Root compaction is one of the most common x-ray syndromes that a radiologist determines on a plain chest x-ray. What does it mean: "the roots of the lungs are compacted"? What diseases and pathological conditions are hidden under this phrase?
Lung root: what is it?
The root of the lung is a complex of structures located at the hilum of the lung. These include the pulmonary artery, vein, main bronchus, as well as nerves, lymphatic vessels, pleura, fatty tissue. All these structures are located in a strictly defined order, however, part of them on the left side is not visible on the radiograph, hiding behind the shadow of the heart.
On plain radiography and fluorography, under such a concept as the root of the lung, they mean only large vessels (artery, vein) and bronchus.
Main characteristics of lung roots
To determine such a symptom as compaction of the roots of the lungs on an x-ray, you first need to know the features of these formations in the norm.
The root of both the right and left lungs consists ofthree parts: head, body and tail. The composition of the tail includes the final small ramifications of the vessels.
In radiology, the width of these structures is also determined. It is usually determined by the width of the right root and includes the arteries and the intermediate bronchus. Normally, its width is 1.5-2 cm.
It is also worth noting that the arteries in the roots of the lung are located more vertically, and the veins - horizontally. Sometimes their structure can be heterogeneous due to the fact that air in the bronchi is visible in some areas.
Differences in the location of the roots of the lungs
The placement of the roots of the right and left lungs is slightly different. So, the root of the right lung normally corresponds to the level of the II rib and intercostal space and has the shape of an arc, curved downward. Starting wide at the top, the root narrows at the bottom. The left root, in turn, corresponds to the level of the 1st rib and intercostal space, that is, it is located above the right one.
Differences in the structure of the roots of the lungs
It must be understood that the left root is poorly visible on the radiograph, as it is covered by the heart, so it is sometimes difficult to see when the root of the left lung is compacted.
It should also be remembered that the root of the left lung is normally heterogeneous in structure, since it consists of practically only vessels, branching into small branches and intertwining with the left bronchus. While the right root has a more homogeneous structure.
Main causes of root compaction
There are many different diseases and syndromes thatlead to the fact that the roots of the lung are compacted. Top reasons include:
- Chronic obstructive pulmonary disease (chronic obstructive bronchitis).
- Swollen lymph nodes of the mediastinum (paratracheal, parabronchial) with the development of petrificates (deposits of calcium s alts) in them.
- Expansion and protrusion of the vessel wall or vessel aneurysm.
- Change in the structure of the bronchus under the influence of the tumor process.
- Pulmonary edema (fluid leaking into the lung parenchyma).
- Growth of connective tissue with the development of fibrosis, which takes place after prolonged inflammatory pulmonary diseases, lung injuries, surgical interventions on the organs of the chest cavity.
- Tuberculosis of the bronchi (tuberculous bronchoadenitis), tuberculosis of the intrathoracic lymph nodes, primary tuberculosis complex. The last two forms refer to primary TB, which is most common in preschool children.
- Occupational diseases (asbestosis, metalloconiosis).
Chronic obstructive pulmonary disease
This group of diseases is one of the most common reasons why the roots of the lungs are compacted and expanded. As a rule, this process is two-sided - it affects both the left and right roots. Most often, the disease develops in long-term smokers and is characterized by alternating periods of exacerbation with periods of remission.
Main clinicalmanifestations are cough, especially disturbing the patient in the morning - with viscous, sometimes purulent sputum. With a prolonged course of the disease, shortness of breath develops, which is first noted during physical exertion, and then at rest.
In addition to taking a plain chest x-ray, which is characterized by the fact that the roots are compacted and tight in the lungs, sputum culture is also performed to determine the causative agent of the disease (viral or bacterial).
Etiotropic therapy, that is, the treatment of the cause, depends on the pathogen that caused the exacerbation. If the cause is a bacterium, then taking antibiotics will be effective, if the virus is taking antivirals.
Symptomatic therapy includes taking mucolytics, drugs that thin sputum, and expectorants to make it easier to discharge. They also take drugs that dilate the bronchi - adrenergic receptor agonists, corticosteroids.
Cancer
A dangerous, but, fortunately, infrequent reason that the roots of the lungs are compacted and expanded is an oncological process in the bronchi and mediastinal organs. Such a process is usually one-sided, so the change in the root of the lung is observed only on one side.
Oncology implies a long chronic process with a gradual deterioration of the patient's condition. A slight cough, heavy breathing are replaced by pain behind the sternum at the site of the projection of the tumor on the chest wall (with compression of the nerves),hemoptysis, severe shortness of breath. In addition to impaired function of the pulmonary system, the whole body suffers. The patient loses weight, emaciated, fatigue and weakness appear.
After conducting a survey radiography of the chest cavity in two projections, the radiologist concludes: "The roots of the lungs are compacted and unstructured." Next, the attending physician issues a referral for a biopsy of a suspicious x-ray formation, which will determine not only the type of tumor (benign or malignant), but also its histological structure (from which tissues it was formed).
Therapy depends both on the stage of the tumor process and on its type. The main therapeutic methods: surgery, radiation and chemotherapy. Only one surgical intervention is used in the initial stages of tumor development, in later stages it is combined with other methods of therapy.
Occupational diseases
People of professions such as miners, metal welders, builders, that is, those who constantly interact with harmful environmental substances, are most susceptible to the development of occupational diseases. This leads to the fact that on the radiograph, the roots in the lungs are fibrously compacted and heavy. This picture develops due to the accumulation in the bronchi and alveoli of harmful particles that settle in the airways. As a rule, root damage is not isolated, but is combined with the presence of focal shadows and heterogeneity of the lung parenchyma.
The symptoms of these diseases are not specific; atWhen making a diagnosis, first of all, they pay attention to the professional history (place of work, length of service). And the main method of treatment is changing qualifications and changing jobs.
Tuberculosis root damage
A situation where the roots of the lungs are compacted usually occurs in children with primary pulmonary tuberculosis. These are such forms as the primary tuberculosis complex and tuberculosis of the intrathoracic lymph nodes. However, these forms can also occur in elderly people with reinfection of an old focus.
Tuberculosis is a chronic disease, so the symptoms develop for a long time and gradually. Typical are dry cough or with a small amount of sputum, possibly with an admixture of blood, chest pain, fatigue, lethargy, weight loss.
After x-rays are performed in two projections, sputum culture and microscopy are performed to detect Mycobacterium tuberculosis, a tomogram of the lungs for more accurate localization of the focus of infection. After sowing a tubercle bacillus, its sensitivity to anti-tuberculosis drugs is determined, which is necessary to select the most effective treatment.
Drug therapy is based on the principles of continuity and long-term (minimum 6 months). It is also necessary to use a combination of at least 4 anti-TB drugs. Only if these principles are followed will treatment be effective.
The roots of the lungs are tight and tight: what does this mean?
As noted above, the most frequently givenX-ray syndrome occurs in chronic smoker bronchitis and occupational lung diseases. However, this symptom can also be determined in acute inflammatory diseases of the respiratory tract, oncological diseases.
These strands are connective tissue fibers that stretch from the root to the periphery. The heaviness is usually combined with the expansion and compaction of the root.
Without being highly specific, this syndrome allows the physician to suspect a certain pulmonary pathology and refer the patient for further examinations.
The roots of the lungs are poorly structured and compacted: what does this mean?
Violation of the structure of the root of the lung, that is, the inability to distinguish the vessel from the bronchus, the appearance of darkening on the root, usually occurs in primary tuberculosis, oncological processes.
On the radiograph with extensive tuberculosis or central lung cancer, instead of the root, a shadow of various contours can be visualized, which is a focus (up to 10 mm in diameter) or an infiltrate (more than 10 mm). This symptom may also be combined with induration, which usually occurs with the deposition of calcium s alts or calcification (petrification). Calcification is a sign of a chronic, long-term process.
Thus, just one x-ray symptom (in the lungs, the roots are fibrously compacted and heavy) can help to suspect a variety of diseases: from ordinary bronchitis to lung cancer. Of course, we should not forget that radiography should be supplemented by otherexamination methods: computed tomography, biopsy, sputum culture, bronchoscopy, and so on. Additional examination methods are performed as prescribed by the doctor, depending on the path of his diagnostic search. It must be remembered that only a comprehensive examination will help to make the correct diagnosis.
