pneumonia
Focal bronchopneumonia is characterized by infiltration of alveolar and interstitial tissue and involvement in the inflammatory process of the lung root on the side of the lesion. At the initial stages of the disease there is a local enhancement of the pulmonary pattern and a slight expansion of the lung root. After a while in the pulmonary field, relatively small (from, to, cm in diameter) and diverse in form foci of infiltration (dimming) begin to appear. They are characterized by a multiplicity, different size, low intensity of the shadow, blurred outlines and, as a rule, are accompanied by an intensification of the pulmonary pattern. The roots of the lungs become enlarged, slightly structured, with indistinct contours.
Often there are several enlarged peribronchial lymph nodes. There is also a limitation of the mobility of the dome of the diaphragm.
In uncomplicated cases under the influence of anti-inflammatory treatment, a positive dynamics of the radiographic pattern is usually observed and after 2 weeks, pulmonary infiltrates dissolve. Sometimes bronchopneumonia can be complicated by reactive pleurisy or destruction of lung tissue.
X-ray signs of staphylococcal pneumonia
X-ray picture of staphylococcal pneumonia is characterized by the presence of multiple inflammatory infiltrates, most often located in both lungs. Inflammatory infiltrates often merge. There is a tendency to their disintegration with the formation, against the background of shadows, of limited bleaching with a horizontal liquid level. With the "bullous form" of pneumonia, the cavities can disappear without a trace in one place and appear in others. Often there is effusion in the pleural cavity.
After the resolution of staphylococcal pneumonia the strengthening of the pulmonary pattern persists for a long time, and in some cases Areas of pionmosclerosis are formed, cysts remain on the place of the cavities, the pleural sheets are preserved (mooring lines).
X-ray signs of pneumonia caused by Klebsiella
The peculiarity of Friedlander pneumonia, caused by klebsiella, is the vastness of the lesion of lung tissue, which radiologically manifests itself from the first days of the disease. Multiple large or smaller inflammatory infiltrates quickly merge with each other, capturing large areas of the lung, often corresponding to the projection of a whole lobe of the lung ("pseudoblary" pneumonia). Quite quickly in the infiltrate, multiple decay cavities appear, which also tend to merge and form a large cavity with a horizontal liquid level. Often, the disease is complicated by the development of exudative pleurisy.
The course of Friedlander pneumonia is long (up to 2-3 months). After recovery, as a rule, remain areas of pronounced pynmosclerosis and lung lining. Often formed bronchiectasises, and the pleural cavity is partially obliterated.
X-ray signs of pneumonia caused by intracellular pathogens
With legionellosis pneumonia, radiographic changes are diverse. Most often, multiple infiltrates are detected in both lungs, which later merge into a large shared darkening. Disintegration of the tissue and the formation of abscesses are rare. Degeneration of infiltrates and normalization of the radiographic pattern in uncomplicated course of the disease occurs in 8-10 weeks.
With mycoplasmal pneumonia, only local enhancement and deformation of the pulmonary pattern can be detected on the radiographs, reflecting the infiltration of the interstitial tissue. Some patients in this foyer have low intensity focal shadows that tend to merge. Normalization of the radiographic pattern occurs through 2-4 pedules.
In chlamydial pneumonia, focal reinforcement and deformation of the pulmonary pattern, expansion of the lung root and pleural reaction in the form of its consolidation are also initially determined. Further on this background, numerous inflammatory foci, of low intensity, with indistinct contours can appear. After their disappearance against the background of treatment for a long time, the enhancement of the pulmonary pattern persists, and sometimes discoid atelectasis is seen. Normalization of the radiographic pattern occurs in 3-5 weeks.
Computed tomography with pneumonia
Computed tomography (CT) is a highly informative method of X-ray examination of a patient, which is becoming increasingly common in clinical practice. The method is characterized by high resolution, allowing to visualize foci up to 1-2 mm in size, the possibility of obtaining quantitative information about the density of tissues and the convenience of presenting an x-ray picture in the form of thin (up to 1 mm) successive transverse or longitudinal "slices" of the investigated bodies.
The transmission of each tissue layer is carried out in a pulsed mode by means of an X-ray tube with a slot collimator that rotates about the longitudinal axis of the patient's body. The number of such translucent images at different angles is 360 or 720. Each time the X-rays pass through the tissue layer, the radiation attenuates, depending on the density of the individual structures of the layer under study. The degree of attenuation of X-ray radiation is measured by a large number of special highly sensitive detectors, after which all the information obtained is processed by a high-speed computer. As a result, a cut image of the organ is obtained in which the brightness of each coordinate point corresponds to the density of the tissue. Image analysis is carried out both in automatic mode using computers and special programs, and visually.
Depending on the specific tasks of the study and the nature of the pathological process in the lungs, the physician-operator can choose the thickness of the axial sections and the direction of tomography, as well as one of the three modes research.
- Continuous CT, when all images of all sections of the organ are successively obtained. This method of tomography makes it possible to obtain maximum information about morphological changes, but it differs in the large radiation load and in the cost of the study.
- A discrete CT with a given relatively large interval between slices, which significantly reduces the radiation load, leading to the loss of some information.
- Aimed CT scan consists of a careful layer-by-layer examination of one or several areas of the organ of interest to the physician, usually in the area of pathology previously identified.
Continuous CT of the lung allows you to get maximum information about pathological changes in the organ and is shown before all with volumetric processes in the lungs, when there is no evidence of lung cancer or metastatic lesion bodies. In these cases, CT provides an opportunity to study in detail the structure and dimensions of the tumor itself and to clarify the presence of metastatic lesion pleura, mediastinal lymph nodes, lung roots and retroperitoneal space (with CT of the abdominal cavity and retroperitoneal space).
Discrete CT is more indicated for diffuse pathological processes in the lungs (pyevmoconiosis, alveolitis, chronic bronchitis, etc.), when operative treatment is supposed.
Sighting CT is used mainly in patients with established diagnosis and the established nature of the pathological process, for example, to clarify the contour of volumetric formation, the presence of necrosis, the state of the surrounding lung tissue etc.
Computer tomography has significant advantages over conventional X-ray examination, since it allows to detect more subtle details of the pathological process. Therefore, indications for the use of CT in clinical practice are in principle quite broad. The only significant factor limiting the application of the method is its high cost and its low availability for some medical institutions. Considering this, one can agree with the opinion of a number of researchers that "the most common indications for CT of the lungs arise when the informativeness routine radiographic examination is not sufficient for the establishment of a languorous diagnosis and the results of CT can affect the tactics treatment ".
In patients with pneumonia, the need for CT is about 10%. With CT, infiltrative changes in the lungs are detected at earlier stages of the disease.
General clinical blood test for pneumonia
The general clinical analysis of blood is included in the mandatory plan of examination of all inpatients and outpatients with pneumonia. The greatest diagnostic value is counting the number of leukocytes, determining the leukocyte formula and ESR.
Number of leukocytes
Normally, the total number of leukocytes is (, ) × 109 / l.
Leukocytosis is typical for the majority of patients with bacterial pneumonia. It indicates the acceleration of the maturation of leukocytes in the organs of hematopoiesis under the influence of numerous natural stimulants of leukopoiesis: physical and chemical factors of inflammation, including inflammatory mediators, tissue decay products, hypoxemia, formed immune complexes, some toxic substances, increased function of the pituitary-adrenal system, which controls the maturation of leukocytes, and others. Most of these factors are natural signals to the activation of protective functions of leukocytes.
Leukocytosis in patients with pneumonia in most cases reflects a satisfactory reactivity of the system of bone marrow hematopoiesis in response to the action of external and internal stimulants of leukopoiesis. At the same time, leukocytosis is a fairly sensitive marker of the severity of the inflammatory process in the lungs
At the same time, it should be remembered that in pneumonia caused by chlamydia, in most cases there is moderate leukopenia (a decrease in the number of leukocytes is less, x 10 ° / l). With mycoplasmal pneumonia, the total number of leukocytes usually remains normal (about, x 109 / L), although in 10-15% of cases, leukocytosis or leukopenia is determined. Finally, viral infections are usually accompanied by an increase in ESR and a normal or reduced number of leukocytes (leukopenia).
In all other cases of bacterial pneumonia caused by pneumococci, streptococci, staphylococci, hemophilic rod, Legionella, Klebsiella, Pseudomonas rod, etc., the appearance of leukopenia, as a rule, indicates a significant oppression of leukopoiesis in the hematopoietic organs and is a very unfavorable prognostic sign. More often it is observed in the elderly, exhausted and weakened patients, which is associated with a decrease in immunity and the general resistance of the body. In addition, it should be remembered that leukopenia can be associated with the use of certain drugs (antibiotics, cytostatics, non-steroidal anti-inflammatory drugs, etc.) and autoimmune processes complicating, in particular, the course pneumonia.
Leukocytosis is typical for most patients with bacterial pneumonia. The exception is pneumonia caused by chlamydia and mycoplasma, as well as most viral infections in which moderate leukopenia or normal white blood cell count can be observed.
The appearance of leukopenia in patients with bacterial pneumonia may indicate a significant inhibition of leukopoiesis and is a very unfavorable prognostic sign, indicating a decrease in immunity and overall resistance organism. In addition, leukopenia can develop on the background of treatment with antibiotics, cytostatics and non-steroidal anti-inflammatory drugs.
The leukocyte formula is the percentage of different types of leukocytes in the peripheral blood. Counting of the leukocyte formula is carried out by immersion microscopy of stained smears stained by Romanovsky-Giemsa or by other methods.
Differentiation of different types of leukocytes and counting of the leukocyte formula requires a good knowledge of the morphological features of different leukocytes and the general scheme of hematopoiesis. Myeloid hematopoiesis is represented by cells of granulocyte, megakaryocytic, monocytic and erythrocyte germs of hematopoiesis.
Granulocytes are blood cells, the most characteristic morphological feature of which is the clearly expressed granularity of the cytoplasm (neutrophilic, eosinophilic or basophilic). These cells have a common precursor and a single evolution up to the stage of promyelocyte, after which a gradual differentiation of granulocytes into neutrophils, eosinophils and basophils, which differ significantly in their structure and function.
Neutrophils have abundant, fine, dust-like granularity of a pinkish-violet color. Mature eosinophils differ large, occupying the entire cytoplasm, granularity, which has a scarlet color ("ketovaya caviar"). The granularity of basophils is large, heterogeneous, dark purple or black in color.
Young immature granulocyte cells (myeloblast, promyelocyte, neutrophilic, eosinophilic and basophilic myelocytes and megayelocytes) of larger sizes, have a large round or slightly concave nucleus with a more gentle and fine pattern and light color. Their nuclei often contain nucleols (nucleoli).
Mature granulocytes (rod and segmented nuclei) are smaller in size, their nuclei of a darker color have the appearance of curved rods or individual segments connected by a "thread" of nuclear matter. The nuclei do not contain nucleol.
Cells of monocyte sprouts are characterized by a pale blue or grayish color of the cytoplasm, devoid of the pronounced granularity that is characteristic of granulocytes. In the cytoplasm, only individual small azurophil granules can be detected, as well as vacuoles. In immature cells of the monocytic series (monoblast, promonocyte), the nucleus is large, occupying a large part of the cell. The nucleus of a mature monocyte is smaller and has the appearance of a butterfly or fungus, although it can often take quite bizarre forms.
For cells of the lymphoid germ of hematopoiesis (lymphoblasts, prolymphocytes and lymphocytes), a very large, rounded, sometimes Bobovidio nucleus of a dense structure that occupies almost the entire cell is characteristic. The blue or blue cytoplasm is located in a narrow band around the nucleus. It is devoid of specific granularity, and therefore lymphocytes along with monocytes are called agranulocytes. Normally, as is known, in peripheral blood only mature cells of leukocytes are detected:
- segmented neutrophils, eosinophils and basophils;
- stab neutrophils (sometimes - eosinophils);
Degenerative forms of leukocytes
In addition to the cells described above, with pneumonia, infections and purulent-inflammatory diseases, there are so-called pre-generative forms of leukocytes. The most common are their following forms
- Neutrophils with toxic granularity and vacuolation of the cytoplasm. The toxic granularity of neutrophils arises from the coagulation of the cytoplasmic protein under the influence of an infectious or toxic agent. In these cases, in addition to the fine, fine granularity typical for neutrophils, large coarse basophil-colored granules and vacuoles appear in the cytoplasm. The toxic granularity and vacuolization of the cytoplasm of neutrophils and monocytes is often found in severe pneumonia, for example with severe pneumococcal croupous pneumonia and other purulent-inflammatory diseases, accompanied by severe intoxication.
- Hypersegmented neutrophils, the core of which consists of 6 or more segments, occur with B12 folio-deficient anemia, leukemia, as well as some infections and purulent-inflammatory diseases, reflecting the so-called nuclear shift of neutrophils to the right.
- Degenerative changes in lymphocytes in the form of a picnotically altered nucleus, sometimes having a bilobate structure, and weak development or absence of cytoplasm
- Atypical mononuclears are cells that combine certain morphological signs of lymphocytes and monocytes: they are larger than normal lymphocytes, but sizes do not reach monocytes, although they contain a monocytic nucleus. According to morphology, lymphomonocytes resemble blast cells and are often found in infectious mononucleosis.
Interpretation of results
Leukocyte formula in healthy people
% of the total number of leukocytes
Absolute quantity (n x 109 / l)
At various pathological conditions, including at pneumonia, can occur:
- change in the leukocyte formula (increase or decrease of any type of white blood cells);
- the appearance of various degenerative changes in the nucleus and cytoplasm of mature leukocyte cells (neutrophils, lymphocytes and monocytes);
- appearance in the peripheral blood of young immature leukocytes.
To correctly interpret changes in the leukocyte formula, it is necessary to evaluate not only the percentage ratios of different types of leukocytes, but also their absolute content in 1 liter of blood. This is due to the fact that the change in the percentage of individual types of white blood cells does not always correspond to their true increase or decrease. For example, with leukopenia due to a decrease in the number of neutrophils, blood can be detected a relative increase in the percentage of lymphocytes and monocytes, whereas their absolute number will in fact be fine.
If along with the percentage increase or decrease of individual types of leukocytes, a corresponding change in their absolute content in 1 liter of blood is observed, it is said about their absolute change. The increase or decrease in the percentage of cells with their normal absolute content in the blood corresponds to the concept of relative change.
Consider the diagnostic significance of some changes in the leukocyte formula, the most common in clinical practice, including in patients with pneumonia.
Neutrophilia - an increase in the number of neutrophils is greater, x 109 / l - is a reflection of a unique defense of the organism in response to the action of numerous exogenous and endogenous factors. The most frequent (but not the only) causes of neutrophilia, in most cases combined with leukocytosis, are:
- Acute infections (bacterial, parasitic, fungal, rickettsial, etc.).
- Acute inflammatory and purulent processes (pneumonia, sepsis, abscess, exudative pleurisy, empyema of the pleura and many others).
- Diseases accompanied by necrosis, decay and tissue damage.
When evaluating the diagnostic and prognostic significance of a neutrophil shift, it is important to determine the percentage of immature and mature forms of neutrophils. To do this, calculate the nuclear neutrophil shift index - the ratio of the content of myelocytes, metamyelocytes and stab neutrophils to segmented nuclei.
Nuclear shear index = myelocytes + metamyelocytes + stab-stem / segment-nuclear
Normally, the nuclear shear index is equal to 5,.
- The shift of the blood formula to the left is an increase in the number of stab neutrophils in the peripheral blood and (rarely) the appearance in a small number of immature granulocytes (metamyelocytes, myelocytes and even single myeloblasts), which indicates a significant stimulation of the bone marrow and acceleration leukopoiesis. The nuclear neutrophil shift index is greater than,.
- The shift of the blood formula to the right is an increase in the number of mature segment neutrophils in the peripheral blood, the appearance of hypersegmented ones, and the decrease or disappearance of stab neutrophils. The nuclear shear index is less, 5.
In the majority of patients with pneumonia, acute infections, purulent-inflammatory and other diseases accompanied by neutrophilia, the shift of formula blood to the left is limited only by an increase in the number of stab neutrophils (hyporegenerative nuclear shift), which in combination with moderate leukocytosis, as a rule, indicates a relatively easy flowing infection or a limited purulent-inflammatory process and good resistance organism.
With a severe course of the disease and the preserved resistance of the body, a shift in the blood formula to metamyelocytes, myelocytes and (less often) to myeloblasts (hyperregenerative nuclear shift to the left), which, in combination with high leukocytosis and neutrophilia, is referred to as a leukemoid reaction of the myeloid type, because it resembles a picture of the blood at myeloid leukemia. These changes are usually accompanied by hypo- and aneosinophilia, relative lymphocytopenia and monocytopenia.
Neutrophilia with degenerative nuclear shift to the left, which is manifested by an increase in immature forms of neutrophils and appearance in peripheral blood degenerate changed segment neutrophils (toxic granularity, pycnosis of nuclei, vacuolation of the cytoplasm) is also observed in severe pneumonia. Purulent-inflammatory diseases and endogenous intoxications and indicates oppression of the functional activity of the bone marrow.
Neutrophilia with a marked shift of the blood formula to the left in combination with a slight leukocytosis or leukopenia, as a rule, indicates a severe course of the pathological process and poor resistance organism. Often such a picture of blood is observed in elderly and senile patients and in weakened and depleted patients.
Neutrophilia with nuclear shift to the right (increase in segmented and hyperpigmented neutrophils, decrease or disappearance of stab neutrophils), as rule, speaks about a good, adequate protective reaction of bone marrow hematopoiesis on infection or inflammation and about the favorable course of the disease.
Severe course of many pneumonia, also infectious, generalized pyoinflammatory, degenerative and other diseases with the preserved resistance of the organism is often accompanied by severe neutrophilia, leukocytosis and hyperregenerative shift of the blood formula to the left.
The appearance in the peripheral blood of degenerative forms of neutrophils (toxic granularity, pycnosis of nuclei and other changes), as well as pronounced neutrophilia and nuclear shift to the left in combination with a small leukocytosis or leukopenia in most cases indicate a depression of the functional activity of the bone marrow, a decrease in the body's resistance and are very unfavorable signs.
Neutropenia - a decrease in the number of neutrophils below, x 109 / l - indicates functional or organic oppression of the medullary hematopoiesis or the intensive destruction of neutrophils under the influence of antibodies to leukocytes, circulating immune complexes or toxic factors (autoimmune diseases, tumors, aleukemic forms of leukemia, the effect of certain medications, hypersplenism and etc.). It should also be borne in mind the possibility of a temporary redistribution of neutrophils within the vascular bed, which can be observed, for example, in shock. Neutropenia is usually combined with a decrease in the total number of leukocytes - leukopenia.
The most common causes of neutropenia are:
- Infections: viral (influenza, measles, rubella, chicken pox, infectious hepatitis, AIDS), some bacterial (typhoid fever, paratyphoid, brucellosis), rickettsial (typhus), protozoal (malaria, toxoplasmosis).
- Other acute and chronic infections and inflammatory diseases that occur in severe form and / or acquire the character of generalized infections
- The effect of certain medications (cytostatics, sulfonamides, analgesics, anticonvulsants, antithyroid drugs, etc.).
Neutropenia, especially associated with a neutrophilic shift to the left, and developing against a background of purulent-inflammatory processes, for which is typical of neutrophilia, indicates a significant decrease in the body's resistance and unfavorable prognosis disease. Such a reaction of bone marrow hematopoiesis in patients with pneumonia is most typical for depleted, weakened patients and persons of elderly and senile age.
Eosinophilia - an increase in the number of eosinophils in the peripheral blood is greater, x 10 e / l - most often a consequence of pathological processes in which the basis lies the formation of antigen-antibody complexes or diseases accompanied by autoimmune processes or bone marrow proliferation of the eosinophilic germ hematopoiesis:
- Allergic diseases (bronchial asthma, hives, hay fever, angioedema, serum sickness, drug disease).
- Parasitic infestations (trichinosis, echinococcosis, opisthorchiasis, ascariasis, diphyllobothriasis, giardiasis, malaria, etc.).
- Diseases of connective tissue (nodular periarteritis, rheumatoid arthritis, scleroderma, systemic lupus erythematosus).
- Nonspecific ulcerative colitis.
- Diseases of the skin (dermatitis, eczema, pemphigus, skinwort, etc.).
- Diseases of the blood (lymphogranulomatosis, erythremia, chronic myelogenous leukemia).
- Eosinophilic lung infiltrate.
- Fibroplastic parietal endocarditis of Leffler.
Moderate eosinophilia often develops during the reconvalescence of patients with pneumonia and other acute infectious and inflammatory diseases ("scarlet dawn of recovery"). In these cases, eosinophilia, as a rule, is combined with a decrease in the previously observed neutrophilia and leukocytosis.
Eosinopenia - a decrease or disappearance in the peripheral blood of eosinophils - is often detected with infectious and purulent-inflammatory diseases and, along with leukocytosis, neutrophilia and a nuclear shift of the blood formula to the left, is an important laboratory sign of an active inflammatory process and a normal (adequate) reaction of bone marrow hematopoiesis inflammation.
Eosinopenia, detected in patients with pneumonia and purulent-inflammatory diseases, in combination with neutropenia, leukopenia and shear The formula of blood to the left, as a rule, reflects a decrease in the body's resistance and is a very unfavorable prognostic sign.
Basophilia - an increase in the number of basophils in the blood - in clinical practice, including with pneumonia, is rare. Among the diseases most often accompanied by basophilia, we can distinguish the following:
- Myeloproliferative diseases (chronic myelogenous leukemia, myelofibrosis with myeloid metaplasia, true polycythemia - Vaquez disease);
- Hypothyroidism (myxedema);
- Chronic hemolytic anemia.
Absence of basophils in peripheral blood (basbopenia) has no diagnostic value. It is sometimes seen in hyperthyroidism, acute infections, after taking corticosteroids.
Lymphocytosis - an increase in the number of lymphocytes in the peripheral blood. In clinical practice, there is a relative lymphocytosis, that is, an increase in the percentage of lymphocytes with a normal (or even slightly reduced) absolute number of lymphocytes. Relative lymphocytosis is detected in all diseases accompanied by absolute neutropenia and leukopenia, including in viral infections (influenza), purulent - inflammatory diseases that occur against the background of a decrease in body resistance and neutropenia, as well as in typhoid, brucellosis, leishmaniasis, agranulocytosis, and others.
Absolute increase in the number of lymphocytes in the blood is greater, x 109 / l (absolute lymphocytosis) is typical for a number of diseases:
- Acute infections (including the so-called childhood infections: pertussis, measles, rubella, chicken pox, scarlet fever, infectious mononucleosis, mumps, acute infectious lymphocytosis, acute viral hepatitis, cytomegalovirus infection and etc.).
- Acute and chronic lymphatic leukemia.
Contrary to popular belief, lymphocytosis with purulent-inflammatory diseases and pneumonia can not considered as a reliable laboratory indication of the compensatory response of the immune system and the onset of recovery. Lymphocytopenia - a decrease in the number of lymphocytes in the peripheral blood. Relative lymphocytopenia is observed in such diseases and at a stage in the development of the pathological process for which characterized by an absolute increase in the number of neutrophils (neutrophilia): various infections, purulent-inflammatory diseases, pneumonia. Therefore, in most cases, such relative lymphocytopenia of independent diagnostic and prognostic value does not matter
Absolute lymphocytopenia with a decrease in the number of lymphocytes is lower, x 109 / l may indicate a deficiency of the T-system of immunity (immunodeficiency) and requires more thorough immunological examination of blood, including evaluation of the parameters of humoral cellular immunity and phagocytic activity white blood cells.
Monocytosis is also relative and absolute.
Relative monocytosis is often found in diseases that occur with absolute neutropenia and leukopenia, and its independent diagnostic value in these cases is small.
Absolute monocytosis, detected in certain infections and purulent-inflammatory processes, should to evaluate, first of all, bearing in mind that the main functions of the monocyte-macrophage series are:
- Protection against certain classes of microorganisms.
- Interaction with antigens and lymphocytes in separate stages of the immune reaction.
- Elimination of affected or aged cells.
Absolute monocytosis occurs in the following diseases:
- Some infections (infectious mononucleosis, subacute septic endocarditis, viral, fungal, rickettsial and protozoal infections).
- Prolonged leaking inflammatory diseases.
- Granulomatous diseases (active tuberculosis, brucellosis, sarcoidosis, nonspecific ulcerative colitis, etc.).
- Diseases of the blood: acute myocytic leukemia, chronic myelogenous leukemia, myeloma, lymphogranulomatosis, other lymphomas, aplastic anemia.
In the first three cases (infections, purulent-inflammatory diseases), absolute monocytosis may indicate the development of pronounced immune processes in the body.
Monocytonies - a decrease or even a complete absence of monocytes in peripheral crocks - often develops during severe pneumonia, infectious and purulent-inflammatory diseases.
Leukemoid reactions are pathological reactions of the hematopoietic system, accompanied by the appearance in the peripheral blood of young immature leukocytes, which indicates a significant stimulation of the bone marrow and acceleration leukopoiesis. In these cases, the picture of the blood outwardly resembles the changes detected in leukemia. Leukemoid reactions are more often combined with pronounced leukocytosis, although in more rare cases can develop and against the background of a normal number of leukocytes or even leukopenia.
There are leukemoid reactions 1) myeloid type, 2) lymphatic (or monocytic-lymphatic) type, 3) eosinophilic type.
The leukemoid reaction of the myeloid type is accompanied by a shift in the blood formula to metamyelocytes, myelocytes and myeloblasts and are observed in severe infectious, purulent-inflammatory, septic, degenerative and other diseases and intoxications, which are characterized by hyper-regenerative nuclear shift neutrophils to the left. A particularly severe and prognostically unfavorable symptom in these diseases is the combination leukemia reaction with a normal or decreased number of leukocytes and neutrophils (leukopenia and neutropenia).
Erythrocyte sedimentation rate (ESR)
The determination of ESR is based on the property of erythrocytes to settle on the bottom of the vessel under the influence of gravity. To this end, the micromethod TP is usually used. Panchenkov. ESR is determined 1 h after the start of the study for plasma column size over the settled red blood cells. In norm or rate ESR at men makes 2-10, and at women - 4-15 mm at an o'clock.
The mechanism of agglomeration of erythrocytes and their subsidence is extremely complex and depends on many factors, first turn from the qualitative and quantitative composition of blood plasma and from the physicochemical properties of erythrocytes.
As is known, the most frequent cause of increased ESR is an increase in plasma content coarsely dispersed proteins (fibrinogen, and beta and gamma globulins, paraproteins), as well as a decrease the content of albumins. Coarse proteins have a smaller negative charge. Adsorbed on negatively charged erythrocytes, they reduce their surface charge and promote the convergence of red blood cells and their faster agglomeration.
The increase in ESR is one of the characteristic laboratory signs of pneumonia, the immediate cause of which is accumulation in the blood of coarsely dispersed fractions of globulins (more often than beta and gamma fractions), fibrinogen and other proteins of the acute phase inflammation. There is a definite correlation between the severity of inflammation of the lung tissue and the degree of ESR increase.
At the same time, it should be remembered that the increase in ESR is, although very sensitive, according to the nonspecific hematological index, the increase of which can be associated not only with inflammation, but also with any pathological process leading to severe disproteinemia (connective tissue diseases, hemoblastoses, tumors, anemia, tissue necrosis, liver and kidney disease, and etc.).
On the other hand, in patients with pneumonia, ESR may not be increased, if there is also condensation blood (increase in viscosity) or a decrease in pH (acidosis), which causes, as is known, a decrease in agglomeration erythrocytes
In addition, in the early stages of some viral infections there is also no increase in ESR, which can to some extent distort the results of the study in patients with viral-bacterial pneumonia.
Biochemical blood test for pneumonia
Evaluation of the results of biochemical blood testing in patients with pneumonia, especially in dynamics - in the course of the development of the disease, has great diagnostic and prognostic value. Changes in various biochemical indicators, being in most cases nonspecific, allow us to judge the nature and degree of disruption of processes metabolism both in the whole organism and in separate organs Comparison of this information with the clinical picture of the disease and the results of other laboratory and instrumental methods of investigation makes it possible to assess the functional state of the liver, kidneys, pancreas, endocrine organs, the system of hemostasis, and often - to make representations about the nature of the pathological process, the activity of inflammation and to recognize in a timely manner a number complications of pneumonia.
Protein and protein fractions
Determination of protein and protein fractions in patients with pneumonia is of particular importance, primarily to assess the activity of the inflammatory process. The concentration of proteins in a healthy person's plasma ranges from 65 to 85 g / l. The bulk of the total protein of the blood plasma (about 90%) is accounted for by albumins, globulins and fibrinogen.
Albumins are the most homogeneous fraction of simple proteins, almost exclusively synthesized in the liver. About 40% of albumin is in the plasma, and 60% in the intercellular fluid. The main functions of albumins are maintenance of colloid osmotic (oncotic) pressure, and also participation in transport of many endogenous and exogenous substances (free fatty acids, bilirubin, steroid hormones, magnesium ions, calcium, antibiotics and others).
Globulins of blood serum are represented by four fractions (a1, a2, beta and gamma), each of which is not homogeneous and contains several proteins that differ in their functions.
The composition of a1-globulins normally includes two proteins that have the greatest clinical significance:
- a1-antitrypsin, which is an inhibitor of a number of proteases (trypsin, chymotrypsin, kallikrein, plasmin);
- a1-glycoprotein, involved in the transport of progesterone and testosterone, binding small amounts of these hormones.
- and 2-globulins are represented by the following proteins:
- a2-macroglobulin - an inhibitor of a number of proteolytic enzymes (trypsin, chymotrypsia, thrombin, plasmin, kallikrein), is synthesized outside the liver;
- Haptoglobin - a protein that binds and transports free hemoglobin A into the cells of the reticuloedothelial system;
- ceruloplasmin - has oxidase activity and oxidizes bivalent iron to trivalent, which provides its transport with transferrin;
- apoproteids A, B and C, which are part of the lipoproteins.
The globulin fraction also contains several proteins:
- transferrin - a protein involved in the transport of ferric iron;
- hemopexin - the carrier of free heme and porphyrin, binds the hemine-containing chromoproteins (hemoglobin, myoglobia, catalase) and delivers them to the cells of the liver RES;
- a part of immunoglobulins;
- some protein components of complement.
Gamma globulins are immunoglobulins, which are characterized by the function of antibodies produced in the body in response to the introduction of various substances with antigenic activity; modern methods make it possible to distinguish several classes of immunoglobulins (IgG, IgA, IgM, IgD and IgE).
Fibrinogen is the most important component of the blood coagulation system (factor I). It forms the basis of a blood clot in the form of a three-dimensional network in which blood cells are retained.
The content of total serum protein in a healthy person ranges from 65 to 85 g / l, and albumin - from 35 to 50 g / l. It should be emphasized that in different clinical laboratories using different automatic analyzers and methods for determining protein fractions, the specifications may differ slightly from those given in table.
Normal values of protein fractions of blood serum (in%)
Electrophoresis on cellulose acetate films
Electrophoresis on paper
52 (4, -6, )
58 (5, -6, )
, (, )
, (, )
, (, -1, )
, (, -1, )
1, (1, -1, )
1, (1, -1, )
2, (1, -2, )
1, (1, -2, )
The albumin-globulin coefficient (A / T) is normally equal to, .
The change in the content of globulin fractions, which is very typical for any acute or chronic inflammation, is usually found in patients with pneumonia,
An increase in the content of the a1 and a2 fractions of globulins is most often observed. This is due to the fact that the so-called acute phase proteins (al-antitrypsin, o1-glycoprotein, a2-macroglobulin, haptoglobulin, ceruloplasmin, seromucoid, C-reactive protein), which naturally increase in any inflammatory process in the body. In addition, an increase in the content of a-globulins is observed with significant damage and decay of tissues (dystrophic, necrotic processes), accompanied by destruction of cells and release of tissue proteases, kallikrein, thrombin, plasmin, etc., which naturally leads to an increase in the content of their natural inhibitors (a1-antitrypsin, a1-glycoprotein, a2-macroglobulin, etc.). Damage to tissues also results in the release of pathological C-reactive protein, which is the product of cell disintegration and is part of the a1 fraction of globulins.
An increase in the beta-globulin fraction is usually observed in acute and chronic diseases, accompanied by an increase in the content of blood of immunoglobulins (usually simultaneously with an increase in the content of y-globulins), including in infections, chronic inflammatory processes in the bronchi, liver cirrhosis, connective tissue diseases, malignant neoplasms, autoimmune and allergic diseases.
An increase in the fraction of y-globulins is found in diseases accompanied by an intensification of immune processes, since the fraction of y-globulin consists mainly of immunoglobulins: with chronic infections, chronic liver diseases (chronic hepatitis and cirrhosis of the liver), autoimmune diseases (including diseases connective tissue - RA, SLE, etc.), chronic allergic diseases (bronchial asthma, recurrent urticaria, drug disease, atopic dermatitis and eczema, etc.). An increase in the y-globulin fraction is also possible with pneumonia, especially prolonged flow.
Proteins of the acute phase of inflammation
In addition to the described changes in protein fractions in patients with pneumonia, an increase in the content of the so-called proteins of the acute phase of inflammation is characteristic: fibrinogen, ceruloplasmin, haptoglobulin, a2-macroglobulin, C-reactive protein, etc., which also refer to nonspecific markers inflammatory process
Among the important in the diagnostic relation carbohydrate-containing compounds are glycoproteins - proteins containing relatively short carbohydrate chains, consisting of 10-20 monosaccharides. Their concentration in the blood also significantly increases with inflammatory processes and tissue damage (necrosis).
The composition of carbohydrate components of glycoproteins, the quantitative determination of which underlies the majority of diagnostic tests, includes:
- hexoses (galactose, mannose, less often - glucose);
- pentoses (xylose and arabinose);
- deoxysugars (fucose and rhamnose);
- aminosugar (acetylglucosamine, acetylgalactosamine);
- sialic acids - derivatives of neuraminic acid (acetylneuraminic and glycolylneuraminic acid).
In clinical practice, the most widely used methods are the determination of sialic acids and the total amount of protein-bound hexoses.
An important diagnostic value is also the determination of hexoses associated with the so-called seromucoids. Seromucoids are a special group of carbohydrate-containing proteins that differ from conventional glycoproteins with the ability to dissolve readily in perchloric acid. This last property of seromucoids makes it possible to identify them from other glycoproteins containing hexoses.
Normally, the total content of hexoses associated with plasma proteins or blood serum is, mmol / L. Of these, the share of seromucoids is, mmol / l. The concentration in blood of sialic acids in a healthy person does not exceed, 3 mmol / l. The content of total hexose, seromucoid, and sialic acids associated with proteins increases substantially in all inflammatory processes and tissue damage (pneumonia, myocardial infarction, tumors, etc.).
Lactate dehydrogenase (LDH)
Lactate dehydrogenase (LDH) (KF 22.214.171.124) is one of the most important cellular enzymes involved in the process glycolysis, and catalyzes the reversible reaction for the reduction of pyruvic acid (pyruvate) into the lactic (lactate).
As is known, pyruvate is the final product of glycolysis. Under aerobic conditions, pyruvate, undergoing oxidative decarboxylation, is converted to acetyl-CoA and then oxidized in a cycle of tricarboxylic acids (Krebs cycle), releasing a significant amount energy. Under anaerobic conditions, pyruvate is reduced to lactate (lactic acid). This last reaction is catalyzed by lactate dehydrogenase. The reaction is reversible: in the presence of O2, lactate is again oxidized to pyruvate.
With electrophoresis or chromatography, it is possible to detect 5 isoenzymes of LDH, which differ in their physico-chemical properties. The most important are two isoenzymes - LDG1 and LDG5. Most organs contain a complete set of LDH isoenzymes, including fractions of LDH2, 3, 4.
Normally, the serum LDH activity does not exceed, mmol / h х l). Any damage to tissue cells that contain a large amount of LDH, including damage, observed during pneumonia, leads to an increase in the activity of LDH and its isoenzymes in blood serum.
Nonspecific biochemical criteria of the inflammatory process in patients with pneumonia are:
- an increase in the content of alpha and beta globulin in the blood serum, and with a more significant activation of the immune system and / or the process of chronization, an increase in the content of y-globulins;
- an increase in the content of acute phase proteins in the blood: fibrinogen, ceruloplasmin, haptoglobulin, C-reactive protein, etc .;
- increase in the content of total, protein-bound hexoses, seromucoid and sialic acids;
- an increase in the activity of lactate dehydrogenase (LDH) and its isoenzymes LDH3.
Determination of sensitivity to antibiotics
The determination of sensitivity to antibiotics is based on the evaluation of the growth of microorganisms cultivated in dense or liquid nutrient media in the presence of antibiotics. The easiest way is to sow a suspension of microorganisms of the isolated culture on the surface of a dense nutrient medium (agar) in plates of Petri, disks with antibiotics in standard concentrations are placed on the surface of the dishes and incubated at 3 ° C for 18 hours. The results are evaluated by measuring the diameter of the microbial growth retardation zone using a ruler.
More accurate data can be obtained by using quantitative methods with the determination of the minimum inhibitory concentration (MIC) of antibiotics. To this end, a series of two-fold dilutions of antibiotics in a liquid nutrient medium (broth) is prepared and added, ml of a suspension of culture of the investigated microorganisms in a concentration of 105-106 mt / ml. All samples, including control, containing no antibiotics, are incubated at 3 ° C for 24 hours. The minimum concentration of antibiotic in the last tube, in which there was complete growth retardation culture, corresponds to the MPC of the preparation and reflects the degree of sensitivity of microorganisms to antibiotic.
According to the degree of sensitivity to antibiotics, microorganisms are divided into three groups:
- Sensitive - microorganisms, the growth of which is suppressed at the MIC, corresponding to the concentration of the drug in the blood serum with the application of usual therapeutic doses of the drug.
- Moderately resistant - such strains of microorganisms, IPC of which is achieved with the appointment of maximum therapeutic doses of antibiotic.
- Stable microorganisms, the growth of which is not suppressed by the maximum permissible doses of drugs.
Such a determination of the degree of sensitivity to antibiotics is possible with the use of quantitative methods of dilution in liquid nutrient media. Nevertheless, there is a definite correlation between the MIC values and the size of the microbial growth retention zones when paper disks are used with antibiotics, which makes it possible to use this simple and convenient method for an approximate quantitative description of the degree sensitivity.
It should nevertheless be remembered that the results of determining the sensitivity to antibiotics in vitro do not always correspond to the real clinical situation, especially with a mixed infection, a decrease in the immunological reactivity of the organism, difficulties arising when trying to isolate the culture of the main pathogen and etc.
Formulation of the diagnosis
When formulating the diagnosis of pneumonia, it is necessary to reflect:
- etiological variant;
- localization and prevalence of the inflammatory process (segment, proportion, one- or two-sided lesion);
- severity of pneumonia;
- presence of complications;
- phase of the disease (height, resolution, ekonvalesentsiya, protracted course);
- accompanying illnesses.
Examples of the formulation of the diagnosis
- Pneumococcal lobar pneumonia in the lower lobe of the right lung, severe course, high-grade phase. Acute subcompensated respiratory failure.
- Streptococcal pneumonia in 6, 8, 10 segments of the right lung, moderate course, midsection. The initial stage of acute respiratory failure. Exudative pleurisy.
How does bronchitis look like on an X-ray?
What is the use of x-rays for bronchitis? Can I see bronchitis on an x-ray? How informative is the X-ray study? Usually these questions are of concern to everyone who has encountered this kind of problem.
X-ray of the lungs allows the most accurate diagnosis, identify obstruction (a condition where the airway is obstructed and pulmonary ventilation is impaired), and an effective treatment. At the same time, it is possible to recognize other dangerous diseases lurking under the mask of bronchitis, for example pneumonia, tuberculosis, timely diagnosing lung cancer.
Nevertheless, X-ray diagnostics is an additional method of examination, since it is "hidden". This means that the X-rays do not reflect the structure of the bronchial tree in the image (they pass right through), and determine by radiograph inflammatory processes are possible only by indirect signs, that is, bronchitis on the x-ray is difficult to determine, all must be carefully to analyze. Therefore, in a medical report you can see the following: "The picture is similar to bronchitis." However, at the initial stage for preliminary diagnosis, radiology is irreplaceable.
Types of bronchitis, symptoms and treatmentBronchitis is a fairly common disease at present. To its origin can result either as a viral or bacterial infection, and professional features of work, smoking, allergic reactions.
Bronchitis is accompanied by an inflammatory process in the bronchi and is a serious disease of the respiratory system.
As a rule, men are more often ill with bronchitis than women. Smokers and elderly people are at risk.
Bronchitis is divided into two forms: acute and chronic. Of the acute form, bronchitis can easily pass into the chronic, and in some cases lead to serious complications, if not start a timely and proper treatment.
The main common symptom for both forms of bronchitis is cough.
The acute symptoms are characterized by, in addition to cough, the following symptoms:
- rising temperature to 39 degrees, accompanied by chills and sweating;
- general weakness and fatigue;
- a sore throat.
These symptoms can be expressed in different ways, weaker or stronger. Acute bronchitis lasts from about 10 days to 2 weeks.
For the chronic form is characteristic:
- deep cough with separation of scanty mucous sputum;
- shortness of breath at physical exertion, malaise;
- spasms in the throat, wheezing.
Chronic bronchitis can be both an independent disease, and reborn from an acute form.
When treating bronchitis, a bed or half-bed regime is prescribed, regular warm and plentiful drink. Depending on the form, causes and stages of the disease, the treating doctor prescribes anti-inflammatory and expectorant drugs, cough suppressants, inhalations. With a chronic form they try to achieve a long-term remission and reduce the rate of damage to the bronchial mucosa.
Before starting treatment, it is necessary to conduct a comprehensive examination to establish the correct diagnosis.
X-ray diagnosis of bronchitisThe patient is assigned a clinical and biochemical blood test, sputum analysis, a pharyngeal smear on the microflora and fungi to determine the exact diagnosis. The doctor examines the chest, appoints spirometry (lung function test) in case of obstructive (complicated) form or for the detection of chronic bronchitis. Other studies can also be performed on indications.With relapsing or obstructive bronchitis, an X-ray examination is mandatory.
With a simple uncomplicated bronchitis on the radiograph, you can hardly see any changes, in view of this, for the X-ray study should be certain indications.
X-ray diagnosis can be indicated with symptoms such as:
- prolonged fever, shortness of breath;
- altered blood composition;
- Ineffectively conducted treatment (unless, of course, the roentgen has not yet been done);
- check the effectiveness of treatment.
Contraindications to X-raysThere are no unconditional limitations for the appointment of X-rays of the lungs and bronchi, only if the patient is in serious condition or the patient is a pregnant woman. But even in these cases, if the health risk is significant and poses the greatest threat, the diagnosis is still carried out by screening the patient's stomach.
Patients often wonder: how many times a year is it safe to do a lung X-ray? After all, every time an X-ray study a person is exposed to radiation. A dose of radiation, which is harmless in a sense, is considered to be a dose of up to 1 mSv per year (during the X-ray of the lungs, the radiation dose is approximately from, to 3 mSv).
The main signs of bronchitis, affecting the x-ray image
When X-ray diagnosis for the definition of bronchitis in the picture pay attention to the following symptoms:
- visibility of lamellar foci of tissue failure;
- small areas of infiltration (accumulation in the tissues of light liquids and other chemicals and elements);
- the pulmonary pattern changes, small vessels become invisible;
- the root of the lung increases and spreads, that is, deformed;
- contours are indistinct;
- the walls of the bronchi are thickened.
In neglected cases, you can see signs of emphysema:
- visible areas of tissue that are completely devoid of blood vessels;
- the pulmonary pattern is very severely disturbed;
- Cavities (blisters) are detected, an unnaturally large amount of air in the lower part of the lungs.
The radiologist usually describes the picture as follows:
- the deformation and diffuse enhancement of the pulmonary pattern due to the interstitial component was revealed;
- widespread pneumosclerosis.
In simple terms, it is an edema of the lung caused by inflammation; proliferation of connective tissue of the walls of the bronchi and tissue surrounding them, which leads to a curvature of the bronchi.
In the chronic form of the disease, X-ray examination helps to identify the affected area and the nature of pathology in the bronchi and lung tissue, which depends on the duration of the inflammatory process.
Obstructive bronchitis on an x-ray
In obstructive bronchitis, the following are added to the main features described above:
- increased transparency of the pulmonary background with increased ventilation of the alveoli (air is transparent for x-rays);
- the diaphragm is thickened, pushed backwards, the smoothness of its domes is noted;
- the heart is vertical;
- there is a disturbance of blood circulation along a small circle, due to which stagnant changes are formed, chronic reactions of the pulmonary parenchyma near the roots.
This picture shows focal redundancy of the pulmonary pattern and its deformation in the lower lobe of the right lung.
At a severe stage of obstructive bronchitis the condition of the roots of the bronchial tree changes sharply on the X-ray picture: clearly visible vagueness of their boundaries, increase the pattern, thicken the walls of the bronchi, reduce them structure.
In severe bronchitis requires a two-way study. X-rays in this case are held in turn for one and the second lung with a five-day break.
Consequently, on X-ray images you can see enough of the indirect signs that help establish a reliable diagnosis.
Despite the fact that such a survey is optional, in some cases it is still mandatory..
Bronchography with radiological examination
Bronchography is a study that is performed with contrast medium. It gives the most complete data on the structure of the respiratory tract and on the presence of any formations. This study is one of the most informative methods to date. But bronchography is preceded by bronchoscopy (examination by translucence). These methods are used in extreme cases, as they cause considerable discomfort to patients..
Conduct bronchography under local anesthetic. The patient is given a warm contrast. Contrast substance is monitored under the X-ray screen.
Will fluorography in the picture show pneumonia?
Every year it is necessary to undergo a fluorographic study, but will X-ray show pneumonia? This question is asked by many. In order for a person to remain healthy as long as possible, it is necessary to exercise, exclude from the food of harmful products, undergo scheduled checks and prevent diseases. Caring about the health of citizens, the government introduces mandatory passage of fluorography.Starting from the age of 18, all citizens are recommended to go through this procedure once a year.
Inflammation of the lungs occurs quite often. Pneumonia is a disease characterized by various signs of the course of the disease, clinical pictures, the causes of the pathology. When pneumonia occurs, the inflammatory process in the lung tissue.
What is pneumonia?
Pneumonia can exist as an independent disease and as a complication after some other diseases. Therefore it is so important in any uncharacteristic indispositions, inflammatory processes and occurrence of other illnesses in time to address to the attending physician. Only a specialist will provide you with qualified assistance. Based on the recommendations should be treated, so that the disease subsequently did not give complications. Pneumonia provokes complications after previous illnesses.
The lungs are in the sternal part, occupying almost all of its volume. They are a respiratory organ supplying blood to oxygen. In addition to performing respiratory function, the lungs are involved in other important processes of the body. Like every organ, they are susceptible to various diseases:
- tuberculosis (infectious disease, transmitted when the patient sneezes and coughs);
- bronchitis (inflammatory process of the apex of the lungs);
- bronchial asthma;
- hypoxia (oxygen starvation);
- Pleurisy (more common as a complication after other pulmonary diseases);
- tracheitis (infectious disease);
A number of lung diseases do not end there. There are many more lung diseases.
For the detection of pathological changes, there are fluorography and roentgenology. This is the same X-ray, only with a low fraction of radiation. Both x-rays and fluorography are very widely used in modern medicine. For prophylaxis and detection of inflammatory processes in the lungs, indications of fluorography are used. X-rays are needed for diagnosis, i.e., revealing a more accurate clinical picture. Both of these methods are based on the use of radiation, which is quite harmful to the human body. Therefore, we must carefully treat these procedures, but at the same time, and responsibly. No other examination will be able to detect pneumonia.
Preventive measures and the use of fluorography
Pneumonia seriously threatens human health. Early detection and timely treatment will bring the best result. The onset of the disease can proceed without symptoms, without causing any inconvenience and without causing complaints from the patient. In time to recognize the disease, doctors recommend to undergo a fluorographic examination once a year. Fluorography is used for prevention.
Despite the small dose of radiation (in comparison with the x-ray), fluorography can detect the presence (or absence) of pathological processes in the lung tissue.When a pathology is detected, additional examinations (including x-rays), analyzes and other measures are necessary. X-rays show more accurate images.
Fluorography is prescribed quite often, although its results can not accurately describe the clinical nature. But the picture gives an opportunity for pneumonia to see changes in the structure and structure of lung tissue. Based on these testimonies, the doctor will propose further measures, if any.
The images show different internal organs differently. For example, bronchi and the heart appear in the form of light spots. The lung tissue of a healthy organ on an X-ray image will look homogeneous and uniform. If there are pathological changes in the lungs, then in the picture, the images will be seen as darker areas or lighter, compared to the original. Darker patches indicate the presence of inflammation and an increase in the density of lung tissue in this place. Lighter spots indicate "looseness a decrease in tissue density in this area.
Modern methods of fluorography
At the beginning of the 20th century, the main method of examining the internal organs was x-rays. It was used for mass observation of the state of human health. Fluorography was considered less accurate, although less safe, was used extremely rarely. Gradually, her role in medicine has become more significant. Doctors recognized many of its benefits and the opportunity to participate in mass surveys. It was used for preventive examinations. The purpose of fluorography is the detection of pathological processes.
In modern medicine, there are two types of fluorography: traditional and digital. With the traditional reflection of X-rays passed through the human body, and converting them into a picture on an X-ray. Advantages of the traditional method:
- small financial costs;
- a small (in comparison with x-ray) dose of the received irradiation;
- the possibility of mass application;
- the possibility of examining a huge number of patients;
- the chance of creating an archive of X-ray images due to their small size.
With the advent of digital technology in various industries, it became possible to create a digital method of fluorography. No need to create pictures. After passing through the internal organs, the rays are projected into the image on the monitor screen. This happens with the help of special sensors, which fix the radiation and their intensity, transmit to the screen. Next, the photo is processed using the latest computer technology. The image quality with the digital method has significantly improved, it became clearer. The dose of radiation received by a person, while significantly reduced. Safety and accuracy give this method of fluorography significant advantages over the traditional method. But its high cost practically nullifies its application in medicine.
Fluorography and X-rays in the detection of pneumonia
In order to avoid complications after illness, as well as for the prevention of internal diseases, doctors recommend the passage of fluorographic examinations once a year. In addition to the recommendatory nature, this procedure is mandatory for a number of persons:
- military personnel;
- conscripts in the ranks of the army;
- persons who have constant contact with newborns;
- persons who have constant contact with pregnant women;
- patients who have appealed to a medical institution with complaints of obvious signs of pulmonary diseases.
A person who has undergone this procedure within the last year is released from roentgenology due to the availability of data. All studies are compared with previous ones, if any.
People in the direction of a doctor undergo an X-ray examination, not thinking about how harmful it is. Knowing that X-rays are harmful to the body, everyone knows. Trusting the actions and qualifications of a specialist, people unconditionally go to this procedure. Psychologically, a person is determined that it is the X-ray that can determine the correctness of the treatment.
Prophylaxis does not always give an exhaustive answer to the question of whether fluorography can show pneumonia. But if a person does not have pneumonia, then do not unreasonably risk. The emergence of pathological processes in the lung tissues is possible with the help of fluorography. If pathology in the lung tissue is detected, then additional examinations are inevitable..
In modern medicine, there are all possibilities for examining the lungs for pathology, including pneumonia. Fluorographs are currently installed both in the form of stationary devices in polyclinics, hospitals, and in the form of mobile mobile means.