Bifurcation lymph nodes are normal. Intrathoracic lymph nodes

Metastasis – most important characteristic any malignant tumor. This process is associated with the progression of the disease, which often ends in the death of the patient. In case of defeat lymphatic system carcinoma of another organ, the average person can designate this phenomenon as “cancer of the lymph nodes”; from a medical point of view, this is, that is, a secondary lesion.

Malignant tumor cells have a number of differences from healthy ones, including not only a local destructive effect in a tissue or organ, but also the ability to separate from each other and spread throughout the body. The loss of specific protein molecules that provide a strong connection between cells (adhesion molecules) leads to the separation of the malignant clone from primary tumor and its penetration into the vessels.

Epithelial tumors, that is, metastasize predominantly by the lymphogenous route, through lymphatic vessels that carry lymph away from the organ. Sarcomas (connective tissue neoplasms) can also affect lymph nodes, although the predominant route of metastasis for them is hematogenous.

Along the path of lymph flow, nature provides “filters” that retain everything “extra” - microorganisms, antibodies, destroyed cellular fragments. Tumor cells also fall into such a filter, but they are not neutralized, and instead the malignant clone begins to actively divide, giving rise to a new tumor.

metastasis

Initially, signs of secondary tumor lesions are found in regional lymph nodes, that is, those that are closest to the organ affected by the tumor and which are the first to encounter lymph carrying carcinomatous elements. With further progression of the disease, metastases spread further, capturing more distant lymphatic groups. In some cases, lymph nodes located in another part of the body are affected, which indicates an advanced stage of the tumor and an extremely unfavorable prognosis.

Enlargement of lymph nodes in cancer is a consequence of the proliferation of tumor cells in them, which displace healthy tissue, filling the lymph node. Inevitably, lymphatic drainage becomes difficult.

By histological structure metastases usually correspond to the primary tumor, but the degree of differentiation in some cases is lower, so the secondary lymph node cancer grows faster and more aggressively. There are often cases when the primary tumor manifests itself only as metastases, and the search for their source does not always bring results. Such a defeat is referred to as cancer metastasis from an unknown source.

Having all the features of malignancy, cancer (metastasis) in the lymph node poisons the body with metabolic products, increases intoxication, and causes pain.

Any malignant tumor sooner or later begins to metastasize; when this happens depends on a number of factors:

• Age – the older the patient, the earlier metastases appear;
• Concomitant diseases in chronic form, debilitating protective forces body, immunodeficiencies – contribute to more aggressive tumor growth and early metastasis;
• Stage and degree of differentiation - large tumors that grow into the wall of the organ and damage blood vessels metastasize more actively; The lower the degree of cancer differentiation, the earlier and faster the metastases spread.

Not every tumor cell that enters a lymph node will divide and metastasize. At good immunity this may not happen or will happen after a long period of time.

In the diagnosis, an indication of metastatic disease of the lymph nodes is indicated by the letter N: N0 – lymph nodes are not affected, N1-2 – metastases in regional (nearby) lymph nodes, N3 – distant metastasis, when lymph nodes are affected at a considerable distance from the primary tumor, which corresponds to severe, fourth stage of cancer.

Manifestations of lymphogenous metastasis

Symptoms of lymph node cancer depend on the stage of the disease. Usually the first sign is their increase. If superficial lymph nodes are affected, they can be palpated in the form of enlarged single nodules or conglomerates, which are not always painful.

Such metastases to the lymph nodes are easily determined in axillary area for breast cancer, in the groin for tumors of the genital tract, on the neck for diseases of the larynx, oral cavity, above and below the collarbone in case of stomach cancer.

If the tumor affects internal organ, and metastasis occurs in the lymph nodes lying deep in the body, it is not so easy to detect their enlargement. For example, enlarged lymph nodes of the mesentery with intestinal cancer, the hilum of the liver with hepatocellular carcinoma, the lesser and greater curvature of the stomach with tumors of this organ are inaccessible to palpation, but the doctor comes to the aid additional methods examinations - ultrasound, CT, MRI.

Large groups of metastatic lymph nodes inside the body may manifest symptoms of compression of the organs or vessels next to which they are located.

With enlarged mediastinal lymph nodes, shortness of breath, heart rhythm disturbances and chest pain are possible; mesenteric enlarged lymphatic collectors contribute to pain and bloating, and indigestion. When the portal vein is compressed, portal hypertension will occur - the liver and spleen will enlarge, abdominal cavity

Fluid will accumulate (ascites). Signs of difficulty in the outflow of blood through the superior vena cava - swelling of the face, cyanosis - may indicate that the lymph nodes are affected by cancer. Against the background of metastasis, the general state

patient: weakness and weight loss increase, anemia progresses, fever becomes constant, emotional background is disturbed. These symptoms indicate increased intoxication, which is largely facilitated by the growth of cancer in the lymph nodes.

Lymphogenous metastasis in certain types of cancer

The most common types of cancer are carcinomas of the stomach, breast in women, lungs, and genital tract. These tumors tend to metastasize to the lymph nodes, and the routes of spread of cancer cells and the sequence of damage to the lymphatic system are quite well studied. At the first metastases can be detected in axillary lymph nodes

already in the second stage of the disease, and in the fourth they are present in distant organs. Lymphogenic spread begins early and often the reason for searching for a tumor is not a palpable formation in the chest, but enlarged lymph nodes in the axillary region. Breast cancer is manifested by damage to several groups of lymph nodes - axillary, peri-sternal, supraclavicular and subclavian. If carcinoma grows in the outer parts of the gland, then it is logical to expect cancer metastases in the lymph nodes armpit

The most common types of cancer are carcinomas of the stomach, breast in women, lungs, and genital tract. These tumors tend to metastasize to the lymph nodes, and the routes of spread of cancer cells and the sequence of damage to the lymphatic system are quite well studied. groups of regional lymph nodes affected first and distant ones involved in advanced stages have been identified. Regional are considered paratracheal, bifurcation, peribronchial lymph nodes located near the bronchi and trachea, distant - supra- and subclavian, mediastinal, cervical.

In the lungs, lymphogenous spread of cancer occurs early and quickly, facilitated by a well-developed network lymphatic vessels, necessary for proper operation organ. Particularly prone to such dissemination central cancer, growing from large bronchi.

The most common types of cancer are carcinomas of the stomach, breast in women, lungs, and genital tract. These tumors tend to metastasize to the lymph nodes, and the routes of spread of cancer cells and the sequence of damage to the lymphatic system are quite well studied. metastases in the lymph nodes may have a peculiar location. The nodes along the greater and lesser curvature and antrum are the first to be affected, then the cells reach the celiac lymph nodes (second stage); gastric cancer can be detected in the lymph nodes along the aorta and portal vein of the liver.

Peculiar types of lymphogenous metastases of stomach cancer are named after the researchers who described them or first encountered them. Virchow's metastasis affects the left supraclavicular lymph nodes, Schnitzler's - the tissue of the rectal region, Krukenberg's - the ovaries, Irish's - the lymph nodes of the armpit. These metastases indicate distant dissemination of the tumor and a severe stage of the disease, when radical treatment impossible or no longer practical.

Lymph nodes in the neck are affected by tumors of the fundus, gums, palate, jaws, and salivary glands. IN pathological process submandibular, cervical, occipital groups of lymph nodes are involved. Distant metastasis to cervical lymph nodes possible for carcinomas of the breast, lungs, and stomach. For cancer located in the facial area, oral cavity lymphogenous spread occurs quickly, which is associated with the excellent lymph supply of this area.

In addition to metastases, in the lymph nodes of the neck primary tumors can form - lymphogranulomatosis, which the average person would also call cervical lymph node cancer. In some cases, it is possible to determine whether the primary tumor or metastasis has affected the nodes in the neck only with additional examination including a biopsy.

Lymph nodes in the neck tend to enlarge not only with metastases. Probably, each of us can find at least one enlarged nodule under lower jaw or between the neck muscles, but this does not necessarily indicate cancer. There is no need to panic, although it won’t hurt to find the reason.

Cervical and submandibular lymph nodes collect lymph from the oral cavity, larynx, pharynx, jaws, which very often have inflammatory changes. All kinds of tonsillitis, stomatitis, caries are accompanied by chronic inflammation, therefore, it is not surprising that the regional lymph nodes are enlarged. In addition, the area of ​​the mouth and upper respiratory tract constantly encounters various microorganisms that enter the lymph nodes with the lymph flow and are neutralized. Such increased work can also lead to lymphadenopathy.

Diagnosis and treatment of metastases to lymph nodes

Diagnosis of metastases in the lymph nodes is based on their palpation, if possible. If there is a suspicion of damage to the axillary or cervical inguinal lymph nodes, the doctor will be able to palpate them along their entire length; in some cases, palpation of internal lymph nodes - celiac, mesenteric - is possible.

Ultrasound of neck vessels

To confirm metastatic lesion Additional examination methods are used:

• Ultrasound– is especially informative when there is an increase in lymphatic collectors located inside the body - near the stomach, intestines, at the gates of the liver, and in the retroperitoneal space, in the chest cavity;
• CT, MRI– allow you to determine the number, size and exact location of the changed lymph nodes;
• Puncture and biopsy– the most informative methods that allow you to see cancer cells in a lymph node; with a biopsy, it becomes possible to guess the source, clarify the type and degree of differentiation of cancer.

lymph node biopsy

Molecular genetic studies are aimed at establishing the presence of certain receptors or proteins on cancer cells, which can most likely be used to determine the type of cancer. Such analyzes are especially indicated when detecting metastases from an unknown source, the search for which was unsuccessful.

Treatment of cancer metastases in the lymph nodes includes surgical removal, radiation and chemotherapy, which are prescribed individually according to the type and stage of the disease.

Surgical removal of the affected lymph nodes is performed simultaneously with excision of the tumor itself, while lymph node dissection is performed on the entire group of regional collectors into which cancer cells have entered or could have entered.

For many tumors, so-called “sentinel” lymph nodes are known, where metastasis occurs most early. These nodes are removed for histological examination, and the absence of cancer cells in them with a high degree of probability indicates the absence of metastasis.

When manipulating the tumor itself and the lymph nodes, the surgeon acts extremely carefully, avoiding tissue compression, which can provoke dissemination of tumor cells. To prevent cancer cells from entering the vessels, they are ligated early.

For metastases it is almost always prescribed. The choice of drugs or their combination depends on the type of primary tumor and its sensitivity to specific drugs. For stomach cancer, 5-fluorouracil and doxorubicin are most effective; for breast tumors, cyclophosphamide, adriamycin, and non-small cell lung cancer sensitive to etoposide, cisplatin, taxol.

chemotherapy

If the primary focus cancerous tumor could not be identified; cisplatin, paclitaxel, gemcitabine, and etoposide are prescribed. For poorly differentiated carcinomas affecting the lymph nodes, platinum drugs (cisplatin) are effective; for neuroendocrine tumors, cisplatin and etoposide are included in the treatment regimen.

The goal of chemotherapy for metastatic tumors is to inhibit the growth and further spread of the malignant process. It is prescribed before surgery (neoadjuvant chemotherapy) to prevent metastasis and destroy micrometastases in the lymph nodes and after surgery (adjuvant) to prevent further metastasis, the risk of which increases after surgery on the affected organ.

radiation therapy

It is more important for hematogenous metastases than lymphogenous ones, but for lymph nodes radiosurgery, or cyber-knife, when cancer in a lymph node is removed using a beam of radiation acting strictly on the affected tissue, can be effective. This method is justified for late single metastases that appear years after treatment, when reoperation can be avoided.

Metastasis to lymph nodes in cancer, regardless of the type of primary tumor, characterizes the progression of the disease, and the worse the prognosis, the more lymph collectors are involved in cancer growth. Metastases respond to treatment only in a fifth of patients, in whom the prognosis may be favorable; in the remaining 80%, treatment at the metastasis stage is aimed at relieving symptoms or prolonging life. With multiple lymphogenous metastases of low- and undifferentiated carcinomas, life expectancy is on average six months to a year; in the case of highly differentiated cancers, the prognosis is slightly better.

Video: removal of lymph nodes in the treatment of breast cancer

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- This primary lesion tuberculosis infection of intrathoracic lymph nodes, occurring without the formation of a primary infiltrate in the lungs and the development of lymphangitis. The disease is manifested by weakness, fever, loss of appetite and weight, sweating, paraspecific reactions, sometimes cough and asphyxia. The diagnosis is established by examination, radiography and CT chest, tuberculin tests, lymph node biopsy. Treatment of VGLU tuberculosis is long-term; includes a combination of tuberculostatic drugs, immunomodulators, diet, plasmapheresis, lymphadenectomy.

General information

Tuberculosis of the intrathoracic lymph nodes ( tuberculous bronchoadenitis) - specific inflammation of the lymph nodes of the mediastinal zone and the root of the lungs, caused by Mycobacterium tuberculosis. Tuberculosis of the intrathoracic lymph nodes (HTLU) is the main clinical type of primary tuberculosis in children, adolescents and young adults aged 18-24 years (up to 80-90% of cases).

Due to mass BCG vaccination and chemoprophylaxis, it now more often occurs independently; less often - as an involuting form of the primary tuberculosis complex (with pulmonary lesions). Tuberculosis of the intrathoracic lymph nodes is characterized by chronic course with long-term preservation of the activity of a specific process in the tissue of the node and slow regression. Most complications (up to 70%) are observed before the age of 3 years.

Causes

Tuberculosis (including intrathoracic lymph nodes) is caused by bacteria of the genus Mycobacterium, most often M.tuberculosis and M.bovis. Bronchoadenitis develops with primary hematogenous or lymphogenous penetration of Mycobacterium tuberculosis into the lymph nodes of the mediastinum and root of the lungs. Less commonly, it may be the result of endogenous reactivation of a previously existing tuberculosis infection in a group of intrathoracic lymph nodes.

Infection usually occurs by airborne droplets from a patient who excretes bacilli, rarely - through food, household and transplacental routes. The risk group for tuberculous bronchoadenitis includes:

• unvaccinated and incorrectly vaccinated children and adults
• persons with immunodeficiency (including HIV-infected)
• smokers
• having chronic pathology, poor living conditions
• experiencing excessive loads, nutritional deficiency.

Pathogenesis

Tuberculosis can affect one or more groups of intrathoracic lymph nodes - paratracheal, tracheobronchial, bifurcation, bronchopulmonary. The intrathoracic lymph nodes, as the main structure of the immune system of the lungs, actively respond to primary tuberculosis infection. In this case, hyperplasia is noted lymphoid tissue with an increase in the volume of the node and the development of specific inflammation with the gradual formation of foci of necrosis (caseosis). In the future, the lesions may become denser and replaced by lime in the form of petrification, and the capsule may hyalinize or melt with a breakthrough and spread of infection into the surrounding tissues.

Classification

Tuberculous bronchoadenitis is more often unilateral, less often bilateral (with severe unfavorable course). Based on the clinical and morphological picture, in phthisiopulmonology, infiltrative (hyperplastic), tumor-like (caseous) and small forms of tuberculosis of the intrathoracic lymph nodes are distinguished.

• Tumor-like form- a severe type of bronchoadenitis, often detected in young children with massive tuberculosis infection and is manifested by a significant increase in lymph nodes (up to 5 cm in diameter) due to proliferation and caseation of lymphoid tissue inside the capsule. The affected nodes can be soldered together, forming conglomerates.
• Infiltrative form. Against the background of a slight enlargement of the lymph nodes, perinodular inflammation predominates outside the capsule with infiltration of the hilar sections of the lungs.
• Small form Tuberculosis of the intrathoracic lymph nodes is more common than before, and is manifested by a slightly noticeable increase (up to 0.5-1.5 cm) of one or two lymph nodes.

Symptoms of VGLU tuberculosis

The clinical picture of tuberculosis of the intrathoracic lymph nodes is mediated by the nature, topography, volume of the specific lesion and the degree of involvement of surrounding structures. The disease is characterized by a predominance of intoxication symptoms, respiratory manifestations and frequent complications. Usually bronchoadenitis begins gradually. Children experience increased fatigue, loss of appetite, bad dream, night sweats, low-grade fever, nervousness, weight loss.

In tumor-like and infiltrative forms, the symptoms are more pronounced; their course is accompanied general weakness, pallor, febrile (up to 38-39°C) and long-lasting low-grade fever. IN early age bronchoadenitis can be acute, with high fever and severe general disorders. Possible whooping cough or bitonal night cough, caused by compression of the bronchi by hyperplastic lymph nodes. Rapid enlargement of the bifurcation group of nodes can cause asphyxia.

Tuberculosis of the intrathoracic lymph nodes can become chronic with the development clinical signs hypersensitization - so-called. paraspecific reactions ( ring-shaped erythema, blepharitis, conjunctivitis, vasculitis, polyserositis, polyarthritis). Minor forms of the disease occur hidden. In children vaccinated with BCG or receiving chemoprophylaxis, the symptoms of bronchoadenitis are erased, with a wave-like increase in temperature, intermittent coughing or coughing, moderate sweating without paraspecific reactions.

Complications

Tuberculous bronchoadenitis often occurs with complications: breakthrough of the caseous node with the formation of lymphobronchial and lymphotracheal fistulas, bronchial tuberculosis, development of segmental atelectasis of the lung. A common complication there may be nonspecific catarrhal endobronchitis, exudative pleurisy, tuberculous dissemination to the lungs. Hilar bronchiectasis, hemoptysis and pulmonary hemorrhage, and broncholithiasis may appear remotely.

Diagnostics

In case of suspected tuberculosis of the intrathoracic lymph nodes, a thorough history taking, consultation with a phthisiatrician, tuberculin tests, lung radiography, bronchoscopy, and, if indicated, lymph node biopsy are necessary. Of primary importance in diagnosis are:

• Physical data. Typical visual signs of bronchoadenitis are dilation of small superficial vessels of the venous network on the chest and back (Widerhoffer and Frank symptoms). With significant lesions, a positive Parsley symptom is determined by palpation (pain when pressing on the upper thoracic vertebrae). Dullness of percussion sound is heard, and sometimes bronchophony and tracheal breathing below the first vertebra may appear.
• X-ray picture. Tuberculosis of the intrathoracic lymph nodes is often detected after an X-ray of the lungs of a child who has a bend or hyperergic reaction to tuberculin tests. The infiltrative form is distinguished by blurred external outlines, slight expansion and blurring of the shadow lung root. Calcifications are defined as uneven round or oval shadows. In the tumor-like form, expansion, lengthening and increased intensity of the shadow of the roots of the lungs, which have a clearly defined tuberous contour, are noticeable. In the diagnosis of “small” forms at the infiltration stage, indirect radiological signs are used. To clarify the size and structure of lymph nodes, it is used

  A combination of 3-4 tuberculostatic drugs (isoniazid, rifampicin, pyrazinamide, streptomycin, ethambutol), hepatoprotectors, immunomodulators, with high sensitivity to tuberculin - corticosteroids, . With absence positive dynamics treatment for 1.5-2 years, complications and formation of mediastinal tuberculoma, chemotherapy is combined with surgical treatment– lymphadenectomy of degenerated intrathoracic lymph nodes.

  An important factor is following a high-protein, fortified diet. Further treatment continues in a sanatorium, then on an outpatient basis. It is advisable for recovered children and adolescents to stay in specialized kindergartens and boarding schools.

  Forecast

  Prognosis for tuberculosis of the intrathoracic lymph nodes, especially small form– favorable, with complete resorption of specific inflammation of lymphoid tissue and recovery. A relatively favorable outcome is considered to be calcification of the lymph nodes, sclerosis of the lung root, and the formation of bronchiectasis. The progression of the tuberculosis process indicates an unfavorable course.

Among common symptoms enough wide range diseases, there is an increase in lymph nodes in the lungs - pulmonary, hilar bronchopulmonary, peribronchial or paratracheal. Since lymph nodes are an integral part of the body’s immune system, their enlargement, detected by X-ray, CT or MRI of the lungs, is one of the clinical signs of pathologies of infectious or oncological origin.

Enlarged lymph nodes can be called lymphadenopathy, hyperplasia, and even enlarged lymph node syndrome (in patients with AIDS), but in any case, the pathology has the same code R59 in accordance with ICD-10, and subclass R includes symptoms and abnormalities, that are detected in patients during a medical examination.

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ICD-10 code

R59 Enlarged lymph nodes

Epidemiology

To date, there are no accurate statistics on cases of enlarged lymph nodes in the lungs, as well as lymphadenopathy of other localizations. But the increase in palpable nodes associated with infections (behind the ear, submandibular, cervical, etc.) in childhood, according to experts from the British Paediatric Association, varies from 38-45%, and this is one of the most common clinical problems pediatrics.

According to the American Society of Clinical Oncology, the degree of malignant lymph node enlargement correlates with age, increasing from 17.5-20% in 18-35 year old patients to 60% among older patients. And in children this is most often a consequence of leukemia, and in adolescents - Hodgkin lymphoma.

Benign reactive lymphadenopathy accounts for an average of 30% of cases, and enlarged lymph nodes in non-tumor diseases account for 26%.

Causes of enlarged lymph nodes in the lungs

The increase in nodes localized in the lungs (intrapulmonary) occurs in response to the main pathological process of the disease - thanks to their T and B lymphocytes, macrophages, dendrites, lymphatic follicles and other protective factors of lymphoid tissue.

The main diseases associated with the causes of enlarged lymph nodes in the lungs include:

• pneumonia caused by staphylococci and beta-hemolytic streptococcus, as well as pneumococcal pneumonia ;
• pulmonary tuberculosis (caused by Mycobacterium tuberculosis);
• tuberculosis of the lymph nodes (with pulmonary and extrapulmonary forms of tuberculosis);
• fibrous lung disease with systemic lupus erythematosus or amyloidosis;
• sharp or chronic forms bronchopulmonary mycoses caused by aerogenic infection of the respiratory system with the fungi Histoplasma capsulatum (histoplasmosis), the mold Aspergillus fumigatus (aspergillosis), the yeast-like fungus Blastomyces dermatitidis (pulmonary blastomycosis);
• exogenous allergic alveolitis(allergic pneumonitis);
• chronic pulmonary occupational diseases – silicosis and pneumoconiosis;
• cancer of the lymph nodes - lymphogranulomatosis (Hodgkin's lymphoma), non-Hodgkin's lymphoma (lymphosarcoma);
• lungs' cancer(adenocarcinoma, carciosarcoma, paraganglioma, etc.);
• acute lymphoblastic leukemia (a form of leukemia associated with malignant damage to blood-forming cells bone marrow);
• metastases to the pulmonary lymph nodes from malignant tumors of the esophagus, mediastinum, thyroid or breast. See also - Metastases in lymph nodes

Depending on the cause of the disease and the mechanism of action on the lymphoid tissue, the types of this pathology are distinguished: infectious, reactive and malignant. Thus, during an infection with lymph flow, phagocytes with captured antigens and cells killed by inflammatory necrosis enter and accumulate in the nodes. For example, in tuberculosis patients, the mycobacterium M. tuberculosis that has entered the lymph nodes is absorbed by macrophages with the formation of phagolysosomes, the formation of granulomas and the development of caseous necrosis of lymphoid tissue.

Granulomatous changes in the lymph nodes (with the displacement of lymphoid tissue by fibrous tissue) are also observed in sarcoidosis, the etiology of which is still unknown to medicine (although autoimmune and genetic causes of its occurrence cannot be ruled out).

In cases of reactive enlargement of lymph nodes in the lungs, the dominant pathological process is the increased proliferation of their follicles, which is provoked autoimmune diseases- when the body's immune system produces antigens against healthy cells, as happens, in particular, with systemic lupus erythematosus.

When the lymph nodes in the lungs are enlarged and malignant in nature, lymphomas with abnormal cell proliferation. And with metastases, lymphoproliferative disorders are caused by the infiltration of healthy tissues by atypical (cancerous) cells and their proliferation, which leads to pathological morphological changes.

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Symptoms of enlarged lymph nodes in the lungs

As clinicians emphasize, enlargement of lymph nodes in the lungs is a consequence of the development of diseases, and information regarding the size of intrapulmonary lymph nodes (diameter > 2 cm) can only be obtained by visualizing them.

So the symptoms of enlarged lymph nodes in the lungs are not distinguished from the clinical picture as causing the disease. Although when examining lymph nodes in the lungs, not only their size, location and number are recorded, but also the presence inflammatory process, granulomas, necrosis (caseous or in the form of an abscess), pulmonary infiltrates, etc.

A tumor of the intrapulmonary lymph node can cause swelling of adjacent tissues or obstruction of lymphatic vessels, which leads to respiratory symptoms: persistent dry cough, wheezing, shortness of breath.

Symptoms of calcified lymph nodes, such as those caused by histoplasmosis or tuberculosis, may also include coughing when the enlarged node protrudes into the trachea.

Complications and consequences

In most cases, consequences and complications are associated with the course of the underlying disease. And complications of an enlarged lymph node in the lungs include the formation of an abscess or phlegmon, the formation of fistulas, and the development of septicemia.

Enlarged lymph nodes in the mediastinum can lead to bronchial or tracheal obstruction, esophageal stricture, and impaired blood flow in the superior vena cava.

Pulmonary infiltration of the lymph nodes in sarcoidosis can lead to scarring and irreversible pulmonary fibrosis, severe pulmonary dysfunction, and heart failure.

In the case of tuberculous lesions of the intrathoracic lymph nodes with caseous contents, their rupture and infection may spread to other structures of the mediastinum.

With malignant enlargement of intrapulmonary lymph nodes, metabolic complications arise: increased levels uric acid in the blood, disorder electrolyte balance, functional kidney failure.

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Diagnosis of enlarged lymph nodes in the lungs

Diagnosis of enlarged lymph nodes in the lungs is, first of all, instrumental diagnostics using radiography, ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET).

Based on the results, a biopsy of the hyperplastic node (endoscopic, bronchoscopic or excisional) and immunohistochemical examination of the resulting tissue sample may be required. Biopsy results are especially important if there is suspicion of malignant tumor lymph node, and there are serious doubts regarding the diagnosis of the disease in which it was detected pathological change lymph node Blood tests are also necessary: ​​general and biochemical, for antibodies, for immune status and tumor markers. Are being done skin tests for tuberculosis and sarcoidosis.

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Differential diagnosis

Differential diagnosis based on the results of biopsy histology is necessary to determine the benignity (or malignancy) of lymph node hyperplasia - in order to establish the correct diagnosis.

Treatment of enlarged lymph nodes in the lungs

Considering that hyperplastic intrapulmonary lymph nodes appear in various pathologies, the main therapeutic efforts are aimed at these diseases, and separate treatment of enlarged lymph nodes in the lungs is simply impossible.

When the main reason lies in bacterial infection, antibiotics are used; For bronchopulmonary mycoses, doctors prescribe systemic antifungal drugs. To reduce inflammation, medications from the group can be used steroid hormones(corticosteroids) or NSAIDs (non-steroidal anti-inflammatory drugs). In all cases, it is recommended to take vitamins A and E.

As tuberculosis progresses, the intrathoracic lymph nodes become involved in the disease. Disease dangerous if not diagnosed in time and with insufficient information to the population of the country.

Today, thanks to preventive efforts, through vaccination of patients and special measures therapy during primary infection, observed reduction in morbidity rates.

What kind of disease is this?

Tuberculosis of the intrathoracic lymph nodes (HTLU) determined by the manifestation of tuberculosis at the initial stage. Occurs in eighty percent of infected patients. The process is caused by the bacteria M.tuberculosis and M.bovis.

This disease can begin to develop as a result of the primary hematogenous or lymphogenous spread of tuberculosis bacteria. In other cases, VGLU may be the cause of activation of tuberculosis that the patient already had.

Tuberculosis VGLU usually occurs unilaterally. Much less often it is double-sided, which is more dangerous for humans.

Forms of VGLU tuberculosis:

1. Tumor-like forms. The most difficult to flow forms. Quite often diagnosed in patients childhood. Appears in the form of up to five centimeters in diameter;
2. Infiltrative forms. Determined by a slight enlargement of the lymph nodes;
3. Small forms. Diagnosed by specialists quite often. It is characterized by a barely noticeable enlargement of lymph nodes in patients.

Prognosis for recovery

With VGLU tuberculosis, complications may appear, which in turn are divided into early and late:

• The initial complication of VGLU tuberculosis is the presence of exudative pleurisy.
• Damage to the bronchi appears as a result of the process transferring from the lymph nodes to the walls of the bronchi. This late complications. Characterized by heavy cough and the appearance of breathing problems.

Course of the disease in children

The main form of tuberculosis in children and patients adolescence It is considered to be VGLU tuberculosis. The main importance in the medical history is pulmonary lesion, bronchoadenitis can be considered as the second of the components that began to develop after the formation of a lesion in the lungs.

Thanks to the vaccination of children using the BCG method, increasing immunity and resistance, in today's conditions the pulmonary affect, which is located subpleurally, separates lung tissue and will not develop in the future.

The course of the disease is determined by lesions in the nodes.

Signs of the disease in children:

• Sick babies may develop coughing , caused by compressed bronchi and due to enlarged lymph nodes.
• Cough causes breathing problems and pain. In pediatric patients, the volume of bifurcation lymph nodes rapidly increases, and due to this reaction, a feeling of suffocation may occur. The cough is dry at first, and then with sputum.
• In addition, the symptoms of asphyxia in patients may be accompanied by cyanosis, difficult breathing, flaring of the wings of the nose and the process of retraction of the intercostal spaces. Lying on the patient's back is painful. When the baby turns onto his stomach, the condition will be alleviated due to the forward movement of the affected lymph node.
• Also in pediatric patients there appears heavy sweating at night. Appetite decreases and severe weakness and fatigue. Symptoms appear intoxication and fever. The child becomes whiny and nervous.

Symptoms

Symptoms appear as general intoxication, slight increase temperature, decreased appetite, apathy, sweating, sleep disturbances and the patient’s psycho-emotional state.

A dry cough may be replaced by a cough with phlegm. It becomes difficult for the patient to breathe, there is pain behind the sternum. The patient may experience bronchospasms.

Main groups of symptoms:

• Symptoms Widergoffer. They are characterized by an expanded venous network in the first and second intercostal space on 1 or 2 sides (the azygos vein is compressed).
• Frank. They are characterized by dilated vessels in the area between the shoulder blades.
• Parsley. This method allows us to identify painful sensations with pressure on the spinous processes of 3-7 thoracic vertebrae.
• Filosofova(also called the “chalice” symptom). Characterized by parasternal dullness percussion sounds in the first and second intercostal space (paratracheal lymph nodes are affected).
• De la Campa may be detected by a dull pulmonary sound between the shoulder blades in the area of ​​the second to fourth vertebrae.
• Koran determined by a dull sound below the first thoracic vertebra(in children one to two years old), below the second vertebra (in children under ten years of age) and below the third vertebra (in patients over ten years of age). This sign is characteristic of enlarged bifurcation lymph nodes.
• D'Espina. Bronchophony can be heard on the spine.
• Geibner. Tracheal breathing can be heard above the spine.

Diagnostic methods

Diagnostic measures will allow you to recognize and identify the stage of development. The first thing a patient should do is primary symptoms, - This contact a specialist - phthisiatrician.

At the doctor’s appointment, the source of infection is identified, and contacts with the patient’s tuberculosis carrier in the family and among friends are determined. The doctor will prescribe the following measures:

Diagnosis as well as therapy must be comprehensive and not consist of only one of the measures. Only A complex approach makes it possible to obtain a detailed clinical picture.

Watch a video about determining the type of tuberculosis using an x-ray:

Treatment

Patients are prescribed treatment only in stationary conditions.

Therapeutic measures are complicated by the fact that innovative, sought-after antimycobacterial agents reach the lymph nodes in very small dosages. Much greater effectiveness of treatment is observed in patients with the infiltrative form of bronchoadenitis.

Patients are prescribed therapy with special medications for four to six months in hospital. The treatment is complex and continues in the sanatorium, and after discharge on an outpatient basis under the supervision of a doctor.

The duration of these stages is from one to one and a half years; an appointment is scheduled for two effective drugs(Isoniazid plus Ethambutol or Isoniazid plus Ethionamide or Isoniazid plus Pyrazinamide).

After completion of treatment, the patient must comply important rules and lead healthy way life. Important complete cessation of bad habits.

Correct balanced diet– also a mandatory measure. The patient is prohibited from prolonged exposure to the cold and any hypothermia. It is important to maintain a rational drinking regime.

Another treatment method is surgery. But there is an intervention for serious indications:

1. Absence of positive dynamics for a long period of time up to 2 years from the start of treatment;
2. Formation of tuberculoma of the lymph nodes.

Difference between lung cancer and tuberculosis

VGLU tuberculosis can be compared to lung cancer. Disease data can pass with the same clinical picture and changes noticeable on x-ray (the presence of darkening at the base of the lung). There are factors that distinguish lung cancer from tuberculosis.

Features of oncology:

• Lung cancer is diagnosed in most cases in males aged over forty years;
• in case of cancer, symptoms are more often associated with cough and difficulty breathing, while tuberculosis is characterized by symptoms of intoxication;
• dynamic course of the disease;
• in certain cases, the lymph nodes on the side where the tumor grows may become enlarged;
• in the results of a general blood test, an increased level of leukocytes is observed, the ESR is significantly increased, anemia can be diagnosed;
• on an x-ray for oncology, the shadow of the lung root has quite distinct contours, unlike other diseases;
• determining importance is given to bronchoscopic examination, which is one of the most effective methods. Often, along with this, bronchial lumen may be observed.

Prevention

Prevention is critical to prevent VGLU tuberculosis. They give a result that reduces the number of cases. Each patient is informed about how to behave so as not to infect others.

Tuberculosis is listed serious diseases of society. But still, the disease is not spreading at the same rate as several years ago.

Thanks to timely vaccination of children, a relative reduction in morbidity has been achieved. Modern drugs, preventive measures and treatment methods have given positive results.