X-ray diagnosis of diseases of the upper mediastinum. Differentiation of mediastinal pathology on a chest x-ray

Duration: 23:03

Mediastinum in X-ray image.

Video seminar by Professor I.E. Tyurin on radiation diagnostics for therapists: “Mediastinum in X-ray image.” Video from the program "".

Transcript

Transcript of a video lecture by Professor Igor Evgenievich Tyurin on the mediastinum in an X-ray image from the series of programs Radiation diagnostics for therapists.

Igor Evgenievich Tyurin, doctor medical sciences, Professor:

- Good afternoon! Good day, dear colleagues and those who listen to us!

We are pleased to begin today a new project, which is announced as: “Radiation diagnostics for therapists.” For attending physicians, I would call this topic this way.

Today in the studio, Candidate of Medical Sciences Irina Aleksandrovna Sokolina. Head of the Department of Radiation Diagnostics, Clinic of Propaedeutics named after Vasilenko, Perm State Medical University.

My name is Igor Evgenievich Tyurin. I head the Department of Radiation Diagnostics at the Russian Academy of Postgraduate Education.

Today is our first seminar, the first lesson on radiation diagnostics. It will be devoted to diseases of the thoracic cavity organs, pathologies of the thoracic cavity organs.

We discussed for a long time in what format and in what form to start this seminar, what could be taken up as the first topic for discussion. We decided that a combination of questions normal anatomy, issues of interpretation of X-ray images with fairly common pathology - this is the best option for initial studies.

Today we are talking about the pathology of the mediastinum. Moreover, we will talk about this both from the point of view of x-ray anatomy and from the point of view of pathology lymphatic system chest cavity. In conclusion, here is a short review of mediastinal neoplasms, since this is one of the most common pathologies in this area.

We will start in the following order. First, I will talk very briefly about the normal x-ray anatomy of the mediastinum, general principles interpretation of X-ray images. This is important for all doctors - not only radiologists, but also doctors of all specialties. We encounter chest x-rays probably every day.

As I already said, the third (final) lecture will be devoted to mediastinal neoplasms.

Let's start. In this case, I will start: with issues of normal anatomy and principles of interpretation of mediastinal pathologies.

(Slide show).

Naturally, we begin with what we can do and how we can examine the mediastinum.

It is clear that the initial examination in the vast majority of cases is an x-ray examination. Minimum volume: anterior direct projection and right lateral projection. If necessary, additional images are taken, although this is now quite rare. But in some cases you still have to do this.

(Slide show).

However, the main way to obtain primary information is, of course, two standard x-rays. In these pictures we see an image of the mediastinal shadow (or middle shadow). On the sides of the middle shadow is an image of the roots of the lungs. This, in fact, is the subject of our discussion today.

(Slide show).

How can radiologists and attending physicians interpret the condition of the mediastinum and identify pathological changes there?

Two main points. The contours of the middle shadow, which are formed by the vascular structures and chambers of the heart, first of all. Secondly, this is the structure of the median shadow, which makes it possible to identify pathological changes in this anatomical region.

It is clear that the bulk of the middle shadow consists of the heart and large vessels. Front – chest wall. Behind – the spine, posterior segments of the ribs, soft tissues. This is all summarized on a survey radiograph. But still, the bulk is, of course, an image of the chambers of the heart.

The heart is located symmetrically in the chest cavity, as you well know. It makes up the lower, widest part of the middle shadow. Above are large vessels that originate from the chambers of the heart or bring blood to the chambers of the heart.

(Slide show).

If we talk about how the contours of the mediastinum are formed (the contours of the middle shadow), then radiologists usually call them arches - according to the tradition formed in the middle of the last century in our classic manuals. These bulges or contours of the middle shadow are formed various vessels and chambers of the heart.

If you move from right to bottom and further to the left (also from top to bottom), then the uppermost part of the middle shadow on the right is formed by the superior vena cava. A slightly intense shadow running parallel to thoracic region spine. Next is the right atrium. Between them is the right atriovasal angle, which normally is, as you can see, one third of the height chest on an x-ray.

At the very bottom, sometimes on plain radiographs we see a low-intensity contour of the inferior vena cava, which flows into the right atrium.

If we talk about the left contour, then this is the left subclavian artery emanating from the aorta. Below, in fact, is the aortic arch. Even lower is the pulmonary artery. The contours of these two vessels create a characteristic, typical crossover on plain radiographs (well visible normally).

Below these two lines you can clearly see a light gray, fairly clearly defined air strip in the lumen of the left main bronchus, which here separates the vessels from the chambers of the heart.

Below is the left atrium (below the left main bronchus).

Finally, the left ventricle, which goes behind the shadow of the diaphragm.

(Slide show).

This is how the contours of the mediastinal shadow (middle shadow) are normally formed. If you depict this on a diagram... We deliberately left this as a slide so that it remains and can later be studied and viewed in a calm atmosphere. All the so-called arcs or contours of the heart shadow or middle shadow are depicted here. They form a normal x-ray picture.

(Slide show).

But besides this, there is also the so-called middle shadow structure. This is due to the fact that the heart and large vessels that form shading in the center of the chest cavity are not an ideal round cylinder, but a rather complex structure in the axial plane. It borders on air-containing lung tissue. Where this or that anatomical structure comes into contact with the air filling the lung tissue, we see the outline of this structure.

The contour of the descending aorta, for example, is clearly visible here. Or the outline of the thoracic vertebrae.

The adjacent lung tissue is airy. Thus, since air is a natural contrast agent, it creates a peculiar structure of the middle shadow.

Naturally, in the center (at the top) you see the air strip of the trachea and the two main bronchi, which cross from top to bottom top part middle shadow.

We will now look more specifically at those anatomical structures that may be of interest when we talk about pathology - the border between normal and pathological.

(Slide show).

What are these lines?

These could be lines, they could be contours, they could be stripes. They will be formed depending on what exactly borders, as I already said, the air-containing lung tissue.

This may be the connection of the mediastinal pleura. These can be the contours of the descending aorta, paravertebral lines, and the contours of the azygos vein. All this can be shown now on separate slides so that it is clear.

(Slide show).

The simplest example. One of the typical components of the mediastinal structure is, of course, the right paratracheal strip. It crosses the mediastinum from top to bottom (this is shown by arrows).

Why does it occur?

Inside the trachea there is air as a natural contrast agent. In the upper part you see the computed tomography reformation in the frontal plane. The main bronchi of the trachea are filled with air. From the outside, if you look at the axial sections, the right wall of the trachea is always normally adjacent to the air-containing lung tissue, which is located in the upper lobe right lung.

While the lung tissue remains airy and is located next to the trachea, we see the wall of this trachea in natural form- in the form of a strip, which is located from top to bottom in the right half of the mediastinum.

Another example from the same area.

Why is this fundamentally important?

(Slide show).

Where pathological changes occur, the normal anatomical structure is altered. On the right on the slide is a patient who has an enlargement of the paratracheal group of lymph nodes. This is shown by an arrow on the axial section.

You can clearly see: expansion of the mediastinum to the right naturally leads to the disappearance and replacement of the right paratracheal strip due to the fact that in this place it is no longer air that is adjacent to the mediastinum, to the right wall of the trachea, but enlarged lymph nodes.

(Slide show).

Another anatomical structure is the so-called line or stripe of the anterior mediastinal joint. On axial sections, the arrow shows how the mediastinal pleura anterior to the aortic arch is connected into one whole structure and is located perpendicular to the sternum and the anterior chest wall.

The display of this structure on x-ray films is a typical perfect line that crosses obliquely the region of the tracheal bifurcation. If it is present, we can almost certainly say that there are no pathological formations in the mediastinum or any changes in this area.

On the other hand, in addition to such stripes or lines that exist in the mediastinum, there are also contours of natural anatomical structures. The most understandable and simplest in this regard are the contours of the arch of the descending aorta (here they are shown with red arrows - you see them on axial tomograms).

Since the arch in its distal part and the descending aorta along its entire length border with air-containing pulmonary tissue, mainly in the lower lobe of the left lung, we always clearly see the left contour of the descending aorta against the background vascular structures mediastinum, against the background of the heart.

On the other hand, we can always see the contours of the thoracic vertebrae (the so-called paravertebral lines) next to the contour of the descending aorta. Here they are indicated by pink arrows. Since the thoracic vertebrae are also in contact with the air-containing lung tissue, they are also normally visible on x-rays very well.

On the other hand, a long, fairly intense vertical line that crosses spinal column almost in the middle is a line that is formed by the retraction of the cardiac silhouette behind the heart. Where the azygos vein is located. The esophagus is located somewhere there. Hence the name - (inaudible, 12:27) - esophageal pouch.

The pulmonary tissue here extends beyond the right atrium deep into the mediastinum and forms a kind of inversion. We can clearly see this on a survey X-ray in the form of a stripe. Many people, by inertia, perceive this as the right wall of the aorta, hoping to see an aortic aneurysm or some other pathological changes in this place.

But if you look at the axial sections, you can clearly see that the left wall of the descending aorta borders the pulmonary tissue, and the right wall of the aorta is located in the thickness of the mediastinum, bordering the fatty tissue. Therefore, of course, we cannot see it in any way on a survey x-ray.

On the left, along the right contour of the middle shadow, you see the contours of the thoracic vertebrae. They are indicated by the same pink arrows. The vertebral bodies on the right border in the same way with the lung tissue.

(Slide show).

What does it mean practical significance?

Here is a young man whose mediastinal configuration is almost normal, we would say. There is nothing special here, perhaps in terms of the width of the middle shadow or the image of the arcs of the middle shadow. However, we see a clear, perfectly defined double outline to the right above the aperture. It's like there are two chambers of the heart.

Where did this circuit come from?

Obviously, there are some additional formations here, in addition to the normal vascular structures. In the lateral view, we see that this additional shadow is projected into the retrocardial space near the spine.

If we now look at the same thing in axial sections on a tomographic image, we clearly see that behind the heart (near the spine), in the paravertebral region, there is a large cystic formation– enterogenous cyst.

The addition of two contours - the contour of the right atrium and the contour of the cyst - forms two contours on the overview image. We can clearly and accurately assume immediately from the survey radiographs that it is additional education located in the posterior part of the mediastinum - near the spine.

(Slide show).

Another example. A clear widening of the mediastinum (middle shadow) to the right in a woman aged 60 years.

Could there be a heart pathology?

Yes, may be. On the X-ray in the lateral projection, you see that this low-intensity shadow is projected onto the front part - onto the region of the heart, onto the shadow of the heart.

It immediately attracts attention that we do not see the contour of the heart, or separately the contour of the right atrium, as we should see normally. The image you see in the axial plane on the CT scan is the same cyst. The same racemose formation. IN in this case This is a pericardial cyst, but only located in the anterior mediastinum.

Since it comes into contact with the chambers of the heart, naturally, we can no longer see the contours of the heart chambers here.

(Slide show).

This is a common x-ray recognition technique. pathological changes mediastinum. Pulmonary changes can also introduce peculiar changes into the normal structure of the mediastinum. You see here an intense, sharp, clear line that crosses the shadow of the mediastinum almost from the bifurcation and towards the diaphragm, towards the chest wall.

(Slide show).

In the lateral projection image, this is all localized in the posterior part. A typical picture of atelectasis of the lower lobe of the right lung with corresponding changes in the configuration and configuration of the structure of the mediastinal shadow.

(Slide show).

The same thing in the form of computed tomography reformation. We see a collapsed, airless lower lobe of the right lung and a pathological formation that completely blocks the lumen of the intermediate bronchus in this patient.

(Slide show).

In the lateral projection, the middle shadow breaks up into several component elements: the aorta, heart, elements of the pulmonary artery, and the root of the lung. The image of the mediastinum (middle shadow) here, of course, is completely different.

If you start from the bottom and front and move around the circle, then the very front bottom part The contour of the mediastinum is the right ventricle. Just above is the ascending aorta. Even further is the aortic arch. Even further is the descending aorta.

In the lateral projection we see almost the entire aortic arch along its entire length.

The posterior contour of the heart is formed in the upper part by the left atrium, and in the lower part by the left ventricle. The esophagus runs along this posterior surface, as you remember well, so contrasting of the esophagus in many cases was used before and is now still used for indirect assessment of the condition of the left chambers of the heart.

Finally, in the lowest part is the contour of the inferior vena cava, which flows here into the right atrium and crosses the contour of the left ventricle.

(Slide show).

This is how the middle shadow looks in lateral projection. Several sections of the middle shadow and mediastinum are distinguished in radiology.

One of them is the aortopulmonary window. Since we are talking about side projection images, it is clearly visible in side projection images. This is the space that is located between the aortic arch and common trunk pulmonary artery, and filled with air.

Why is it important?

The clearing between two large vessels is filled with fatty tissue in the mediastinum. It can be clearly detected by tomographic examination between the ascending and descending aorta and trachea.

Pathological processes often occur in this place when the normal image of the aortopulmonary window disappears. The reformation clearly shows the relationship between the pulmonary artery and the aortic arch, the reason for the appearance of such a window on an x-ray in the lateral projection.

(Slide show).

Pathology.

• Enlarged lymph nodes.
• Neoplasm of the bronchus.
• Aneurysm of the aortic arch.
• Pericardial cysts.
• Variants of vessel arrangement located here.

(Slide show).

All this can be detected already on a regular x-ray. Here you can clearly see that in the projection of the aortopulmonary window there is an additional formation. The air-containing lung tissue is practically invisible here. This is the indication to do additional research: in this case - computed tomography.

(Slide show).

You see that between the ascending and descending aorta there is a huge pathological formation emanating from the bronchus of the upper lobe of the left lung.

(Slide show).

Other sections that are traditionally identified during X-ray examination.

This is usually the retrosternal space. Enlightenment, say radiologists. The air-filled part behind the sternum, which is usually clearly visible on a plain film.

This is the retrocardial space. The same air-containing area behind the heart.

Finally, there is the retrotracheal space behind the air column of the trachea.

All these areas are filled, one way or another, with airy lung tissue. If pathological formations appear there...

(Slide show).

For example, the restrosternal space. Intrathoracic goiter or some kind of tumor of the anterior mediastinum, aneurysm of the ascending aorta, and so on. In this case, we naturally see pathological changes on a plain radiograph.

(Slide show).

In this situation, the retrocardial space: we see in the direct projection image an additional shadow that is adjacent to the descending part of the aorta. In this case, the contour of the descending aorta disappears. In the lateral projection, this formation is located against the background of the shadow of the vertebrae in the retrocardial space, we would say.

Naturally, this requires the use additional methods research to identify the same formation that is located to the left of the descending aorta and requires appropriate treatment.

(Slide show).

Retrotracheal space. The air column in the center of the chest cavity is clearly visible. The anterior wall of the trachea and the posterior wall of the trachea. Here is an image of the scapula in lateral projection. But everything that is located behind the posterior wall of the trachea (naturally, normally this is air that shines through the mediastinum) - there should be no pathological changes here.

(Slide show).

If we see such a picture, when behind the trachea - it is pushed towards the front, curved - there is such a formation, of course, these are pathological changes that require the use of additional research methods.

In this case, it is an intrathoracic goiter, which is clearly visible during a tomographic examination.

(Slide show).

Of course, the right paratracheal space, which we already talked about today. Most often these are the lymph nodes of the mediastinum, which will be discussed later today. They enlarge and lead to modification of this area, to the disappearance of the paratracheal strip, to the expansion of the mediastinal shadow to the right, as in this patient with sarcoidosis and enlarged paratracheal lymph nodes.

Here is what concerns normal anatomy, the initial analysis of the mediastinal condition, which is usually performed by radiologists. It is very useful for all specialists who in one way or another deal with the pathology of the thoracic cavity.

This is due to the fact that even the overview X-ray(sometimes even in one projection, when it comes to examinations in intensive care conditions in the ward intensive care) in many cases allows you to very accurately, very reliably determine, firstly, the presence or absence of pathology. Secondly, guess where it is and what it could be.

In our conditions, of course, it is fundamentally important to decide whether something else needs to be done for this patient (some additional research). If necessary, then which ones?

I would like to stop here.

22.02.2017

All parts of the mediastinum are closely connected to each other by fissures and sinuses, so inflammatory processes easily become widespread.

The fiber surrounding the mediastinal organs in children is loose and tender, and therefore the mediastinum is more pliable and elastic. All parts of the mediastinum are closely connected to each other by fissures and sinuses, so inflammatory processes easily become widespread.

The mediastinum in newborns and infants is larger than in adults, occupying almost 1/3 of the volume of the chest cavity. A significant part of the anterior mediastinum in newborns and infants is occupied by thymus.

The thymus gland, glandula thymus, consists of two lobes enclosed in a connective tissue capsule. In front it is adjacent to the posterior surface of the sternum, in the back it is in contact with the ascending aorta, the superior vena cava and the pulmonary trunk; on the right and left, the mediastinal pleura separates it from the lungs. Form thymus diverse: pyramidal, triangular or oval. The width of the gland ranges from 3.3 to 10.8 cm, the thickness reaches 1 cm. The upper edge of the gland is located 1-1.5 cm above the manubrium of the sternum, the lower one reaches the anterior sections of the bodies of the III-IV ribs, in in rare cases- to the diaphragm. Its weight in newborns is 4.2% of the total body weight.

By the time the child is born, the transverse size of the thymus gland is greater than its length and anteroposterior size.

In the first 2-3 years, the growth of the gland is especially rapid, and then slows down. After puberty, the thymus gland usually atrophies and is replaced by connective and fatty tissue.

X-ray examination in a direct projection does not identify the thymus gland, which does not extend outward from large vessels. When the gland is eccentrically located, one of its lobes becomes edge-forming in upper section middle shadow, often on the right (Fig. 232).

Rice. 232. Radiographs of the organs of the chest cavity in the direct posterior and right lateral projections. Shape options,

the size and position of the thymus gland in children of the first year of life.

With thymic hyperplasia, it pushes the layers of the mediastinal pleura outward. The thymus gland forms a uniform, intense darkening with distinct outer contours. The latter can be unevenly convex, sometimes with noticeable polycyclicity, rectilinear or even concave.

As a rule, the shape of the contours and the length of the shadow are asymmetrical. The lower pole of the gland merges with the cardiovascular bundle, overlapping its corresponding sections; sometimes the shadow of the gland reaches the diaphragm. Often the lower pole of the gland is rounded or pointed, the shadow of which is wedge-shaped and resembles mediastinal-interlobar pleurisy. In addition to the location of the gland in the edge-forming section, it is possible that it is wedged between the ascending aorta and the superior vena cava. In this case, the thymus gland shifts the superior vena cava to the right, thereby increasing the width of the median shadow at the level vascular bundle. To clarify the size and position of the thymus gland, X-ray examination in the lateral projection is crucial.

On a radiograph in a lateral projection, the thymus gland is located at the level of the upper part of the retrosternal spaces a, merging with the shadow of the heart and large vessels.

With hyperplasia, the thymus gland, spreading anteriorly and downward, fills, to a greater or lesser extent, the anterior mediastinum and creates a uniform, medium-intensity shadow with a fairly clear inferoanterior contour at the level of the retrosternal space.

Knowledge of the anatomical and radiological variants of the shape, position and size of the thymus gland is of practical importance, since the shadow of the gland can be the cause of diagnostic errors, simulating enlarged lymph nodes, a mediastinal tumor, encysted mediastinal pleurisy and other pathological processes.

The hyperplastic thymus gland, in contrast to the tumor and pathologically changed lymph nodes of the anterior mediastinum, is characterized by the absence clinical manifestations. It remains relatively constant in size in the coming months of radiological observation. As the child ages, there is a gradual decrease in the gland.

With age, as the diaphragm descends and the size of the thymus gland decreases, the size of the chest cavity increases, and the mediastinum decreases. In this regard, in an x-ray image in a direct projection, the median shadow becomes narrower relative to the transverse size of the chest, and in a lateral projection, the retrosternal space appears wider and more transparent.

It is carried out using multi-axial fluoroscopy and radiography, contrasting of the esophagus, tomography (linear and computer), pneumomediastinum, diagnostic pneumothorax, angiography, ultrasonography.

3.1 X-ray examination

Brief information: the mediastinum is a volumetric formation located in the center of the chest, bordered on the sides by the pleural cavities, below by the diaphragm, and above by the entrance to the chest. The mediastinum is anatomically divided into three zones: 1) the anterior mediastinum, which is located above the heart and contains the thymus gland (thymus) along with lymphoid and adipose tissue; 2) the posterior mediastinum, which is located behind the heart and includes the esophagus, thoracic duct, descending aorta and autonomic nerve cords; 3) the middle mediastinum, which contains the heart, pericardium, aorta, trachea, first-order bronchi and corresponding lymph nodes.

Indications for research: the most common symptoms of mediastinal damage are nonspecific (chest pain, cough, respiratory distress) and are associated with compression of the trachea and esophagus. These symptoms may be signs of the development of the following mediastinal diseases: mediatinitis, paramediastinal pleurisy, mediastinal lipomas, enlarged mediastinal lymph nodes, mediastinal tumors and cysts.

Preparation for the study: not required.

The interpretation of the study results must be carried out by a qualified radiologist, the final conclusion based on all data on the patient’s condition is made by the clinician who referred the patient for the study - a therapist, pulmonologist, allergist, surgeon, oncologist, cardiologist.

During X-ray examination, there is often a need to establish a more precise localization of the pathological formation, especially if it is located in the anterior mediastinum. In these cases, it is practically advisable to divide the anterior mediastinum into two parts: the anterior section, or retrosternal space, and the posterior section, or, according to Twining and other foreign authors, the middle (central) mediastinum. The practical significance of this division of the anterior mediastinum becomes clear when we consider that various malignant lesions of the lymph nodes are usually localized in the middle mediastinum, where the main groups of mediastinal lymph nodes are located, while dermoid formations and tumors of the thymus are in most cases located in the retrosternal space. This circumstance, as will be shown below, plays an important role in the differential diagnosis of tumors and mediastinal cysts. In addition to the above, in some cases it is possible to clarify the localization by determining in which part (upper, middle, lower) of the anterior or posterior mediastinum the pathological formation is located.

Experience has shown that a thorough conventional multi-axial x-ray examination of the mediastinum, the so-called hard photographs with overexposure, tomography, as well as artificial contrast (examination of the esophagus with an aqueous suspension of barium sulfate, pneumomediastinography, angiocardiography, bronchography) still allow a fairly complete study of the topographic anatomy of the mediastinum in x-ray image.

The least favorable conditions for x-ray examination are created with direct projections (anterior and posterior). In this case, as is known, all mediastinal organs are summed up into one intense so-called median shadow. Analysis of the shape of this shadow in various projections is given in many manuals.

In the anterior direct projection, the right contour of the median shadow is formed in the upper part by the right innominate vein, followed by two arches - the first is formed by the ascending aorta and partially by the superior vena cava, second - right atrium. Along the left contour of the median shadow, four arches are distinguished, formed sequentially by the aortic arch, reaching at the top almost to the level of the sternoclavicular joint, the conus of the pulmonary artery, the left atrial appendage and the left ventricle.

The best conditions for studying the mediastinum are created with oblique and especially lateral projections. We take lateral radiographs with the anterior transverse direction of the X-rays (according to A.E. Prozorov), i.e. the patient stands behind the screen not strictly sideways, but is slightly turned towards the X-ray tube so that the sternum takes a strictly profile position. This projection ensures that the symmetrical anterior sections of both sides of the chest coincide.

On a lateral chest x-ray, a cardiovascular shadow is visible, occupying predominantly the middle part of the chest image. Anteriorly and more upward (to the level of the first intercostal space) from this shadow to the posterior wall of the sternum there is a light field, sharply narrowing in the lower part, or the so-called retro-sternal space, which is a reflection of the summation of the anterior pulmonary edges of the opposite sides with a narrow fissure of the anterior mediastinum. Posteriorly from the cardiovascular shadow to the spine, another clearing is visible, wider in its middle part and narrow in the upper and lower third, irregular strip-shaped - the so-called retrocardiac space. In this space, the posterior sections of the lungs and the organs of the posterior mediastinum are displayed in total. In older people, the shadow of the descending aorta is clearly visible in the retrocardial space, overlapping most of it with the spine. Above the level of the first intercostal space, an intense shadow begins, caused by the total display of the muscles and bones of the upper shoulder girdle and the branches of the large blood vessels. In the upper part of the mediastinum, along the posterior edge of the vascular shadow, there is a vertically located light stripe up to 2 cm wide - the trachea, which crosses the shadow of the aortic arch and immediately below its lower contour at the level of the DV-DVI vertebrae is divided by a fork into two narrower stripes of clearing - the main bronchi. The right bronchus is a projection continuation of the trachea, the left bronchus extends posteriorly at a slight angle. The frontal plane, drawn along the posterior contour of the trachea, will be the conventional boundary that separates the anterior mediastinum from the posterior one. The lower contour of the aortic arch serves as an identification point by which one can determine the location of the tracheal bifurcation, the initial sections of the main bronchi and the branching of the common pulmonary artery. Anterior to the bifurcation and projection of the right main bronchus, the shadow of both roots of the lungs is visible. The length of the shadow of the roots occupies approximately two intercostal spaces, and the width is about 2-3 cm. These dimensions in healthy people may vary depending on the age and structure of the chest. The upper pole of the shadow of the roots of the lungs, formed by the right and left pulmonary arteries, borders on the lower contour of the aortic arch. The posterior edge of the shadow of the roots is limited by a light strip of the right main bronchus, and the anterior edge, uneven and branched, is formed by the branches of the pulmonary arteries. The chest is delimited from below by the diaphragm, and in the left lateral projection the left dome of the diaphragm with the gas bubble underneath is located above the right one; in the right lateral projection - vice versa. The central part of the diaphragm, which is the lower border of the mediastinum, is not differentiated. It is also necessary to note other differences in the X-ray display of the chest in the right and left oblique projection. Thus, on the right lateral radiograph, the right main bronchus is better visible, and sometimes a cross-section of the right upper lobe bronchus in the form of a rounded clearing under the aortic arch. On the left lateral radiograph in older people, the shadow of the arch and descending aorta is better defined, and below it the shadow of the arch of the left pulmonary artery. The choice of right or left projection when taking a chest x-ray depends on the localization of the pathological process in the mediastinum according to the well-known principle: the affected side is closer to the film. Other organs of the mediastinum (esophagus, lymph nodes, nerves) are usually not differentiated under normal conditions.

Of great importance in the study of the x-ray anatomy of the mediastinum are, in addition to the lateral ones, oblique projections, as well as pneumomediastinography, which allows a more thorough examination of the aortic arch and its descending part, the trachea, the main bronchi, the pulmonary arteries, the esophagus, and sometimes the thymus.

Flaws. As is known, not all organs of both the anterior and posterior mediastinum can be seen during an X-ray examination. This is due to the lack of necessary conditions for natural contrast between the mediastinal organs in their x-ray display, which creates great difficulties in x-ray analysis of the median shadow.

Thus, despite significant difficulties in analyzing the X-ray picture of the mediastinum, careful conduct of conventional multiaxial X-ray examination, as well as a number of additional methods (hard images with overexposure, tomography, bronchography, pneumomediastinography, angiocardiography) allows in most cases to obtain fairly clear ideas in this regard and make a correct judgment about the state of individual organs of the mediastinum.

Contraindications, consequences and complications. X-ray of the mediastinum is usually contraindicated in the first trimester of pregnancy. If it is necessary to carry it out during exposure, the patient's abdomen and pelvic area should be protected with a lead screen or apron. X-rays are prohibited for patients in serious condition, as well as for patients with bleeding or open pneumothorax.

The study is accompanied by a certain radiation dose, so it is not recommended to undergo plain radiography of the mediastinum frequently over a short period of time.

When conducting an X-ray examination in direct projection, organs mediastinum form an intense middle shadow. From the sides it is clearly demarcated from the lungs, downwards it merges with the medial sections of the dome of the diaphragm, at the top it noticeably narrows and smoothly passes directly into the neck area.

About the pathology syndrome of the median shadow is accepted speak when its normal x-ray picture changes (changes in the position, shape, size and contours of the shadow), which may be due to various diseases(tumors, mediastinal cysts, lymphomas, sarcoidosis, lymphogranulomatosis).

The shape and size of the median shadow largely depend on age and constitutional features , breathing phases and position of the subject. In people with an asthenic build, the mediastinum is narrower and longer, in hypersthenics it is wider and shorter than in normosthenics. When inhaling, there is a moderate decrease in the transverse size of the mediastinum, and when exhaling, there is a slight expansion of it. Changing its transverse dimensions during breathing, the median shadow should not make noticeable lateral displacements.

When examining in the lateral projections of mediastinal organs visible more clearly than in direct projection. Radiologically, when examining in a lateral projection, it is possible to draw boundaries according to the conditional division of the mediastinum into anterior, central, posterior and, accordingly, upper and lower.

Anterior mediastinum is between back surface sternum and a vertical line drawn along the anterior wall of the trachea. It corresponds to the retrosternal space, where the thymus gland, anterior mediastinal or retrosternal lymph nodes, fatty tissue, heart and ascending aorta are located.

In this area mediastinum most often there are tumors thyroid gland retrosternal localization, cervical-mediastinal lipomas, thymus tumors (thymomas) and cysts.

The thyroid gland may enlarge with malignant neoplasms , with diffuse toxic and endemic goiter, with toxic adenoma.

X-ray for retrosternal goiter characterized by a thick, uniform, goblet-shaped shadow with a sharply defined convexity on both sides, located symmetrically or asymmetrically in the upper part of the anterior mediastinum. This shadow is accompanied by a pronounced displacement of the trachea, blood vessels, and sometimes the esophagus. A similar picture can be observed with isolated tuberculosis damage to the paratracheal and tracheal lymph nodes, which is rare.

Enlarged thyroid puts pressure on the trachea, causing its flattening with symptoms of stenosis. Radiographs reveal a symptom of overlap of the goiter with the trachea. Radiologically, when coughing or swallowing, a displacement of this shadow is observed.

Cervicomediastinal lipomas can grow from the pericardium, lungs, trachea, bronchi, diaphragm and other mediastinal organs. Morphologically, fatty tumors are predominantly benign, but they can also be liposarcoma.

True mediastinal lipomas localized only in the anterior mediastinum. Radiologically, they are characterized by an intense, homogeneous shadow of an irregular round shape with clear contours, which does not change with breathing and changes in body position.

Intrathoracic lipomas long time are asymptomatic, detected incidentally during X-ray examination. Clinical symptoms such as shortness of breath and chest pain appear only with large tumors up to 20 cm in size.
Increase thymus can be observed in thymomas, which must be differentiated from VGLU hyperplasia in tuberculosis and sarcoidosis.

In most cases radiographic shadow with thymomas is similar to changes with the tumorous form. It is symmetrical and has well-defined contours. Unlike tuberculosis, its transverse size is no less than its longitudinal size. Distinctive feature Timom during fluoroscopy is a symptom of divergence and disappearance of the shadow when the patient turns. It should be remembered that thymomas, like other intrathoracic tumors, lead to displacement of the mediastinal organs. This phenomenon is not observed with VGLU tuberculosis.

Coelomic cysts The pericardium is located in the lower part of the anterior mediastinum in the cardiophrenic angle, usually on the right. The cyst grows slowly and over a long period of time. For many years it retains its size (no more than 4-6 cm in diameter). In most cases it does not cause any clinical symptoms, being an accidental radiological finding. VGLU tuberculosis differs from them in the severity of intoxication, thoracic syndromes and characteristic features primary tuberculosis process.

Dermoid cysts most often located in the middle part of the anterior mediastinum. They grow quickly and reach large sizes, which distinguishes them from coelomic cysts. Along the periphery, dermoid cysts are sharply separated from the surrounding lung tissue, most often they are unilateral. When swallowing and coughing, these cysts, unlike the retrosternal goiter, do not move.

Central mediastinum projected onto the trachea, main bronchi and root of the lung. Here are the aortic arch, pulmonary trunk, pulmonary arteries and veins.

Lower section middle mediastinum busy at heart. In this part of the mediastinum, tuberculosis of the upper lymph nodes, sarcoidosis of the upper lymph nodes, lymphogranulomatosis and metastatic tumors are most often detected. Differential diagnosis of this pathology is given above when describing the syndrome of pathological changes lung root and VGLU.

Rear mediastinum is projected between the posterior wall of the trachea and the anterior surface of the thoracic vertebral bodies. It corresponds to the retrocardial space, in which the descending aorta, esophagus, phrenic and celiac nerves, thoracic lymphatic duct, posterior mediastinal lymph nodes. In this area of ​​the mediastinum, VGLU tuberculosis, leaky abscesses in tuberculous spondylitis and neuromas can be detected.

Paravertebral shadows, caused by a leaky abscess in tuberculous spondylitis, can simulate hyperplasia of the upper lymph nodes. To differentiate them, ODM and x-ray examination of the spine are used.

One of pathologies posterior mediastinum, which must also be differentiated from VGLU tuberculosis, are neuromas. The source of tumor development is nerve sheaths (neurinomas, neurofibromas, neurosarcomas), nerve cells and fibers (ganglioneuromas, neuroblastomas, ganglioblastomas) near the spinal column.

Clinical manifestations neuroma the mediastinum is absent for a long time. In this regard, their diagnosis is often quite late. Their clinical picture manifests itself in two groups of symptoms: neurological and compression. Enlarged lymph nodes with TVGLU, as a rule, do not cause compression of the mediastinal organs. When neuromas become malignant, there is a rapid increase in size, unevenness and polycyclicity of the external contours, and destruction of the ribs and vertebrae.

The role of blood vessels and lymphatic capillaries is to absorb and drain protein fluid from the blood capillary bed and return it to the venous circulation. Along the lymphatic system, near blood vessels and large veins, lymph nodes are grouped (there are more than 600 of them in the human body) - pinkish-gray round or oval formations of approximately 0.5-50 mm, including in the mediastinum - middle section chest, where are located the most important organs human: heart, bronchi, lungs, pulmonary artery and veins, etc. They are a kind of filtration chamber for lymph and serve as a barrier to various infections. Enlargement of the mediastinal lymph nodes or lymphadenopathy is a response to a pathological process occurring in the lungs, or a consequence of malignant formations in anatomically adjacent organs: mammary gland, larynx, thyroid gland, gastrointestinal tract.

Epidemiology

According to statistics, mediastinal lymphadenopathy is detected in 45% of patients. Since this disease is associated with such diagnoses as cancer, pneumonia, sarcoidosis, data related to these pathologies also provide insight into the epidemiology of enlarged mediastinal lymph nodes. In the world, more than 14 million people are registered with lung cancer, and about 17 million a year with pneumonia. Sarcoidosis in different countries distributed unevenly, so in 40 cases per 100 thousand. it is detected in Europe and 1-2 people in Japan.

Causes of enlarged mediastinal lymph nodes

The reason for the enlargement of the mediastinal lymph nodes lies in getting into them pathogenic microbes, which activate white blood cells, fighting infection. The primary causes are bronchopneumonia, tuberculosis, sarcoidosis, and malignant tumors. Malignant pathologies include lymphomas that affect not only the lymph nodes of the mediastinum, but also other areas, metastases of carcinomas - tumors of epithelial tissues.

Enlarged lymph nodes in lung cancer

Lung cancer is a malignant tumor, in 95% of cases developing in the epithelial layers of the bronchi and bronchioles. Less commonly, neoplasms affect pleural cells or auxiliary tissues of the lungs. Of all the types of cancer, this is the most common cause deaths of people all over the world. 4 stages of cancer are determined depending on the size of the tumor, its spread to neighboring tissues and the presence of metastases in the lymph nodes and other organs. At stage 1 of cancer, the lymph nodes are not involved in the pathological process. Enlarged lymph nodes in lung cancer are observed from stage 2. First, the bronchial ones are affected, at stage 3a the mediastinal lymph nodes of the opposite side are involved, at stage 3b the bronchopulmonary ones of the opposite side, and supraclavicular lymph nodes are involved.

Enlarged mediastinal lymph nodes after bronchopneumonia

Bronchopneumonia is an acute infectious disease affecting the walls of the bronchioles. It often occurs after an acute respiratory viral infection, but it can also be a primary disease. Enlargement of lymph nodes after bronchopneumonia occurs due to involvement in inflammatory process lymphatic and vascular system, including the mediastinal lymph nodes. As a rule, with this disease they are moderately enlarged.

Risk factors

Risk factors for enlarged mediastinal lymph nodes include smoking, prolonged exposure to chemicals, harmful fumes, dusty and polluted air, gases. Hypothermia leads to decreased immunity and various viral infections that can be complicated by pneumonia. A hereditary factor in the occurrence of the disease, as well as long-term exposure to various medications, cannot be ruled out.

Pathogenesis

Lymph nodes exist to filter various infectious agents from the tissues of our body, and therefore are located in strategically important places in the body. Once in such “traps,” white blood cells are activated, which fight the invading infection. The pathogenesis of the disease lies in the increased proliferation of lymphocytes - protective cells to intensify the fight against foreign elements if the existing ones cannot cope. As a result, the lymph nodes become enlarged and become denser.

Symptoms of enlarged mediastinal lymph nodes

Symptoms of enlarged mediastinal lymph nodes have a clearly defined clinical picture.

The first signs appear intense and sharp pain in the chest, sometimes they can radiate to the shoulder and neck. Hoarseness of voice, cough, pupils of the eyes are dilated, eyeball may sink, causing tinnitus and headaches. The veins in the neck may swell, making it difficult for food to pass through. The chronic course of the disease is characterized by increased temperature, tachycardia, swelling of the extremities, weakness, and sweating.

Stages

Based on the time course of the disease, three stages of disease development are distinguished:

• spicy;
• chronic;
• recurrent.

The latter is associated with a repeated outbreak of the disease.

Enlarged lymph nodes in the root of the lung

Enlarged lymph nodes in the root of the lung are one of the most common pathologies of this part of the organ. Unilateral damage is most often caused by tuberculous bronchoadenitis, cancer metastases and malignant lymphomas, bilateral damage is caused by stage 1 sarcoidosis, which is characterized by the formation of granulomas in the lymph nodes.

Enlarged intrathoracic lymph nodes of the lungs

One of the reasons for the enlargement of the intrathoracic lymph nodes of the lungs, as well as in their roots, is pulmonary tuberculosis. Lymphoid tissue grows, and the lymph node enlarges accordingly. Then signs of specific inflammation appear.

A slight increase in nodes (up to 1.5 cm) is called bronchoadenitis. With inflammation in the circumference of the lesion, infiltrative bronchoadenitis occurs, which is localized mainly on one side. Even with a bilateral arrangement, it is asymmetrical. Tissue death in the form of a curdled mass is characteristic of tumor-like or tumorous bronchoadenitis.

Another cause of pulmonary lymphadenopathy is a benign disease - sarcoidosis, which is characterized by the formation of epithelioid granulomas in the lymph nodes. This pathology is susceptible more women aged 20-40 years. The nature of this disease is not clear enough today; some scientists associate its occurrence with infectious agents, others - with a genetic factor.

Enlargement of the intrathoracic lymph nodes of the lung can also be caused by injury to the organ.

Complications and consequences

Since enlargement of the mediastinal lymph nodes is most often secondary and develops against the background of a number of the above diseases, the consequences and complications depend on the underlying pathology. Enlargement of the mediastinal lymph nodes can lead to pulmonary thromboembolism and sepsis. Anyway, early detection problems even with malignant formations makes them not as life-threatening as in the later stages of the disease.

Diagnosis of enlarged mediastinal lymph nodes

Diagnosis of enlarged mediastinal lymph nodes is carried out on the basis of a medical history, tests, instrumental and differential diagnosis, because visually the lymph nodes inside the chest are not accessible.

Analyzes

To confirm the suspected diagnosis in a laboratory, a general and biochemical blood test and a blood microreaction (syphilis test) are performed. A lymph node biopsy is also performed. In case of malignant neoplasms, leukocytosis, a decrease in the total number of lymphocytes, an increase in ESR, and anemia are detected in the blood.

Assuming lymphogranulomatosis or leukemia, a puncture is performed bone marrow. If tuberculosis is suspected, a sputum test is performed. Sarcoidosis also alters general analysis blood and urine, biochemical, including, the level of red blood cells decreases, monocytes, lymphocytes, eosinophils, ESR increase. There are also specific tests for this disease: a significant increase in ACE enzyme in venous blood or calcium in the urine confirm the presence of pathology.

Instrumental diagnostics

In addition to x-ray examination of the mediastinum, which is characterized by a two-dimensional flat image and is not able to give full picture of all its organs, including due to insufficient imaging contrast, there are other methods of instrumental diagnostics.

Fluoroscopy is a modern and effective examination that displays a more accurate three-dimensional image. It helps to clarify the structure and contours of the darkening, if it is a neoplasm - the degree of its growth into the mediastinum, its relationship to other organs. Informative methods are and CT scan, magnetic resonance imaging, ultrasound.

Bronchoscopy is a way to use an endoscope to obtain material for biological research if tuberculosis is suspected, to examine the trachea and bronchi. Endoscopy is used to examine enlarged lymph nodes.

Enlarged lymph nodes on x-ray of the mediastinum

With absence pathological process In the lungs, the lymph nodes are not visible on the image. Enlarged lymph nodes on an x-ray of the mediastinum look like a “pathological shadow” and give an idea of ​​the localization of the tumor focus, shape, outline, mobility, and relationship with neighboring organs. Enlargement of the lymph nodes may be indicated by compaction and expansion of the roots of the lungs in the image. This picture is typical for bronchitis, pneumonia and lungs of smokers. Tuberculosis of the intrathoracic lymph nodes is determined using a plain radiograph, and clinical picture depends on the volume of their damage, as evidenced by the shadow of the root of the lung, the outline of its outer contour and other characteristics. For a more accurate study of the anatomy of the mediastinum, they resort to various contrasted fluoroscopy methods - pneumomediastinography (using gas injection by puncture), angiocardiography (using iodine), bronchography (various contrast agents), examination of the esophagus using barium.

Differential diagnosis

The task of differential diagnosis is to correctly recognize the pathology among all possible diagnoses: tuberculosis, tumors, sarcoidosis, lymphocytic leukemia, lymphogranulomatosis, viral infections, pneumonia and other diseases leading to enlargement of lymph nodes in the mediastinum.

Treatment of enlarged mediastinal lymph nodes

Treatment for enlarged mediastinal lymph nodes directly depends on the diagnosis. Let's consider the therapy most possible pathologies. Thus, the treatment of sarcoidosis is effective with steroid inhalations. Treatment of tuberculosis involves a long period (up to six months) and is carried out in a hospital, after which it continues on an outpatient basis for up to one and a half years. Anti-tuberculosis therapy includes a combination of 3-4 anti-tuberculosis drugs in combination with immunomodulators, metabolic therapy, and physiotherapy. Various neoplasms most often require surgery in combination with chemotherapy and radiation. For mediastinal lymphoma and late stages of tumors, only conservative treatment is used.

Medicines

Prednisolone is initially used to treat sarcoidosis.

Prednisolone – synthetic analogue hormones cortisone and hydrocortisone. It is an anti-inflammatory, antitoxic, anti-allergenic drug. Available in tablets and ampoules. The dose is determined individually, but usually starts at 20-30 mg per day during an exacerbation. At chronic course– 5-10 mg. They may initially be prescribed intravenously (30-45 mg), and if the dynamics are positive, switch to a reduced dose in tablets. Side effects sometimes include excessive hair growth, obesity, and the formation and perforation of ulcers. Prednisolone is contraindicated during pregnancy, old age, hypertension, ulcerative lesions gastrointestinal tract.

Used for inhalation large doses fluticasone, budesonide. If the pathology cannot be treated, azathioprine, crizanol, and cyclosporine are prescribed.

Azathioprine is a drug that corrects immune processes. Release form: tablets. It is recommended to take 1-1.5 mg per kilogram of weight per day. Nausea, vomiting, and toxic hepatitis may occur. Contraindicated for leukopenia.

Combination treatment of tuberculosis may include the following combinations of drugs: isoniazid, pyrazinamide, rifampicin or isoniazid, rifampicin, etama butol. During out-of-hospital treatment, a combination of two drugs is prescribed: isoniazid with ethambutol, or ethionamide, or pyrazinomide.

Isoniazid is prescribed for the treatment of all forms and localizations of tuberculosis, both in adults and children. Available in tablets, powders, solutions. The methods of administration are different: orally, intramuscularly, intravenously, intracavernosally, by inhalation. The dose for each case is individual, on average up to 15 mg once after meals 1-3 times a day. Side effects may occur in the form of nausea, vomiting, dizziness, drug-induced hepatitis, enlarged mammary glands in men and bleeding in women. Contraindicated in patients with epilepsy, high blood pressure, liver disease, coronary artery disease, etc.

Rifampicin is an antibiotic wide range action, in the pharmacy chain it is presented in capsules and ampoules with a porous mass. Capsules are drunk on an empty stomach half an hour to an hour before meals, administered intravenously only to adults, using sterile water and glucose to prepare the solution. For adults, the daily dose is 0.45 g, for children 10 mg/kg. The course of treatment lasts a month and is carried out under the careful supervision of doctors, because... there may be allergic reactions, decreased blood pressure, indigestion, disorders of the liver and kidneys. Not prescribed for pregnant women, children under 3 years of age, hypersensitivity to the drug.

Vitamins

Enlargement of the mediastinal lymph nodes, no matter what the cause, requires balanced diet, rich in vitamins and microelements. Scroll healthy products very large, including low-fat varieties meat, vegetables (zucchini, carrots, asparagus, celery, cabbage, cucumbers, eggplants, onions, garlic, sweet peppers), various fresh and dried fruits, nuts, cereal porridge, cottage cheese, yoghurts, fresh juices and other products. Rosehip infusions will help increase immunity, beef liver, butter, citrus fruits. For sarcoidosis, there is a restriction on calcium intake, but vitamins E, D, C, and omega-3 are necessary for the sick body.

Physiotherapeutic treatment

Physiotherapeutic treatment for the tumor nature of enlarged mediastinal lymph nodes is not used. For patients with sarcoidosis, EHF therapy on the thymus gland is effective. Pulmonary tuberculosis is treated with laser, ultrasound, and inductothermy. These methods increase blood circulation in the lungs, thereby increasing the effect of anti-TB drugs. Contraindicated in acute disease, hemoptysis, tumor processes.

Traditional treatment

In recipes traditional treatment herbs are used for various pulmonary diseases, bee products, animal fats and plant origin, nuts, etc. Here are some of them:

• mix the interior lard(200g), butter (50g), honey (tablespoon), cocoa (50g), egg yolks(4 pcs.), cream (300g). The resulting mass is whipped in a blender and boiled until it becomes thick sour cream. Drink 1 tablespoon when cooled 3 times a day;
• 2 tbsp. spoons of lycopodium and a pack of softened butter are added to half a liter of honey, mixed thoroughly. Take a tablespoon several times a day;
• beet juice, aloe, honey, Cahors wine (100g each), spoon pork fat mixed and infused for 2 weeks, daily portion 40-50g per day;
• at temperatures, compresses made from grated horseradish and rubbing with vinegar are effective;
• inhalation using pine needles and eucalyptus oil.

Herbal treatment

There are many herbs in nature that can help in combination with drug treatment. If the enlargement of the mediastinal lymph nodes is associated with infectious diseases, pneumonia, tuberculosis, sarcoidosis, then you can safely use teas and decoctions with linden, berries or elderberry flowers, coltsfoot, licorice, plantain, sage, celandine, nettle, and calendula. The pharmacy chain sells special herbal mixtures that balance all necessary components to combat pathological foci.

Homeopathy

Homeopathy is often turned to when various other methods have already been tried, but the result has not been achieved. Homeopathic treatment for cancer uses open different time different scientists biologically active substances, aimed at stimulating the body's resistance and activating antitumor mechanisms. If all known treatment methods have been exhausted, but the effect is not achieved, they resort to autonosode - a homeopathic autovaccine made using ultra-small doses of toxins and poisons. Such preparations are individual and are made from the patient’s blood, urine or saliva based on an alcohol solution.

When treating tuberculosis they also resort to homeopathic remedies. Depending on the symptoms, one or another drug is prescribed. Yes, when prolonged sputum phosphorus is prescribed in different dilutions (6, 12, 30); shortness of breath – Adonis vernalis, apocinum, digitalis; hemoptysis – millefolium, ferrum aceticum, witch hazel; fever - aconite, belladonna, gelsemium, ferrum phosphoricum; cough - natrium phosphorus, natrium sulfuricum.

Apocinum - made from the root of red kutra, used in 3, 6, 12, 30 dilutions. Side effects and contraindications are not described.

Millefolium is an anti-inflammatory and venotonic drug in drops. It is recommended to take 10-15 drops three times a day before meals. Side effects not found.

Aconite - has a combined effect, reduces the secretion of sputum in the bronchi, reduces temperature, has antiseptic, anti-inflammatory, anesthetic properties. Consume half an hour before meals or an hour after. During an exacerbation, place 8 granules under the tongue 5 times a day, gradually reducing to three doses. After 2 weeks, reduce the frequency of administration to 2 times, continue for another two weeks. Possible allergic manifestations, but you shouldn’t stop treatment. Contraindicated for pregnant women, hypotensive patients, and hypersensitive people.

Witch hazel - used in granules to treat lungs, the dose is determined individually by the homeopath. For use by pregnant women, consultation with a gynecologist is necessary.

Surgery

TO surgical treatment are used for tumors and cysts of the mediastinum, and this must be done as early as possible. In the case of malignant tumors, the approach is individual, because on last stage radical method doesn't make sense. Indications for surgical intervention for tuberculosis are the absence of positive dynamics for 1.5-2 years. Sarcoidosis rarely requires surgical intervention, such a need may arise to save a person’s life with various complications.

Prevention

The best prevention is healthy image life, exercise, good nutrition– all this strengthens the immune system, makes the body less susceptible to various infections. It is also necessary to avoid factors causing diseases mediastinal organs: working or living in places of air pollution, contact with patients, hypothermia, stress.

Forecast

The prognosis for the development of pathologies is different for different diseases. Sarcoidosis is not directly life-threatening, but its complications can be very dangerous. Timely and complete treatment of tuberculosis has favorable dynamics, and neglect leads to fatal outcome. Malignant tumors detected on early stages, are successfully eliminated surgical method, later ones have an unfavorable prognosis.