Could there be old dark spots on the lungs? Darkening in the lungs on x-ray. Decoding of received images

The anatomical structure of the lungs, their ability to be filled with air that freely transmits x-ray radiation, makes it possible to obtain, during fluoroscopy, an image that reflects everything in detail. structural elements lungs. However, darkening in the lungs on an X-ray does not always reflect changes in the tissues of the lung itself, since other organs of the chest are located at the level of the lungs and, therefore, the radiation beam, passing through the body, projects on the film a superimposed image of all organs and tissues , falling within its range.

In this regard, if any darkened formation is detected in the image, before answering the question of what it could be, it is necessary to clearly differentiate the localization of the pathological focus (in the tissues of the chest, diaphragm, pleural cavity or, directly, in the lungs).

Main syndromes on radiographs

On an x-ray taken in an anterior projection, the contours of the lungs form pulmonary fields over the entire area, intersected by symmetrical shadows of the ribs. A large shadow between the pulmonary fields is formed by the combined overlap of the projection of the heart and main arteries. Within the contour of the lung fields, one can see the roots of the lungs located at the same level with the anterior ends of the 2nd and 4th ribs and a slight darkening of the area caused by the rich vascular network located in the lung tissue.

All pathological changes, reflected on x-rays can be divided into three groups.

Dimming

Appear on the image in cases where the healthy part of the lung is replaced by a pathological formation or substance, causing the displacement of the air part by denser masses. As a rule, it is observed in the following diseases:

bronchial obstruction (atelectasis);
accumulation of inflammatory fluid (pneumonia);
benign or malignant tissue degeneration (tumor process).

Change in pulmonary pattern

total (complete) or subtotal (almost complete) blackout;
limited dimming;
round (spherical) shadow;
ring shadow;
focal darkening.

Enlightenment

The clearing in the image reflects a decrease in the density and volume of soft tissues. As a rule, a similar phenomenon occurs when an air cavity forms in the lung (pneumothorax). Due to specific reflection X-ray results on photographic paper, areas that easily transmit radiation are reflected more dark color Due to the more intense effect of X-rays on the silver ions contained in photographic paper, areas of a denser structure have a light color. The wording “darkening” in the image is actually reflected in the form of a light area or focus.

On x-ray pulmonary drawing of healthy lungs

Total blackout syndrome

Total darkening of the lung on an x-ray is a complete or partial darkening (at least 2/3 of the lung field). In this case, gaps are possible in the upper or lower part of the lung. The main physiological reasons for the manifestation of this syndrome are the lack of air in the lung cavity, an increase in the density of the tissue of the entire surface of the lung, the content of fluid or any pathological content in the pleural cavity.

Diseases that can cause such a syndrome include:

atelectasis;
cirrhosis;
exudative pleurisy;
pneumonia.

To carry out differential diagnosis of diseases, it is necessary to rely on two main signs. The first sign is to assess the location of the mediastinal organs. It can be regular or offset, usually in the direction opposite to the darkening focus. The main landmark in identifying the displacement axis is the shadow of the heart, located mostly to the left of the midline of the chest, and less to the right, and the stomach, the most informative part of which is the air bubble, always clearly visible on the images.

The second sign that makes it possible to identify a pathological condition is an assessment of the uniformity of darkening. Thus, with uniform darkening, atelectasis can be diagnosed with a high degree of probability, and with heterogeneous darkening, cirrhosis can be diagnosed. Interpretation of the results obtained using the radiographic method is as follows: comprehensive assessment all visually detected pathological elements in comparison with the anatomical features of each individual patient.

Limited dimming syndrome

To identify the causes of limited darkening of the pulmonary field, it is necessary to take an image in two directions - in direct projection and lateral. Based on the results of the obtained images, it is important to assess the localization of the darkening focus. If the shadow in all photographs is located inside the pulmonary field and is similar in size to its contours or has a smaller volume, it is logical to assume a lung lesion.

If there is darkening adjacent to the diaphragm or mediastinal organs with a wide base, extrapulmonary pathologies (fluid inclusions in the pleural cavity) can be diagnosed. Another criterion for evaluating limited shades is size. In this case, two possible options should be considered:

The size of the darkening clearly follows the contours of the affected part of the lung, which may indicate an inflammatory process;
Shade size is smaller normal sizes, the affected segment of the lung, which indicates cirrhosis of the lung tissue or bronchial blockage.

Particular attention should be paid to cases in which there is a darkening of normal dimensions, in the structure of which light foci (cavities) can be traced. First of all, in this case, it is necessary to clarify whether the cavity contains liquid. To do this, a series of photographs are taken in different positions of the patient (standing, lying down or bending over) and changes in the level of the estimated upper limit of the liquid contents are assessed. If fluid is present, diagnose lung abscess, and if it is not there, then the probable diagnosis is tuberculosis.

Important! The detection of several cavities with limited darkening of the lung is characteristic of pneumonia caused by staphylococcus. Such a lesion has an unfavorable prognosis, and often treatment is only possible through surgery.

X-ray shows limited darkening of the lungs in two projections

Round shadow syndrome

I state round shadow syndrome when the spot on the lungs has a round or oval shape in two photographs taken perpendicular to each other, that is, from the front and the side. To decipher the results of radiography when a round shadow is detected, they rely on 4 signs:

form of shading;
localization of darkening relative to nearby organs;
clarity and thickness of its contours;
structure of the internal shadow field.

Since the shadow reflected on the image within the lung field may actually be located outside it, assessing the shape of the darkening can greatly facilitate diagnosis. Thus, a rounded shape is characteristic of intrapulmonary formations (tumor, cyst, infiltrate filled with inflammatory contents). An oval shadow in most cases is the result of compression round education, the walls of the lung.

The structure of the internal shadow field is also highly informative. If, when analyzing the results, the heterogeneity of the shadow is obvious, for example, lighter foci, then with a high degree of probability, it is possible to diagnose the disintegration of necrotic tissue (with disintegrating cancer or disintegration of tuberculous infiltrate) or the formation of a cavity. Darker areas may indicate partial calcification of tuberculoma.

A clear and dense contour indicates the presence of a fibrous capsule, characteristic of hydatid cyst. Round shadow syndrome includes only those shadows that are more than 1 cm in diameter; shadows with a smaller diameter are considered lesions.

Ring shadow syndrome

A ring-shaped spot on the lung on an x-ray is the easiest syndrome to analyze. As a rule, a ring-shaped shadow appears on an x-ray as a result of the formation of a cavity filled with air. A mandatory condition under which the detected darkening is classified as ring-shaped shadow syndrome is the preservation of a closed ring when taking pictures in all projections and in various positions of the patient’s body. If in at least one of the series of photographs the ring does not have a closed structure, the shadow can be considered an optical illusion.

If a cavity is detected in the lung, the uniformity and thickness of its walls should be assessed. Thus, with a large and uniform thickness of the contour, one can assume the inflammatory origin of the cavity, for example, a tuberculous cavity. A similar picture is observed with an abscess, when purulent melting of tissue occurs and the contents are removed through the bronchi. However, with an abscess, the remains of pus, most often, continue to be in the cavity and their complete removal a rather rare occurrence, so usually such a cavity is a tuberculous cavity.

The unevenly wide walls of the ring indicate the process of decay of lung cancer. Necrotic processes in tumor tissue can cause the formation of a cavity, but since necrosis develops unevenly, tumor masses remain on the inner walls of the cavity, creating the effect of an “uneven” ring.

Important! The main difficulty in assessing the ring-shaped shadow is determining the localization of the formation, since in most cases a similar syndrome is observed in extrapulmonary processes (deformation of the ribs, gases in the intestines, gases in the pleural cavity).

The image shows a ring-shaped shadow in the lower lobe right lung

Focal opacification syndrome

Spots on the lungs larger than 1 mm and smaller than 1 cm are considered lesions. On an x-ray, you can see from 1 to several lesions located at a considerable distance from each other or in a group. If the area of distribution of foci does not exceed 2 intercostal spaces, the lesion (dissemination) is considered limited, and if the foci are distributed over larger area– diffuse.

Main evaluation criteria focal darkening are considered:

area of distribution and location of foci;
shadow contours;
darkening intensity.

When one or more dark spots are located in the upper parts of the lung- a clear sign of tuberculosis. Many foci with limited spread are a sign of focal pneumonia or the result of the disintegration of a tuberculous cavity, located, as a rule, slightly above the detected foci. IN the latter case, a round or ring-shaped shadow may also be observed in the picture.

The reason for the appearance of a single darkening in any part of the lung is, first of all, considered the likelihood of developing cancer or tumor metastasis. This is also evidenced by the clear contours of the shadow. Fuzzy contours indicate the inflammatory origin of the darkening.

To assess the intensity of darkening, they are compared with the image of the vessels visualized in the image. If the severity of the lesion is inferior to the shadow of the vessel, this is a low-intensity darkening characteristic of focal pneumonia or infiltrated tuberculosis. With medium and strong darkening of the focus, when the severity is equal to or darker than the vascular pattern, one can judge the attenuation of the tuberculosis process.

Since extensive dissemination of lesions can indicate more than 100 diseases, to distinguish between causes, the size of the shadows should be assessed. Thus, the smallest foci covering the entire area of the lung may indicate pneumoconiosis, miliary tuberculosis or focal pneumonia.

The image shows small focal shadows

Important! Regardless of what changes are observed on an x-ray of the lungs, when analyzing the results, one should take into account the presence of a normal pulmonary pattern, which is characterized by the presence of shadows of the vascular system.

In the vast majority of cases, it is impossible to diagnose on the basis of chest radiography final diagnosis, since analysis of the resulting image allows us to identify only a syndrome characteristic of a particular disease. If the x-ray showed darkening of any area, then to clarify the diagnosis and assess the dynamics of the disease, it is necessary to conduct a set of laboratory tests and additional diagnostics using MSCT, bronchography, biopsy, etc.

Preventive medical examinations must be completed annually. One of the mandatory activities of periodic medical examination is - this is done for the early detection of diseases. An alarming signal will be pathological darkening in the lungs. The reasons for such manifestations may be different, and in order to identify them accurately, the doctor will definitely prescribe additional examination. The symptom of darkening of the lungs established during fluorography is not a diagnosis of the disease, but an indicator of the presence of a variety of diseases.

What is darkening of the lungs?

Pulmonary diseases are mainly accompanied by compactions in the tissues of the lungs; this occurs due to a decrease or absence of air permeability in certain areas of the organ, which appears on X-ray examination as darkened spots. Such a symptom may indicate pathological processes both in the lung itself and beyond.

Blackouts, the causes of which lie in pulmonary pathologies, may differ in their intensity, clarity, quantity and size. Darkening may show:

and tissue compaction.
Knots.
An area impassable for air is a collapsed lung.
Development .
The presence of fluid in the pleural area of the lungs (the pleura is the membrane that covers the lungs and chest cavity).
Inflammation in the pleural area, possibly purulent ().

Pulmonary opacities that appear due to problems with other organs may also be visible on imaging and may include:

Increase lymph nodes.
Masses on the ribs or spine.
Problems with the esophagus, such as enlargement.

Shade types

The location of the dark spots, their size and shape depend on the developed pathological lesion of the lung. Several types of organ darkening are classified:

Focal.
Focus.
Segmental.
Blackout indeterminate form.
Share.
Darkening with the presence of liquid.

Focal darkening in the lungs

Focal darkening is small, up to one centimeter, nodular spots. They appear during inflammatory and tumor processes, as well as in connection with vascular disorders. This could very well be the beginning of some kind of lung disease. From one image it is impossible to accurately determine the cause of the outbreak and its nature, therefore additional examinations are prescribed, in particular, additional examinations. Appointed lab tests, in which urine and blood are examined.

If focal darkening is accompanied by fever, weakness, headache, wet or dry cough, chest pain, these signs may indicate bronchopneumonia.
If the blood test shows no changes, this may be a sign of focal tuberculosis, with the patient complaining of loss of appetite, weakness, dry cough, irritability and chest pain. If this diagnosis is suspected, targeted studies are prescribed.

Most often it manifests itself as thrombophlebitis of the lower extremities, cardiac pathology, pain in the side and even hemoptysis.
"Small" peripheral lung cancer usually immediately determined on a fluorography image.

These are the most common diseases, the onset of which can be indicated by focal shadows, but they can also indicate other pulmonary pathologies.

Round (focal) shades

Single focal shadows round shapes and larger than one centimeter can also be signs of various diseases. They require a more thorough examination to establish an accurate diagnosis.

The causes of round spots can be acquired or congenital. They can be filled with air or liquid.

Such darkening may indicate tumor formations:

- fibromas, adenomas, lipomas, hamartochondromas;
malignant - , .

Callus(spherical) - this could be a rib fracture or island areas on it. This factor also needs to be taken into account when deciphering a photo with focal shadows.

Segmental shading

Darkening can be localized in individual segments various shapes, mostly in the shape of a triangle. There may be several such areas on the lung, and the diagnosis is made after comprehensive survey. Darkening of individual segments on one or both lungs may indicate diseases such as:

Single segments:

endobronchial tumors (benign or malignant);
foreign body or mechanical damage to lung tissue.

The presence of several darkened segments:

acute or chronic pneumonia(pneumonia);
tuberculosis or other inflammatory processes;
central cancer;
stenosis (narrowing) of the central bronchus;
accumulation of a small amount of fluid in the pleura;
metastases malignant tumors in other organs.

Blackouts of indeterminate shape

Such darkening in X-ray images does not form geometric shapes and does not have definite boundaries.

These pathological changes in lung tissue are most often staphylococcal pneumonia. This disease has primary and secondary forms:

The primary form occurs as a result of inflammatory processes in the bronchi or lung tissues.
The secondary form of the disease manifests itself due to hematogenous spread from some purulent focus in the body (this can be osteomyelitis, adnexitis, or others. similar diseases). IN Lately Staphylococcal pneumonia has become quite common.

Such darkening may indicate tissue edema, pulmonary infarction, hemorrhage, tumor, accumulation of pleural fluid and other diseases that can be accurately determined after laboratory tests.

Such darkening may occur due to inflammation of the lung (pneumonia) or effusion of fluid into the pleura (exudative pleurisy). These diseases are accompanied by fever, cough, weakness, and headaches.

Lobar dimming

With lobar darkening in the lung, its contours are clearly visible and clearly defined in the photographs. They can have convex, concave, rectilinear and other shapes.

Lobar darkening can be signs of any chronic pulmonary disease. Tomography can easily identify diseases such as cirrhosis, bronchiectasis (expansion of part of the bronchus due to damage to its wall), purulent lesions and other diseases.
All of these pathological processes on tomographic images can be easily distinguished from cancerous formations. Therefore, the need to accurately determine a malignant tumor arises if bronchial obstruction (inflammatory or scar formation) is detected.

Malignant and benign tumors usually form in the intermediate bronchus. In this case, the lower and middle lobes of the organ are darkened.

Darkening with liquid

This type of darkening of the lungs may indicate developing swelling of the organ. This can occur when pressure in the pulmonary capillaries increases or when protein levels in the blood decrease. Water in the lungs interferes with the normal functioning of the organ. Swelling can be of two types and depends on the reasons that caused it.

Hydrostatic edema can occur when intravascular pressure increases, which increases the risk of fluid escaping from the vessel and entering the alveolus (the terminal part of the vessel). breathing apparatus), fills the lung. This pathology can occur if there is coronary disease heart or other cardiovascular diseases.
Membranous edema occurs under the influence of toxins that can disrupt the wall of the same alveoli and leave the extravascular space of the lung.

When making a diagnosis, a lot depends on the qualifications and experience of the radiologist who will describe the fluorographic image. The machine used to take the x-rays is also important. Therefore, it would be useful to double-check by having, if possible, fluorography done on a more advanced device and with another radiologist.

The danger of tuberculosis

Today medicine is for timely diagnosis and the prevention of pulmonary diseases requires citizens to undergo an annual fluorographic or x-ray examination. Decoding an X-ray of the lungs allows you to strictly monitor the condition of the lungs of the subjects and detect them in time possible pathologies. In particular tuberculosis. Despite the fact that medicine is developing rapidly and very successfully, tuberculosis still leads the list of common pathologies of the respiratory system. Koch's bacillus, capable of infecting any organ, with enviable consistency chooses the lungs. Weakened immunity contributes to the active proliferation of tuberculosis bacteria, which is easily determined by X-ray examination. It will absolutely reveal dark spots on the lungs, which indicate the occurrence of a pathological process. The larger the percentage of the surface of the lungs that is infected, the larger the spots. Their presence indicates the severity of the condition, being a sign of destruction of lung tissue.

Clinical picture

Spots on the lungs can be multiple (with disseminated tuberculosis) and single (with infiltrative tuberculosis). This infection is a chronic, sluggish disease, the causative agent of which is the already mentioned Koch bacillus. It is mainly transmitted by airborne droplets, and the presence of an infected person is not at all necessary: it is often enough to use poorly washed cutlery or a towel, or simply stand not far from the place where the patient just passed. For bacteria to multiply, certain conditions are necessary: reduced immunity, weakened body, frequent stress. Also, Koch's wand feels great in an organism affected by a chronic disease or in a state of pregnancy.

Detection of tuberculosis

The entry of an infection into the body does not guarantee the rapid manifestation of symptoms - a person may feel well for a long time, not suspecting that a destructive process is in full swing in the body. It often happens that a person learns about the disease only during a routine examination, which includes mandatory fluorography. The picture shows spots on the lungs, and only specialists can decipher it: they know that the light areas of the picture are “darkenings”, and the dark ones are “clearances”. These are the characteristics of negativity.

Treatment of tuberculosis

Spots on the lungs, indicating the presence of tuberculosis, are not a death sentence today. The disease is successfully treated, although the process is long and difficult. Its essence is to destroy the pathogen - the same Koch bacillus that has chosen the lung tissue - using antibacterial drugs. Although medicine is now at the stage of active development, there are still no other methods of treating tuberculosis. Only the medication regimen and the medications themselves may differ, depending on the type and stage of the disease. Take care of yourself!

During the annual medical examination, the patient is offered to undergo fluorography to check the condition of the lungs. The procedure involves obtaining an image of a person's internal organs when X-rays pass through the tissues of his body. Thanks to X-rays of the lungs, it is possible to early stages diagnose various diseases in the lung, the symptoms of which have not yet appeared in humans - tuberculosis, lung cancer, atelactase, etc.

Classic X-ray of the lungs

The human lungs look like this in the picture: the right and left lungs on the sides of the spine, the shadow of the heart, the collarbone, the ribs, the dome of the diaphragm. The images obtained are deciphered by specialists who assess the condition of the patient’s lungs according to the following scheme:

how the lungs are located in the chest relative to other organs;
number of pulmonary lobes;
the shape of the paired organ and its size;
pulmonary pattern.

The lung tissue of a healthy person has a homogeneous and uniform structure. In some cases, dark or light colored spots appear on x-rays. This may indicate both the presence of serious pathologies and physiological processes in the lungs, which are not a deviation from the norm. However, having received such a picture, the patient anxiously begins to look for information about the meaning of darkening or light circles in the picture. What they mean will be explained below.

Reasons for the appearance of spots in the photo

There are many reasons for the appearance of dark spots on the lungs. When a pathological process affects an organ, its structure changes noticeably - areas with compactions appear, which, when exposed to X-rays, absorb rays in more than healthy tissue. This is why dark areas are visible in the pictures. These areas can vary in shape and size:

Focal darkening. Usually detected during inflammation and cancer processes in organ tissues. They look like small spots, up to 10 mm in diameter. Based on their presence, it is impossible to make a correct diagnosis. Additional studies are needed - CT scan, blood, urine and sputum tests.
Round shades. They are visualized as single round shadows. Usually an indicator inflammatory process in lung tissue. This picture is indicative of pneumonia, abscesses, benign formations in this organ, bronchial asthma and even about broken ribs. Less commonly, round single dark spots indicate oncological processes in the lungs.
Segmental darkening. Localized in the shape of a triangle (triangles) on one or both lobes. They can be either single or multiple. Single segmental darkening may indicate foreign object in an organ or about tumors inside the bronchi, which can be either benign or malignant. Multiple segments in the images indicate the presence of pneumonia, central lung cancer, narrowing of the central bronchus, pleurisy, and oncology of neighboring organs.
Darkening of fuzzy shape. These dark areas do not have definite contours and cannot be compared with geometric shapes. Most often, the presence of such dark areas of uncertain shape indicates infectious lesions lung – staphylococcal pneumonia, exudative pleurisy.
Lobar darkening. These are clearly defined and clearly visible shadow boundaries in photographs, having curved, convex and other shapes. This type of darkening indicates chronic diseases in the bronchi.

What dark spots look like on an x-ray in various diseases

Spots in the lungs on x-rays may appear due to the following diseases:

Tuberculosis

With this disease, the upper parts of the organ are seriously affected. In the image, this is manifested by the presence of multiple darkened lesions of small size - up to 2 mm in diameter. In this case, foci can merge, forming larger locations.

Pneumonia

In pneumonia, the presence of dark areas is noted in the lower parts of the lung tissue. The symptoms of the disease will be most clearly visible in the photographs at the time of the development of the disease. Visually, this will be manifested by an increase in the root of the lung due to the infiltration process, a change in the pulmonary pattern, shadows with an indistinct, blurry contour and numerous spots of different diameters.

With pneumonia, on an X-ray of the lungs, these spots have unclear contours and a heterogeneous structure.

In addition to pneumonia, the presence of multiple lesions in the lower parts of the pulmonary lobes indicates the consequences of pneumonia or bronchitis. At full recovery these traces will disappear.

Lungs' cancer

Lung cancer is a life-threatening condition. Its manifestations can also be noticeable during fluorography or x-rays. It is worth noting that in the presence of formations up to 2 mm in diameter, x-rays will not be able to detect the tumor. It is visualized on photographs when it reaches a diameter of more than 3 mm. For accurate diagnosis, x-rays are performed in two projections at once - lateral and direct.

In the image, if cancer is suspected, the following signs can be detected: a shadow on the periphery of the lung with a vague and lumpy outline, a thin outline of rays around the cancer focus, a large shadow stands out against the background of a strong shadow White spot– this is how the picture of tumor disintegration appears.

However, when diagnosing oncology, you should not rely only on the image. The patient is referred to specialists who take a tissue biopsy and conduct additional studies - MRI, CT scan of the organ to make the correct diagnosis.

Pleurisy

Pleurisy is inflammation of the pulmonary lining. In this case, the darkening is not explained by obstruction of air in those zones. In this case, fluid accumulates in the cavities from the folds of the pleura.

In the presence of dry pleurisy, the dome of the diaphragm is raised upward and the lung tissue is opaque. With effusion pleurisy, the angle of the diaphragm is smoothed out due to the accumulation of fluid, the lower part of the lung is darkened by an oblique border.

Nicotine addiction

Smoker's lungs

Heavy smokers also show dark spots on fluorograms or x-rays. They are explained by the thickening of the pulmonary pattern and the formation of cavities in the bronchi. The roots of the lungs in smokers are blurred - it is difficult to determine their structural boundaries. The blurring of the contours of the roots is explained by the increase in pulmonary vessels due to respiratory failure. In addition, the image of a heavy smoker can reveal bronchitis, tuberculosis, and lung tumors.

Presence of a foreign body in the lungs

Dark spots in the lungs can be caused by the presence of a foreign object in the lung tissue. This can most often be found in children who are careless with small objects. Unfortunately, it is not always possible to detect an object in the bronchi or lungs on an x-ray due to swelling of the organ, so endoscopy is preferable to x-rays.

Listed above are the main reasons for the appearance of dark spots on the lungs on X-rays. It is very important to know that the shadows in the image itself look like the lightest areas, because... these are negatives. And vice versa - enlightenment in this paired organ The darkest fragments will be reflected on the negatives. It is impossible to understand the symptoms of the disease and make a correct diagnosis based only on photographs. This should be done by a qualified radiologist.

The fact is that in our country the number of people suffering from tuberculosis is increasing every year. Although the mortality rate from this disease is gradually decreasing.

Sometimes the image shows some darkening of the lungs. Many people, upon learning about this, panic. But in vain. First we need to find out the reason. After all, spots on the lungs during fluorography may not always mean serious illness. Darkness in the lungs occurs for many reasons.

What are the types of blackouts?

First you need to understand what types there are dark spots and what is their origin.

There are several types of dark spots in the lungs on X-ray:

What is meant by focal opacities? These are small spots in the form of nodules. They can manifest themselves in tumors and inflammations, vascular disorders. But one cannot draw a conclusion about the disease from just one image. It is necessary to undergo an additional full examination. This includes: x-ray, CT scan, blood and urine tests, sputum examination.

With a combination of focal darkening and cough with elevated temperature, one can assume the development of bronchopneumonia.

Sometimes blood tests are normal, but a patient with such dark spots complains of weakness, lack of appetite, and severe cough. This may be a sign of the development of focal tuberculosis. Also, focal darkening in the lungs on fluorography can be a manifestation of pulmonary infarction, oncological processes in the lung and many other diseases.

Focal shadows are dark spots of a round shape, having a diameter of more than ten millimeters. Their presence indicates many diseases, for example:

The presence of tumors can also be assumed. Sometimes this phenomenon indicates a rib fracture.

Segmental darkening in the lungs on fluorography indicates that this is:

pneumonia;
the presence of a foreign body in the lung;
tuberculosis;
metastases in other organs.

It all depends on how many such segments there are and what shape they are. Often segmental darkening in the lungs on fluorography appears in the form of a triangle. Sometimes children inhale small parts of toys, and this can be seen on a fluorographic image as a segmental spot on the lungs.

With lobar darkening, the outlines are clearly visible. They come in different shapes: convex, concave, rectilinear, etc. This phenomenon may indicate:

possible chronic pulmonary disease;
cirrhosis;
bronchiectasis;
purulent inflammation;
tumors.

If the darkening contains fluid, this means that pulmonary edema is developing. It comes in two types:

Hydrostatic edema. It happens when high blood pressure in vessels. The liquid leaves the vessel and enters the alveoli, then fills the lung. This happens with diseases such as angina pectoris and other cardiovascular pathologies.
Membranous. It happens when toxins displace fluid from the vessels into the lung.

A dark spot in the lungs of an indeterminate shape indicates the development of staphylococcal pneumonia. This may also indicate pulmonary infarction, edema, tumor, hemorrhage, accumulation of pleural fluid and other diseases that need to be confirmed with a full examination.

It must be said that there are not only dark spots in the pictures; with emphysema, for example, a white spot in the lungs can be seen on an x-ray. White spots also occur when foreign bodies enter the respiratory tract.

How to decipher the results of fluorography and what to do next?

Often the location of the shadows can tell a lot. A single spot often indicates a tumor. Multiple spots on the lungs indicate the presence of tuberculosis, inflammation, and fluid accumulation.

If the darkening is in the upper part of the lung, it is most likely tuberculosis. A spot with unclear boundaries indicates the development of pneumonia. Some form of opacity indicates pulmonary infarction or hemorrhage. If a person smokes for a long time, there will also be changes in the FLG. A smoker's lungs are usually covered with dark spots.

Usually, after undergoing fluorography, a person receives a picture with a transcript. It contains phrases that sometimes frighten the patient.

We need to consider what they mean.

The expansion of the roots in the picture indicates the development of bronchitis or pneumonia.
Fibrous tissue indicates previous inflammatory processes in the lungs, as well as operations or injuries.
Heavy roots occur in smokers or patients with bronchitis.
The presence of calcifications indicates that the person had an encounter with a patient with tuberculosis. But no infection occurred.
The diaphragm is altered in patients with obesity, pleurisy or diseases of the gastrointestinal tract.
Focal shadows are various shadings.
The pattern of blood vessels is aggravated, which means there are diseases of the cardiovascular system, as well as bronchitis or pneumonia. One can even assume oncology.
Sinus means there are air cavities. Usually healthy people they fill with air, and in patients with pneumonia or tuberculosis - with liquid.
The mediastinum is displaced (widened). This means there is a pathology of the cardiovascular system. This may be myocarditis, heart failure, hypertension.

First, we need to put aside panic. Sometimes it happens that the equipment makes mistakes or there is a defect on the film. As a result, the lungs in the image may also be darkened. Therefore, you should not immediately give in to despair.

Secondly, you should contact a specialist. It’s good if there is a pulmonologist in the city. If not, then you need to go to a TB doctor. They work in any locality. The attending physician will refer you for a full examination. It may also include Diaskintest.

Diaskintest - the newest effective research method human body for the presence of tuberculosis. It is done in the same way as the Mantoux test, but is an improved version of it. When performing this test, errors are minimal.

A computed tomography scan of the lungs may be prescribed, as well as pulmonary bronchoscopy or tracheobronchoscopy. In this case, the upper respiratory tract and lungs are examined using a probe that is inserted through the nose. The procedure is harmless and painless.

This is a very effective examination and gives a complete picture of the condition of the lungs and upper respiratory tract. You should not refuse it if your doctor has prescribed this procedure.

After a complete examination of the patient, the diagnosis and how to treat it immediately become clear. Therefore, the sooner the examination is carried out, the sooner appropriate treatment will begin.

Read better what Honored Doctor of the Russian Federation Victoria Dvornichenko says about this. For several months I suffered from a debilitating COUGH - the cough began suddenly, was accompanied by difficulty breathing, chest pain, weakness, and shortness of breath appeared even with the slightest physical exertion. Endless tests, trips to doctors, syrups, cough drops and pills did not solve my problems. BUT thanks to a simple recipe, I COMPLETELY got rid of the COUGH and feel HEALTHY, full of strength and energy. Now my attending physician is surprised how this is so. Here is a link to the article.

Dark spots in the lungs on x-ray

The anatomical structure of the lungs, their ability to be filled with air that freely transmits x-ray radiation, makes it possible to obtain, during fluoroscopy, an image that reflects in detail all the structural elements of the lungs. However, darkening in the lungs on an X-ray does not always reflect changes in the tissues of the lung itself, since other organs of the chest are located at the level of the lungs and, therefore, the radiation beam, passing through the body, projects on the film a superimposed image of all organs and tissues , falling within its range.

Main syndromes on radiographs

On an x-ray taken in an anterior projection, the contours of the lungs form pulmonary fields over the entire area, intersected by symmetrical shadows of the ribs. A large shadow between the pulmonary fields is formed by the combined overlap of the projection of the heart and great arteries. Within the contour of the lung fields, one can see the roots of the lungs located at the same level with the anterior ends of the 2nd and 4th ribs and a slight darkening of the area caused by the rich vascular network located in the lung tissue.

All pathological changes reflected on x-rays can be divided into three groups.

Dimming

bronchial obstruction (atelectasis);
accumulation of inflammatory fluid (pneumonia);
benign or malignant tissue degeneration (tumor process).

Change in pulmonary pattern

total (complete) or subtotal (almost complete) blackout;
limited dimming;
round (spherical) shadow;
ring shadow;
focal darkening.

Enlightenment

The clearing in the image reflects a decrease in the density and volume of soft tissues. As a rule, a similar phenomenon occurs when an air cavity forms in the lung (pneumothorax). Due to the specific reflection of x-ray results on photographic paper, areas that easily transmit radiation are reflected in a darker color due to the more intense effect of x-rays on the silver ions contained in photographic paper; areas of a denser structure have a light color. The wording “darkening” in the image is actually reflected in the form of a light area or focus.

X-ray showing a pulmonary pattern of healthy lungs

Total blackout syndrome

Diseases that can cause such a syndrome include:

atelectasis;
cirrhosis;
exudative pleurisy;
pneumonia.

The second sign that makes it possible to identify a pathological condition is an assessment of the uniformity of darkening. Thus, with uniform darkening, atelectasis can be diagnosed with a high degree of probability, and with heterogeneous darkening, cirrhosis can be diagnosed. Interpretation of the results obtained using the radiographic method consists of a comprehensive assessment of all visually detected pathological elements in comparison with the anatomical features of each individual patient.

Limited dimming syndrome

The size of the darkening clearly follows the contours of the affected part of the lung, which may indicate an inflammatory process;
The size of the darkening is smaller than the normal size of the affected segment of the lung, which indicates cirrhosis of the lung tissue or blockage of the bronchus.

Particular attention should be paid to cases in which there is a darkening of normal dimensions, in the structure of which light foci (cavities) can be traced. First of all, in this case, it is necessary to clarify whether the cavity contains liquid. To do this, a series of photographs are taken in different positions of the patient (standing, lying down or bending over) and changes in the level of the estimated upper limit of the liquid contents are assessed. If fluid is present, a lung abscess is diagnosed, and if it is not present, then the likely diagnosis is tuberculosis.

X-ray shows limited darkening of the lungs in two projections

Round shadow syndrome

I identify round shadow syndrome when the spot on the lungs has a round or oval shape on two photographs taken perpendicular to each other, that is, from the front and the side. To decipher the results of radiography when a round shadow is detected, they rely on 4 signs:

form of shading;
localization of darkening relative to nearby organs;
clarity and thickness of its contours;
structure of the internal shadow field.

A clear and dense contour indicates the presence of a fibrous capsule, characteristic of an echinococcal cyst. Round shadow syndrome includes only those shadows that are more than 1 cm in diameter; shadows with a smaller diameter are considered lesions.

Ring shadow syndrome

A ring-shaped spot on the lung on an x-ray is the easiest syndrome to analyze. As a rule, a ring-shaped shadow appears on an x-ray as a result of the formation of a cavity filled with air. A mandatory condition under which the detected darkening is classified as ring-shaped shadow syndrome is the preservation of a closed ring when taking pictures in all projections and in various positions of the patient’s body. If in at least one of the series of photographs the ring does not have a closed structure, the shadow can be considered an optical illusion.

If a cavity is detected in the lung, the uniformity and thickness of its walls should be assessed. Thus, with a large and uniform thickness of the contour, one can assume the inflammatory origin of the cavity, for example, a tuberculous cavity. A similar picture is observed with an abscess, when purulent melting of tissue occurs and the contents are removed through the bronchi. However, with an abscess, the remains of pus most often remain in the cavity and their complete removal is quite rare, so usually such a cavity is a tuberculous cavity.

The image shows a ring-shaped shadow in the lower lobe of the right lung

Focal opacification syndrome

The main criteria for assessing focal darkening are:

area of distribution and location of foci;
shadow contours;
darkening intensity.

When one or more dark spots are located in the upper parts of the lung, this is a clear sign of tuberculosis. Many foci with limited spread are a sign of focal pneumonia or the result of the disintegration of a tuberculous cavity, located, as a rule, slightly above the detected foci. In the latter case, a round or ring-shaped shadow may also be observed in the picture.

Since extensive dissemination of lesions can indicate more than 100 diseases, to distinguish between causes, the size of the shadows should be assessed. Thus, tiny lesions covering the entire area of the lung may indicate pneumoconiosis, miliary tuberculosis or focal pneumonia.

The image shows small focal shadows

In the vast majority of cases, a final diagnosis cannot be made on the basis of lung x-rays, since analysis of the resulting image allows us to identify only a syndrome characteristic of a particular disease. If the x-ray showed darkening of any area, then to clarify the diagnosis and assess the dynamics of the disease, it is necessary to conduct a set of laboratory tests and additional diagnostics using MSCT, bronchography, biopsy, etc.

What does darkening in the lungs mean on x-ray?

It happens that an x-ray shows darkening of the lungs in the image. There may be a darkening of the upper part of the lung on the X-ray, as well as the lower part, both on the right lung and on the left lung.

Anyone who discovers such an X-ray will ask the question, “What does this mean?”

It is important to understand that this fact can be an alarm bell and warn of a pathological process or painful physical condition. Darkening in the lungs on an X-ray in a child can occur for the same reasons as in an adult. The difficulty lies in the initial identification of the pathology, since X-rays are rarely prescribed for children. This is due to the destructive properties of radiation, which adversely affect the human body, especially the child’s body.

Any darkening of the lung on an x-ray appears as a white spot on the image. It can occur for various reasons and be of different sizes.

Spots on the photo

The main causes of dark spots in the lung

To begin with, it is important to know that the presence of a spot does not mean an unambiguous sign of a disease; sometimes the formation of spots can be an error of the X-ray machine (faulty development technology, poor film quality, etc.).

Within radiology, there are many different classifications of darkening, which may indicate different reasons for the appearance in both an adult and a child. An experienced radiologist can identify a specific type of spot and determine the cause that was the decisive factor in its appearance on the image.

Lobar and focal darkening

Darkening on an x-ray in an adult and a child is usually divided into lobar and focal. When the darkening is lobar, you can clearly see the outlines of the spot. As a rule, such a spot is a sign chronic pathology. It can be located on both the left and right lung.

With the second type of darkening, the spots are quite large (up to 1 centimeter in diameter) and indicate the presence of an inflammatory process. Sometimes this kind of darkening is a sign of vascular pathology or cancer. The causes can also be a heart attack of the left or right lung, tuberculosis and other diseases. If there is headache and cough, this may indicate bronchopneumonia. A sign of bronchopneumonia is also pain in the upper part of the lung.

If thrombophlebitis and coughing up blood occurs, this indicates the likelihood of a heart attack of the left or right lung (depending on the location of the spot).

Classification of blackouts by shape and reasons for their appearance

There are blackouts of the following forms:

Indefinite shape (lack of clearly defined outlines). To establish an accurate diagnosis, the radiologist, as a rule, prescribes additional clinical studies (CT, urine, blood, etc.). Possible diseases may be: pneumonia, infarction of the left or right lung, hemorrhage, the presence of a tumor or pleurisy.
Liquid darkening (tissue edema). This happens due to an increase in pressure in the vessels and the fluid from them exits into the alveolar apparatus of the organ, as a result of which the proper functioning of the organ is disrupted. The cause may be a disruption of the cardiovascular system.
Segmental darkening. Triangular shape spots most likely indicate a tumor (cancerous or benign), fluid in the pleural cavity, pneumonia or tuberculosis. To obtain a complete and plausible picture of the disease, the doctor gives a referral for tests and prescribes additional examinations.
Focus dimming. For example, a round spot with a diameter of up to 1 centimeter may indicate pneumonia, tuberculosis or an abscess.
Encapsulated caseous focus. Sometimes indicates cancer, about the presence of a lipoma or adenoma. However, for an accurate diagnosis, the patient also needs to undergo other examinations prescribed by the doctor and undergo additional tests.

What to do if spots are detected on an x-ray?

If you notice any darkening in the picture, do not immediately start panicking. Just listen to your doctor and take all additional tests necessary to establish an accurate diagnosis and understand what it is.

Remember that x-rays are just helper method diagnostics, which only supplements information about the patient’s health status. Even the radiograph says “Conclusion”, not “Diagnosis”. In this regard, do not invent illnesses for yourself, but simply follow your doctor’s instructions.

What does darkening in the lungs mean on fluorography?

Some patients panic when, after another fluorography done as part of scheduled inspection, a darkening is detected.

There are no particular reasons for concern yet - darkening in the lungs on fluorography does not necessarily imply some kind of “death sentence”. It is likely that this is simply a film defect or traces of constant smoking.

But in some cases there really is cause for concern. Final conclusions can be drawn only after additional examination has been completed. The doctor will definitely prescribe it in such a situation. So, what does darkening in the lungs hide under fluorography?

Reasons for blackouts

In any case, darkening indicates some problems, so you should not ignore it. This fluorography result shows that some part of the lung is compacted or has changes in the tissues.

Smoking (and long-term and frequent; if a person “indulges,” then the study is unlikely to show anything);
Pneumonia or bronchitis;
Fluid in the lungs;
Foreign object in the bronchi;
Tuberculosis;
an abscess, like any other serious inflammatory process.

Of particular note are tumors. This is the most serious thing that can happen to the lungs except severe injuries. Even if at this stage the neoplasm has no signs of cancer, its transformation into a malignant form is a matter of time and some external influences on the body.

Important! Sometimes darkening in the image shows a problem not with the lungs, but with other organs that are located “neighborhood” to the respiratory system. For example, it could be a growth on the bones, an enlargement of the esophagus, or inflammation of a large lymph node.

Classification of blackouts

Each problem has its own form of darkening in the image. This circumstance gives doctors the opportunity to make preliminary diagnoses before the upcoming examination, as well as most accurately give referrals to specialized specialists.

This saves time, which is very important when identifying and treating certain diseases, especially inflammation and tumors.

Multiple opacities in the area of the apex of the lung. This location often indicates tuberculosis.
Blurred spot boundaries. This indicates pneumonia. Additional signs include high fever and general weakness.
Multiple blackouts. The spectrum is very wide - tuberculosis, inflammatory processes, tumors in other organs and systems. If such spots are detected, the examination will be lengthy and quite complex.
Single clear spot. This is the most unpleasant option, since it speaks of a tumor. But in some cases, similar results are obtained with advanced pneumonia, foreign objects in the bronchi and heart problems, such as a heart attack.

When deciphering the results of fluorography, the doctor pays special attention to the geometric shape of the spots. It is she who speaks about suspected problems and allows us to adjust diagnostic measures.

Important! The most harmless reason darkening - defective film or foreign object between chest and emitter. The subtlety is that a repeat shot to correct the result should not be taken earlier than six months later. You will still have to undergo the examination.

Smoker's lungs

A person who smokes, by definition, is at risk for pulmonary diseases, and quite serious ones at that. Such citizens should undergo fluorography as often as possible, but not violate safety standards. Once every six months is the most appropriate time.

Smoking itself can cause darkening in the lungs - a large amount of foreign substances in the form of tar affects it (the average annual “clogging” of the bronchi is about a glass). In addition, the natural lung tissue is replaced with scar tissue. This circumstance greatly complicates a full diagnosis, since the spots caused by the disease can be covered by the darkening of the “smoker”.

Learn more about shading types

The features of the geometric shape of lung darkening on fluorography were discussed above, now let’s talk about this in more detail.

Medical types of film stains:

Focus. Round spots, the size of which exceeds 1 cm. They talk about pneumonia, asthma, abscess, fluid in the lungs. These are the most common pathologies accompanied by this type of darkening. A very thorough examination is required.
Focal. They are nodular spots, their size does not exceed 1 cm. They talk about inflammation, tumors and problems with blood circulation. If the spots are accompanied by elevated temperature, then most likely we're talking about about pneumonia. In any case, blood, urine and sputum tests should be taken.
Segmental. Such darkening can be either single or multiple, affecting entire sectors of the lungs. In the first case, we are talking about injury or a foreign object in the bronchi, as well as a tumor on initial stage. If the lesion is multiple, the doctor will assume central cancer, fluid in the pleura, acute pneumonia, chronic tuberculosis. Also, such darkening may indicate cancer metastases from other organs.
Equity. These spots are clear, clearly visible and have a regular geometric shape. The main causes are purulent processes and damage to the bronchi. If the spots are located in the middle and lower lobes of the lung, then we can talk about a neoplasm.

If none of the diagnoses listed above are confirmed after a thorough examination following fluorography, then the picture will have to be taken again. Moreover, you need to use a more modern device.

Important! Sometimes errors when deciphering images occur due to the inexperience of the doctor. In this case, you should contact a specialized clinic with experienced specialists for a repeat image. The harm from radiation is not comparable to the consequences of such mistakes, so there is no need to be afraid.

In most cases, darkening in the lungs on fluorography indicates a pathology, often very serious. If spots are found on the picture, you should immediately undergo a full examination.

There are frequent errors during decoding, which arise due to poor-quality film and inexperience of the doctor. In such a situation, fluorography needs to be done again. There is no need to be afraid of excess radiation, because the consequences misdiagnosis in the end they will turn out to be much more terrible!

Darkening of the pulmonary field or part of it

Most lung diseases are accompanied by hardening of the lung tissue, i.e. reduction or absence of its airiness. Densified tissue absorbs x-rays more strongly. Against the background of the light pulmonary field, a shadow appears or, as they say, darkening. The position, size and shape of the darkening depend, naturally, on the volume of the lesion. There are several typical shading options. If the pathological process has involved the entire lung, then the entire lung field is darkened to one degree or another on the x-ray. This syndrome is referred to as “extensive darkening of the pulmonary field.” It is not difficult to detect it - it catches your eye the first time you look at the photo. However, you need to immediately determine its substrate. Darkening of the entire pulmonary field is most often caused by blockage of the main bronchus and atelectasis of the corresponding lung.

An atelectatic lung is airless, so its shadow is uniform. In addition, it is reduced, so the mediastinal organs are shifted towards darkening. These two signs are enough to recognize pulmonary atelectasis and using tomography and fibrobronchoscopy to accurately determine its origin (tumor of the main bronchus, its damage, foreign body). A similar picture can be obtained after lung removal(pneumonectomy), but this option is clear from the anamnesis.

Another pathological process in which the mediastinal organs are shifted towards extensive darkening is fibrothorax with cirrhosis of the lung. However, with this pathology, the darkening is never uniform: against its background, areas of preserved lung tissue, swollen lobules, sometimes cavities, coarse fibrous cords, etc. are visible.

Inflammatory infiltration very rarely extends to the entire lung. If this does happen, then extensive darkening of the pulmonary field is also observed. It is distinguished from atelectasis not only by its clinical picture, but also by its radiological symptoms. In pneumonia, the organs of the mediastinum remain in place, and against the background of darkening, the lumens of the bronchi filled with air can be seen.

Finally, it is very important to point out that darkening of the pulmonary field can be caused not only by compaction of the lung tissue, but also by fluid accumulated in the pleural cavity. With large effusion, the darkening becomes extensive and uniform, as with atelectasis, but the mediastinal organs are shifted to the opposite side.

Much more often, the pathological process does not affect the entire lung, but only a lobe, part of a lobe, segment or even a subsegment. On radiographs, a shadow is detected whose position, size and shape coincides with the changed lobe, segment or subsegment. This syndrome is called “limited darkening of the pulmonary field.” Its substrate is infiltration of the lung tissue (accumulation of any exudate in the alveoli), atelectasis or sclerosis of the lung tissue, tumor growth.

Having discovered limited darkening on radiographs, you must first establish its topography, i.e. determine which share, segment, or subsegment is compacted. The task is essentially simple if two views are available, since each lobe and each segment occupies a specific place in the chest cavity. It is more difficult to install the darkening substrate. Of course, the anamnesis data, the results of clinical and laboratory research often shed light on the nature of compaction of lung tissue. However, given the clinical information, the radiologist always forms his own opinion, guided by a number of considerations. It is convenient to list them using the example of a lesion in the upper lobe of the right lung.

With pneumonic infiltration, the darkening corresponds in size to the lobe, has a clear straight or convex border downwards, separating it from the middle lobe (interlobar pleura). Against the background of darkening, the lumens of the bronchi may be visible. The position of the mediastinum is not changed. With atelectasis, the lobe is reduced, the lower border is retracted, the shadow is uniform, and the mediastinum is slightly shifted towards the darkening. With pneumosclerosis, the lobe is also reduced, and the mediastinum is pulled towards it, but the darkening is heterogeneous: against its background, clearings are visible, corresponding to swollen areas of preserved lung tissue or cavities, as well as intertwining dark stripes fibrous tissue. In contrast to atelectasis, bronchial patency is preserved, which is clearly displayed on tomograms.

The above considerations for differential diagnosis apply entirely to intralobar segmental pathological processes. However, the smaller the volume of the lesion, the more difficult it is usually to unravel its nature. The most general considerations here are as follows. Pneumonic and tuberculous infiltration has the appearance of diffuse or focal darkening with blurred outlines (see below for more details). Tumor growth is indicated by a more or less delimited shadow with uneven contours. The lumens of the bronchi cannot be traced in it; enlarged lymph nodes in the root of the lung may be visible. The compaction caused by a large pulmonary infarction gives a triangular shadow, the base adjacent to the chest wall or interlobar border. Of course, the diagnosis of a heart attack is helped by facts such as the presence of an obvious source of thromboembolism (for example, thrombophlebitis lower limb), chest pain, shortness of breath, hemoptysis, overload of the right heart, detected by electrocardiography.

Darkening of part of the lung field is not necessarily associated with compaction of the lung tissue: a tumor growing from the rib or pleura, pleural mooring and pleural effusion will also cause darkening of the pulmonary field, since they also absorb large amounts of X-ray radiation. However, with the help of radiographs in different projections and, even more so, computed tomograms, it is always possible to establish the marginal localization of the lesion, outside the lung tissue.

Limited darkening of part of the pulmonary field may be due to diaphragmatic hernia, i.e. exit of abdominal organs into the chest cavity through a defect in the diaphragm. In this case, the darkening is inseparable from the contour of the diaphragm and is sharply demarcated from the lung tissue. If the hernia contains part of the stomach or intestinal loops, then the darkening is heterogeneous due to the presence of clearings caused by gas accumulations in these organs. All doubts are eliminated by a study conducted after the patient received a barium suspension, which sequentially fills the stomach and intestines. In this case, the picture shows which part alimentary canal is part of the hernia, and the localization of the hernial orifice can be established.

The special round shadow syndrome in the pulmonary field is classified as limited dimming pulmonary field, in which the shadow of the pathological formation on the images in all projections has the shape of a circle, semicircle or oval with a diameter of more than 1 cm. Such a shadow determines the focus of the lesion, which is spherical or ovoid in shape. The substrate may be eosinophilic infiltrate, tuberculous infiltrate or tuberculoma, a rounded area of pneumonic infiltration, pulmonary infarction, closed cyst (bronchial, retention, echinococcal, alveococcal), aneurysm, benign tumor, malignant tumor(primary or metastatic) and many other pathological conditions.

Differential diagnosis of single and multiple round shadows in the lungs is sometimes difficult. In these cases, anamnesis and clinical picture diseases (for example, pneumonia, pulmonary infarction, metastatic tumors). In addition, it is of great help that many diseases in which round shadows are visible on an x-ray are rare. “What is common is often, and what is rare is rare,” old radiologists like to repeat. In practice, we have to distinguish mainly between closed cysts, tuberculomas and lung tumors.

A closed cyst is defined as a round or ovoid shadow, sharply demarcated from the surrounding lung tissue. On CT scanning, the cyst immediately reveals itself, since, according to densitometry, its contents turn out to be liquid.

Differentiation of tuberculoma, benign tumor and cancerous lump is facilitated if there are radiographs taken earlier, since the growth rate of the formation can be established. Otherwise, a transthoracic needle biopsy may be necessary because X-ray picture in these pathological conditions can be very similar. However, there are also reliable reference points for radiological differential diagnosis. From benign tumors lung hamartoma is most often observed. It, like tuberculoma and cancer, gives a rounded shadow on an x-ray with sharp and not entirely even outlines, but it is easy to recognize if there are calcareous or bone inclusions in the depths of the node. Signs of tuberculoma, to a certain extent, can be considered tuberculous foci around it or in other parts of the lungs, as well as the presence of a silk-like cavity in the place where the draining bronchus enters the tuberculoma. Primary lung cancer is indicated fast growth, the appearance of narrow stripes of lymphangitis to the periphery of the node and towards the root of the lung, enlargement of the lymph nodes in the root. If a single spherical formation is detected in the lung, it is recommended to use the following diagnostic program.

A peculiar form of darkening is a ring-shaped shadow in the pulmonary field - an x-ray display of a cavity containing gas or gas and liquid. A mandatory requirement for identifying such a syndrome is the closedness of the ring on radiographs in different projections. The fact is that in the image in any one projection, the intersecting shadows of the vessels can resemble a ring. Sometimes the ring-shaped figures in the picture in one projection can be formed by bone bridges between the ribs.

The abscess cavity contains gas and liquid; a characteristic horizontal liquid level is visible in it. The walls of the abscess are thick, and in the surrounding lung tissue there is an infiltration zone with soft, vague outlines. A fresh tuberculosis cavity has the appearance of a ring-shaped shadow, around which tuberculosis foci are scattered or a belt of compacted lung tissue is located. The internal contour of the cavity is initially uneven, bay-shaped, then becomes smooth. The dimensions of the cavity range from a few millimeters to several centimeters. Peripheral lung cancer often gives a symptom of a cavity. As a result of the disintegration of necrotic tumor tissue, one or several cavities with scalloped edges appear in it. As the necrotic masses are rejected, the cavity may become round with smooth outlines, but a lumpy mass always remains on the wall of the cavity, at least in a limited area. The external contours of the cavity are uneven and relatively sharply demarcated from the surrounding lung tissue.

The most commonly observed type of shadowing is focal shadows. This term refers to round or irregular shape shadow formations, the sizes of which vary from 0.5 mm to 1 cm. Conventionally, lesions up to 2 mm are considered miliary, from 2 to 4 mm small, from 4 to 8 mm medium and from 8 to 12 mm large. Let us only note that a single round lesion larger than 1 cm in size is usually referred to as round shadow syndrome in the pulmonary field.

The number of focal shadows may vary. In some cases it is a single formation, in others it is a group of nearby foci. Sometimes there are many lesions. If they cover a fairly large area, but not larger than the apex of the lung and two adjacent intercostal spaces on a direct radiograph, they speak of limited dissemination. A larger dispersion of foci over a territory is called widespread dissemination. Finally, there are cases of diffuse dissemination, when foci densely dot both lungs.

When analyzing radiographs, the location of the lesions should first be taken into account. Their location in the apices and outer parts of the subclavian zone in most cases indicates the tuberculous nature of the disease - focal tuberculosis lungs. The presence of lesions in the middle and lower sections lungs is typical for focal pneumonia. It is necessary to analyze with special care the contours and structure of the lesions, as well as the pulmonary background around them. Blurred outlines of lesions are a sign of an active inflammatory process. This is also evidenced by the enhanced pattern in the same zone and the tendency of the lesions to merge. Dense, clearly defined lesions are evidence of granulomatous or subsided inflammatory lesion. Some tuberculosis lesions become calcified during the inactive phase of the disease.

Typically, diagnosing and establishing the nature of focal formations in the lungs, with due attention to clinical data, does not cause great difficulties. Difficulties arise mainly with diffuse disseminations. As a rule, the decision is made on the basis of the results of the analysis of plain radiographs of the lungs, but if there are clinical signs of active tuberculous process or closely grouped foci, it is advisable to perform tomography in order to identify cavities that are invisible on survey photographs.

Medical Expert Editor

Portnov Alexey Alexandrovich

Education: Kyiv National Medical University them. A.A. Bogomolets, specialty - “General Medicine”