X-ray signs of emphysema. What is emphysema and how is it treated? Foreign bodies of the respiratory tract and lungs, X-ray diagnostics

What features of X-ray diagnostics of this condition exist today? The article discusses the main signs of pulmonary emphysema in the images.

Briefly about the essence of the disease

Emphysema is considered the final stage of many chronic inflammatory diseases. In addition, an increase in the airiness of the lung tissue is characteristic of bronchial asthma and occupational diseases of the organ parenchyma. Thus, there are factors for the development of emphysematous disorganization of the lungs:

Long-term smoking experience.
Chronic obstructive pulmonary disease.
Bronchial asthma.
Chronic bronchitis, including with an obstructive component.
Long-term professional contact with dust and other pollutants.
Congenital defect - deficiency of alpha-antitrypsin, expressed in the weakness of the walls of the final structures of the respiratory functional unit.

Deficiency of this compound (congenital pathology) or chronic exposure to the above factors lead to the inability of the bronchioles and alveoli to perform their functions. Their walls are deformed and expanded. An air trap occurs - a condition in which air passes freely into the respiratory tract, but it cannot move back, in the opposite direction. Large spaces appear that are filled with air and are completely or partially excluded from the act of breathing. Development of emphysematous bullae is possible.

Features of X-ray diagnostics of emphysematous changes

Emphysema is a pathology that includes not only signs of structural damage to the lung tissue, but also the functional failure of this organ. Intact areas of lung tissue do not participate in respiration and gas exchange. Therefore, a symptom of progressive respiratory failure arises.

There are two groups of signs of pathology during an X-ray examination:

In order to evaluate and see them, one snapshot will not be enough. It is necessary to conduct a study in two projections, because it is the lateral projection (laterogram) that will be informative in terms of visualization of X-ray morphological signs.

A lot of information is provided by radiography according to the Sokolov method.

This is an X-ray method that allows you to assess the functionality of the lungs. That is, the patient is forced to inhale as much as possible, hold his breath, and then forcefully exhale as much as possible. At all these stages, snapshots are recorded. With the help of a tunnel cassette, it becomes possible to examine the lung tissue, pulmonary pattern and other signs in the context of the functional state.

X-ray morphological symptoms

It should first be mentioned that this group of signs refers to secondary changes and is characteristic of a long, protracted course of emphysema. They affect the size of the chest, its spatial deformation, changes in the syntopy of the organs and tissues contained in it, expressed quantitatively (degrees or centimeters).

Even representatives of old therapeutic and propaedeutic schools said that with a long course of pulmonary pathology with the formation of respiratory failure, deformation of the chest develops, which can be seen even on examination. X-ray examination only confirms the guesses of prominent clinicians. Emphysematous deformity is called barrel-shaped. That is, the anteroposterior chest size increases significantly. Moreover, this increase can be traced throughout the chest cavity.

Radiologists note the following signs of barrel emphysematous deformity:

Sternum protruding anteriorly.
The horizontal course of the costal spaces and ribs.
Kyphotic change in the thoracic spine.

Changes in the mediastinal structures are an important sign in the diagnosis of pulmonary pathology. The anterior mediastinum expands due to the anteriorly protruding sternum. Radiologists call this change an anterior mediastinal gap. The shadows of the heart, the aorta and its branches, large venous highways are moved backward due to an increase in the volume of the lungs due to the altered pathological airiness. The heart itself can take on an atypical appearance. In some cases, it resembles an hourglass or a drop (drop-shaped deformation), which requires differential diagnosis with diseases such as acquired or congenital heart valve disease.

The next classic sign of emphysema is a change in the transparency of the lung tissue, which diffusely increases. This phenomenon is formed due to excess air in the terminal sections of the bronchial and acinar tree. If there is a bullous deformation of the lung tissue, then at this place the radiologist will see enlightenment.

Pay close attention to the dome of the diaphragm. In emphysema, it is located lower than in a healthy person. Sometimes its slight downward deflection can be observed.

Due to the fact that emphysema cannot proceed in isolation from other pathological processes in the lungs, signs of sclerotic changes are very often observed.

Pneumosclerosis with emphysema is suspected when the pulmonary pattern becomes "excessive" and deformed. Sometimes the root of the lung is even pulled up.

X-ray functional symptoms

Respiratory failure is also reflected in the X-ray diagnosis of the disease. Usually, on fluoroscopy of the lungs, the specialist in this imaging technique can very clearly see the decrease in the mobility of the diaphragm. In a healthy person, the amplitude of the movements performed by this muscle is sufficient. With emphysema, this value progressively decreases.

According to the previously described method, Yu.N. Sokolov, the functional state of the lung tissue can be assessed. Normally, the intensity and contrast of structures when taking pictures varies greatly depending on the phases of respiration. At the same time, the opposite picture is characteristic of emphysema. These indicators do not change significantly. This is a rather specific sign of emphysematous disorganization of lung tissue.

How does pulmonary emphysema manifest on x-rays

Enlightenment on the roentgenogram with pulmonary emphysema reflects the severity of the disease. This X-ray syndrome indirectly indicates the severity of the pathological process.

What the radiologist sees on the radiograph with emphysema

The following radiological syndromes are observed on the chest image (OGK) in frontal and lateral projections with an increase in the airiness of the lungs:

enlightenment;
expansion of the intercostal spaces;
barrel chest;
deformation of the pulmonary pattern;
decrease in the structure of the roots of the lungs;
smoothness of the contours of the domes of the diaphragm;
drip heart.

Attention! A barrel-shaped chest with emphysema is clearly visible in the lateral view, which shows an increase in the anteroposterior size (the distance between the sternum and the spine).

Radiograph of the lungs in lateral projection: an increase in the anterior-posterior size with emphysema is clearly visualized

X-ray morphological symptoms are secondary. They appear due to the expansion of the chest due to the increase in lung volume.

Other X-ray morphological symptoms of excess air in the lung tissue:

deviation of the sternum forward;
horizontal arrangement of ribs;
expansion of the anterior mediastinum;
symmetrical protrusion of the chest anteriorly.

On the part of the lungs, radiological symptoms of emphysema are also observed:

An increase in the area of the pulmonary fields.
Diffuse transparency enhancement.
Local areas of enlightenment in places of accumulation of emphysematous bullae.
Excessive pulmonary pattern.

The dome of the diaphragm in a disease deviates downward due to the pressure on it of the enlarged lungs. With severe disease, the dome of the diaphragm becomes like a "tent" - a pointed roof, with which the shadow of the heart merges.

Functional X-ray diagnostic syndromes

Functional X-ray diagnostic syndromes arise from increased ventilation in the lung tissue. With a decrease in the elasticity of the alveoli, their volume increases. As a result, the inner cavity of the alveolar acini is filled with air. X-rays, passing through such anatomical formations, are not delayed, therefore, enlightenment is formed in the picture.

The difference in contrast of the radiograph is clearly visible in the lower (basal) parts of the lungs, where active ventilation takes place.

To correctly read a picture with emphysema, radiologists perform the following tests:

When the patient's chest is exposed, the right dome of the diaphragm is covered with a screen so that its upper edge is in the lower part of the rectangle. With emphysema, there is a limitation of the mobility of the diaphragm in a rectangle measuring 5x5 cm.
Sokolov's method: a series of pictures is taken on a small film (13x18 cm) in different phases of breathing (on inhalation, exhalation and holding the breath). In a healthy person, there is a difference in contrast between these images. With emphysematous lesions of the lung tissue, the difference is not noticeable.
The method of sighting photographs involves performing a series of sighting radiographs in areas of pronounced airiness with maximum inhalation, exhalation and respiratory pause.

Aiming shot of the right half of the chest with emphysema. It shows a total increase in transparency (enlightenment)

What the x-ray will tell about the increased transparency

X-rays provide the clinician with a lot of information about the condition of the pulmonary fields. Classical survey radiography of the lungs allows you to make a diagnosis, but it does not always correctly reflect the nature of the pathological process that formed the airiness of the pulmonary fields. In such a situation, a non-standard X-ray of the OGK is used, and computed tomography. It is more informative, but it is characterized by increased radiation exposure, therefore, it is used only in case of emergency.

Maximum benefit from computed tomography when bullous emphysema (with the formation of large air cavities) is suspected. To identify the features of the course of other forms of pathology, it is better to use magnetic resonance imaging.

X-rays can also be used to differentiate between the following types of emphysema:

The primary form is not associated with bronchoconstriction. Early detection can prevent complications, so radiographers should be very careful when reading lung scans.

In the secondary form of the disease, X-rays are less informative, since during the study it is impossible to view the internal structure of the bronchi, where chronic inflammatory changes accumulate.

The localized type of disease is even more difficult to diagnose. Local small foci of increased airiness in the images is very difficult to determine, since the lesions are small, and X-rays are not reflected from the air tissue.

No matter how informative an X-ray is in diagnosing emphysema, one cannot focus only on its signs, since a layered image is rather deceptive.

3. Clinical and radiological signs of pulmonary emphysema.

Emphysema of the lungs is characterized by increased airiness of the lungs, as a result of the expansion of the respiratory bronchioles, alveolar passages and alveoli. The most common in practice is diffuse pulmonary emphysema (bronchitic diffuse emphysema), caused by chronic obstructive bronchitis. With bronchospasm and cough shocks, exhalation is sharply impeded, the interalveolar pores expand and the alveolar walls break; capillaries are simultaneously compressed, which leads to dystrophy of the walls of the bronchi and alveoli. The pressure in the pulmonary artery rises, i.e. cor pulmonale is formed. Large blisters may appear - bullae, more often in the upper sections (bullous emphysema).

Clinic of pulmonary emphysema

With emphysema, there is dyspnea of an expiratory nature, swelling of the cervical veins, first in a horizontal position, then in a sitting position, and finally even in a vertical position. A persistent, unproductive cough is very characteristic, in which wheezing rales in the lungs are heard at a distance from the patient. Cyanosis is observed, in severe cases of "cast iron" shade (due to erythrocytosis). The ribcage is expanded, its anteroposterior size is increased, up to barrel-shaped, the costal angle is more than 90 °, the course of the ribs is almost horizontal, the neck is shortened due to the high standing of the shoulder girdle, the sclera are injected, the eyes are protruding ("frog face"). In the act of breathing, auxiliary muscles are involved: sternocleidomastoid (on inhalation), abdominal (on exhalation).

Characterized by a boxed percussion sound of unequal intensity in different zones under the lungs ("variegation"), the lowering of the lower border of the lungs, a decrease in the respiratory excursion of the pulmonary edge. When listening, breathing is diffusely weakened ("cotton"), exhalation is lengthened, wheezing (usually few) wheezing is heard. With exacerbation of bronchitis, with bronchiectasis, moist rales are noted. With the long-term existence of pulmonary emphysema, in most cases cor pulmonale is formed.

Emphysema of the lungs is characterized by a slow, steadily progressive course with increasing shortness of breath, cyanosis, and more frequent attacks of unproductive cough. Often, a bronchopulmonary infection joins, which is accompanied by an increase in temperature, sweating of the upper half of the body at night, separation of purulent sputum, and inflammatory changes in the blood. Gas exchange disorders and secondary infection with pulmonary emphysema lead to pneumosclerosis. Bullous pulmonary emphysema can be complicated by spontaneous pneumothorax.

X-ray with emphysema of the lungs: there is increased transparency of the lungs, depletion of the pulmonary pattern, barrel-shaped chest (in lateral projection), standing of the sternum, bulging of the lower parts of the chest up to the formation of an "hourglass", flattening and low standing of the domes of the diaphragm. The study of external respiration in pulmonary emphysema reveals an increase in the residual lung volume (an early sign) up to 35-55% VC (the norm is 25%), a decrease in the expiratory power and Tiffno's test, a progressive decrease in VC (a relatively late sign).

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Emphysema photo

Bullous emphysema of the lungs: individual groups of alveoli are expanded in the form of large thin-walled bubbles containing air - bull (a, b - preparations of I.N.

X-ray of emphysema of the lungs

Tsentroatsinaren emphysema. Lung surface.

Bullous emphysema of the lungs, spontaneous pneumothorax. Thoracoscopy.

X-rays for bullous emphysema of the lung.

X-ray of the chest cavity of a patient with emphysema and chronic cor pulmonale (frontal projection): the heart is relatively small.

Emphysema of the lungs on the roentgenogram

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Smoker's Body Lung Emphysema

PULMONARY EMphysema Emphysema is accompanied by increased fatigue, increased heart rate, decreased performance. In acute

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DEVELOPMENT MECHANISM increase in permeability Allergic edema develops urticaria develops acute pulmonary emphysema erythematous scarlet fever

Emphysema of the lungs

X-ray diagnostics. X-ray semiotics of pulmonary emphysema is very diverse and reflects certain pathomorphological and pathophysiological changes in various stages of this disease. Currently, most authors divide all radiological symptoms of pulmonary emphysema into morphological and functional.

X-ray morphological symptoms, reflecting changes in the shape and size of the difficult cell, are secondary and, as a rule, indicate far-reaching phases of the course of pulmonary emphysema. Most characteristic feature pronounced emphysema of the lungs is the so-called barrel-shaped deformity of the chest (Fig. 3), which is especially clearly detected when examining in the lateral projection due to the predominant increase in the anteroposterior size, that is, the distance between the sternum and the spine. This is facilitated by three factors: more horizontal than normal, the location of the ribs, kyphosis of the thoracic spine, and the anterior sternum. Standing sternum - a frequent and important symptom of pulmonary emphysema - is usually combined with another significant symptom - the expansion of the anterior mediastinum and its increased transparency ("gaping" of the anterior mediastinum). At the same time, in the lateral projection, a noticeable increase in the distance between the sternum, on the one hand, and the shadow of the heart and great vessels, on the other, is noted. This occurs as a result of the pushing back of the heart and large vessels posteriorly by the dilated anterior parts of the lungs.

In the front projection, there can be a noticeable symmetrical protrusion of the lower chest, over which, in pronounced cases of pulmonary emphysema, a kind of "waist" is formed, as a result of which the chest takes the shape of a bell or hourglass (Fig. 4).

X-ray morphological symptoms are also observed on the part of the lungs. Along with a general increase in the area of the pulmonary fields (mainly due to the expansion of the vertical dimensions) and a diffuse increase in their transparency, local areas of increased transparency can be detected due to the formation of multiple large emphysematous bullae, local emphysema or acute swelling of individual areas of the lung (lobe, segment). These local areas of enlightenment, observed more often in the basal parts of the pulmonary fields, are of great diagnostic value.

Most authors consider changes in pulmonary pattern characteristic of pulmonary emphysema - its redundancy, sometimes deformation, since pulmonary emphysema is usually combined with pneumosclerotic changes. Some authors consider the redundancy of the pulmonary pattern to be a consequence of peribronchial and perivascular pneumosclerosis, others as a result of an increase in the contrast of vascular shadows against the background of increased pneumatization of the lung, and still others as a consequence of blood stagnation in arterial vessels as a result of narrowing of the capillary bed of the pulmonary circulation. Apparently, all these factors matter both in themselves and in their mutual combinations.

With emphysema of the lungs, the diaphragm also undergoes changes. Its dome is located lower than usual, flattens, and in rare cases it can even slightly bend down. Costophrenic sinuses expand. In severe cases of emphysema of the lungs, the dome of the diaphragm takes the form of a tent or a pointed roof, with the top of which merges the shadow of the so-called hanging, centrally located, small-sized heart (Fig. 5).

The most important X-ray functional symptom of pulmonary emphysema - impaired pulmonary ventilation - is associated with a loss of elasticity of the lung tissue and a decrease in the vital capacity of the lungs (VC).

The fluoroscopic density (transparency of the pulmonary fields) of normal lungs changes significantly due to the phases of respiration. During inhalation, there is a significant clarification of the lungs compared to exhalation. This difference is especially noticeable in the basal parts of the lungs, which are more actively involved in the process of pulmonary ventilation compared to other parts. With emphysema of the lungs, this difference is reduced to one degree or another, and in severe cases it almost completely disappears. In these changes in the transparency of the lungs at maximum inspiration and expiration, VC is displayed radiographically.

The most simple and effective way X-ray assessment of pulmonary ventilation during transillumination is a limitation by diaphragming on an X-ray screen a portion of the lung above the right dome of the diaphragm measuring approximately 5x10 cm so that the edge of the dome of the diaphragm is located in the lower third of this vertical rectangle, which makes it possible to simultaneously monitor respiratory excursions of the diaphragm.

With emphysema, along with a decrease in the difference in the transparency of the lungs with deep breathing, there is a significant decrease in the amplitude of movements of the diaphragm, which in severe cases of emphysema of the lungs can become completely motionless, and sometimes make paradoxical movements (with a deep breath - up) due to upward movements of the front parts ribs.

For X-ray registration of pulmonary ventilation disorders in pulmonary emphysema Yu. N. Sokolov proposed the following method (Fig. 6). A series of three images is produced on a small film (13x18 cm) using a tunnel cassette under the same exposure conditions, but in different breathing phases: respiratory pause, maximum inhalation, maximum exhalation.

In a healthy person, there is a noticeable difference in photographic density between all three images (especially between inhalation and exhalation). With emphysema of the lungs, this difference decreases sharply, and in severe cases it almost disappears.

The recognition of pulmonary emphysema using roentgenokymography and electrokymography is also based on the identification of X-ray functional symptoms reflecting impaired pulmonary respiration and blood circulation.

Rice. 3. Chronic emphysema; typical barrel chest deformity. Kyphosis of the thoracic spine. A pronounced anterior sternum and anterior mediastinum "gaping".

Rice. 4. Severe chronic emphysema, hourglass chest.

Rice. 5. Severe chronic emphysema. The area of the pulmonary fields is increased mainly due to the vertical size. Low aperture position; its dome looks like a tent. In the right lung - a picture of limited basal pneumosclerosis and a dense interlobar mooring.

Rice. 6. Test for pulmonary ventilation by the method of targeted serial images (negative): 1 - basal section of the right lung of a healthy person with normal VC (4200 ml); 2 - the basal section of the right lung of a patient with chronic emphysema (VC 2100 ml). The right picture is the moment of a respiratory pause; medium - extremely deep breath; left picture - deep exhalation. The squares indicate the fields of the X-ray diffraction pattern that have undergone photometry in order to more accurately determine the photographic density.

Symptoms and treatment of pulmonary emphysema

Almost every disease of the respiratory system is life-threatening. One of these pathologies, accompanied by unpleasant manifestations, is pulmonary emphysema.

If you experience shortness of breath, wheezing with breath or symptoms of shortness of breath, you should immediately seek qualified help.

After a comprehensive examination, the doctor will be able to make an accurate diagnosis, and, if necessary, prescribe therapy.

The main causes of the disease

What is pulmonary emphysema? To understand the essence of the presented pathological process, you need to delve a little into the anatomy. The disease occurs against the background of a violation of natural breathing. This system in the human body performs a gas exchange function. When it works properly, oxygen received from the outside enters the blood directly from the lungs. Then it spreads throughout the body. After oxidation, oxygen is converted to carbon dioxide. At the final stage, it goes out through the lungs.

With severe emphysema, the gas exchange function fails. As a result, some of the oxygen remains in the lungs, it is not carried along with the bloodstream. The organs gradually increase in volume. Breathing becomes very difficult because there is simply not enough space in the lungs to get the necessary portion of oxygen. The development of this defect is usually preceded by an increase in the size of the alveoli. These sacs cease to fully contract, so a certain amount of air settles in them.

Under emphysema of the lungs, it is customary to understand a chronic disease of the respiratory system, which, in the absence of proper treatment, can lead to disability. It is most often diagnosed in women. People over 60 years old who abuse smoking also fall into the risk group.

Emphysema is a consequence of various kinds of diseases of the respiratory system, characterized by a chronic course. First of all, we are talking about obstructive bronchitis. In this pathology, inflammation quickly spreads from the bronchi to the alveoli, which is accompanied by the appearance of favorable conditions for their deformation. This emphysema is classified as secondary.

The primary variant of the disease is also distinguished. Its development, as a rule, is preceded by a persistent deficiency in the body of the protein alpha-1-antitrypsin. As a result of such a violation, the structure of the tissues of the organs is damaged. They are losing their former elasticity.

The onset of emphysema is not preceded by any diseases of the respiratory system. Protein deficiency is usually caused by a genetic predisposition. In rare cases, the disorder is a consequence of exposure to irritating factors, among which should be noted:

long-term smoking;
inhalation of toxic substances;
living in an unfavorable ecological environment.

Only a doctor can determine the root cause of emphysema after a comprehensive examination.

Clinical picture and diagnostic methods

Emphysema of the lung on initial stage its development is practically not manifested in any way. Shortness of breath may occur after intense physical activity. Over time, it becomes permanent and does not leave the patient even during rest.

In this disorder, a rapid, shallow breath is observed, which is replaced by a problematic exhalation. The skin on the cheeks becomes pink. As emphysema progresses clinical picture becomes more pronounced.

All new symptoms join severe shortness of breath:

cyanosis of the lips, nails and tongue;
the so-called emphysematous chest appears (against the background of an increase in volume, it acquires a barrel-shaped silhouette);
widening the spaces between the ribs;
the fingers on the hands become like drumsticks.

In some cases, patients with emphysema begin to rapidly lose weight. This symptom is caused by fatigue of the respiratory muscles, which are under tremendous stress when you exhale. A noticeable weight loss signals the aggressiveness of the pathological process.

Pulmonary emphysema has fairly characteristic symptoms. However, the same signs may indicate other pathological processes in the body. If the patient has previously been diagnosed with bronchitis or asthma, he may not pay due attention to shortness of breath.

That is why emphysema is very often detected at the later stages of development, when the clinical picture is especially pronounced. Asthma attacks now recur so often that the patient develops a fear of death.

If you suspect emphysema, you should seek help from a physician. If necessary, he will refer you for additional consultation to a pulmonologist. In this condition, the initial examination includes a physical examination, listening to the pulmonary system. At the next stage, they move on to instrumental diagnostic options for emphysema.

The doctor first tests the breathing function. With the help of specialized devices, he assesses the indicators of the severity of respiratory failure and narrowing of the bronchi, the approximate volume of the lungs. These parameters are studied not only in a calm position, but also after several deep breaths.

In especially serious cases, testing is carried out using the so-called bronchodilator medications. Such a detailed diagnosis of pulmonary emphysema makes it possible to differentiate it from asthma and bronchitis.

A potential patient is always additionally assigned a chest X-ray.

With its help, a qualified specialist will be able to determine the presence of defects, assess the volume of the lungs, the degree of change in the vascular pattern. Downward displacement of the diaphragm allows to confirm the diagnosis of pulmonary emphysema.

X-ray in this matter is considered the most informative examination method. Only CT is second to him.

Therapeutic options

The treatment regimen for emphysema is determined by a pulmonologist or therapist. Each patient should understand that it is not possible to completely overcome the disease. Therapy is carried out at home and has only one goal - to stop the symptoms. For this, the following methods can be used:

Medication for emphysema. It implies the use of antibacterial agents (Euphyllin, Salbutamol, Berodual). The choice of specific drugs, their dosage is determined by the doctor. Antibiotic treatment is usually prescribed for a long time. After a certain time, medications must be changed, since many of them are addictive. Potent medications often lead to complications.
Breathing exercises. This procedure involves alternating inhalation of the most common air and one in which the oxygen level is within the lower limit of normal. In this case, the frequency is approximately 5 minutes. In one treatment session, a patient with emphysema can make 6-7 such changes. Complete therapy includes repeating the listed procedures daily for 3 weeks.
Low-flow oxygen therapy. Such treatment is especially effective in the presence of not only emphysema, but also concomitant respiratory failure. Sessions of low-flow oxygen therapy can be carried out both in a medical institution and at home. For non-exacerbated emphysema, massage is recommended. It promotes the discharge of phlegm and the expansion of the bronchi. As a rule, classic or segmental massage options are used.

Emphysema is a fairly serious illness. When it occurs, the patient requires not only the appointment of drug treatment, but also a lifestyle correction. What advice do doctors give? First of all, they recommend revising the working conditions and the intensity of physical activity.

If the labor activity of a patient with emphysema is associated with the chemical industry or other harmful production, it is necessary to change the place of work. As for sports hobbies, now it is necessary to approach this issue with special attention. Preference should be given to dosed physical activity, which corresponds to the patient's condition.

Nutrition is of particular importance. For some time, doctors advise to follow a diet. It implies the elimination of allergenic foods from the diet. The emphasis should be on nutritious and fortified meals.

After confirming the diagnosis of emphysema, or even better before this time, it is necessary to quit smoking.

This addiction is not beneficial to the body. It only slowly destroys the human body, including the respiratory system.

Emphysema of the lungs in children is rarely diagnosed. Its appearance is due in most cases to a hereditary predisposition. If this diagnosis was previously confirmed in close relatives, special attention should be paid to the state of health of children.

For preventive purposes, doctors recommend that you undergo spa treatment twice a year. In this case, you should choose vacation spots with a warm and dry climate. If there are salt mines near the region of residence, the child can undergo wellness procedures in them.

Any changes in the lung tissue are characterized by the irreversibility of the process. It is impossible to completely cure the pathology, you can only slow down its course and try to stop the unpleasant symptoms. In this case, you should adhere to the doctor's instructions for treatment.

The prognosis for pulmonary emphysema also depends on a combination of the following factors:

timeliness of the therapy;
compliance with the recommendations of the attending physician;
the duration of the course of the disease.

With significant dysfunctions of the bronchi and a pronounced course of emphysema, the prognosis is in most cases unfavorable. Such patients have to artificially maintain their respiratory function with expensive drugs. The severity of the pathological process increases significantly with a complicated course of emphysema.

The development of negative consequences may be associated with heart or respiratory failure, pneumothorax, pulmonary hemorrhage. This requires a more serious therapeutic effect, and in some cases even surgery. Patients with complicated emphysema often seek support from psychologists and psychotherapists.

nervousness, disturbed sleep and appetite.
frequent colds, problems with the bronchi and lungs.
headache.
bad breath, plaque on the teeth and tongue.
change in body weight.
diarrhea, constipation and stomach pain.
exacerbation of chronic diseases.

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Changes occurring inside the lung tissue can be demonstrated by an x-ray: emphysema of the lungs looks so specific that doctors can easily establish a diagnosis. The severity and degree of neglect of the process is judged by the nature of the picture on the X-ray.

Emphysema occurs most often in old age and affects men 2 times more often than women. Doctors call the main causes of the disease:

frequent inhalation of tobacco smoke and other toxic substances present in the polluted air;
chronic lung diseases (bronchitis, asthma, etc.);
work in conditions associated with high air pressure in the lung tissue and bronchi;
violation of microcirculation of blood in the alveolar tissue, congestion;
congenital deficiency of the enzyme antitrypsin.

The course of the disease consists in the gradual loss of elasticity by the walls of the alveoli. As a result, the lung tissue loses its ability to collapse during exhalation, and its bubbles remain expanded and filled with an air mixture. Areas of increased airiness squeeze small branches of the bronchi and impede ventilation of healthy areas. As a result, there is a state of obstruction of the lungs, when their function is gradually lost, and the patient begins to experience a constant feeling of lack of air.

Classification and symptoms

The main division is made into primary and secondary emphysema. Primary occurs as an independent disease due to the influence of adverse factors. In secondary pathology, the process develops as a complication of other diseases.

There are 2 forms of the prevalence of changes:

localized, affecting individual, small and fairly clearly delineated foci;
diffuse, in which the tissue is uniformly changed over large areas of the organ.

Emphysema can also affect different parts of the acinus - a functional unit of the lung, consisting of several alveoli and a branch of the bronchus. Doctors distinguish:

panacinar form, which covers the entire acinus;
centriacinar - only the central alveoli are expanded;
periacinar - extreme vesicles are affected;
uneven;
bullous (there are persistent swelling in the lung tissue).

Emphysema can also affect individual lobes of an organ or be concentrated in only one lung.

The first manifestations of the disease look like severe shortness of breath. First, it occurs when physical activity and does not cause concern. As respiratory failure progresses, difficulty breathing is observed at rest or with minimal movement. A feature of shortness of breath with emphysema is difficult exhalation. Outwardly, this often manifests itself in the puffing of the cheeks and increased exhalation through the closed lips. Already in the early stages, a cough appears.

In the course of the development of the disease, the following symptoms occur:

mucous sputum when coughing (excreted in small quantities);
weight loss for no reason;
puffy, puffy face;
cyanosis of the lips, pallor of the skin;
visible swelling of the veins in the neck.

In the absence of treatment for respiratory failure, the cardiovascular system also begins to suffer.

How is the study going, and what does the doctor see on the radiograph with emphysema?

There is no preparation before the procedure. To make the radiograph clear, the patient will be asked to undress to the waist and remove the jewelry that hangs on the chest.

The study is most often carried out in a standing position, on special equipment for X-ray diagnostics. The patient must stand up as the doctor requires, so that the image in the desired projection is well readable. The clarity of the x-ray is also affected by the immobility of the chest at the time of irradiation. The specialist's requirement to inhale and hold the breath for a few seconds is based on the maximum expansion of the chest and lungs for a better view of organs and their immobility.

For an accurate diagnosis, the specialist may ask you to take test shots:

irradiated with a delay, inhalation and exhalation - in a sick person, the enlightenment remains the same;
aiming shots are taken to examine areas with high pneumatization;
cover part of the diaphragm with a screen to detect its reduced mobility.

Receiving X-rays is associated with exposure to the body. If, due to the patient's inattention to the doctor's request, the picture is indistinct, the procedure will have to be repeated, once again being exposed to hard rays.

Decoding

Areas of the lung affected by emphysema appear the most transparent in the picture. This indicates an increased pneumatization of these areas. In addition to the enlightenment in the picture, the doctor assesses:

Change in the shape of the chest. The barrel-shaped pulmonary region and an increase in the anterior-posterior size can be seen only in the lateral projection. With emphysema, the intercostal spaces also become dilated, and the ribs are located horizontally.
Changes in the drawing of the lung and its redundancy. The size of the organ itself (pulmonary field) increases in relation to the physiologically normal one. Because of this, the outlines of the dome of the diaphragm change, and with a high degree of development of the process, it becomes similar to a tent: with a sharp, raised middle and steeply descending sides.
Transparent (enlightened) lungs. On the roentgenogram, the entire lung tissue is filled with air and transmits rays, creating a more or less pronounced "haze". The affected areas appear even more transparent.

If an X-ray examination does not give an unambiguous result, a computed tomography scan is recommended to the patient to confirm the diagnosis.

Treatment of the disease

Medication for emphysema is prescribed only to relieve symptoms. To improve the condition of the bronchi, bronchodilators (Salbutamol, Theophylline, etc.) are prescribed in the form of tablets and inhalations. The use of glucocorticoids (for example, Prednisolone) is also indicated. Diuretics help reduce tissue swelling. Patients are shown and breathing exercises or special complexes of exercise therapy.

The main therapeutic measure is an operation associated with a decrease in the volume of an organ. At the same time, its extreme sections are excised. The rest of the organ can expand in the vacated space and begins to perform its physiological function. With a severe degree of damage, only a lung transplant (transplant) can help.

To avoid relapses, the patient is advised to quit smoking, change jobs, if the reason is related to professional activities. In the presence of chronic inflammatory processes in the lungs, they are treated. If the doctor's recommendations are followed, the quality of life of patients can be improved, although there will be restrictions on professional activities.

Self-medication and application folk remedies with emphysema is unacceptable. The disease is most easily treated at an early stage of development. The time lost in search of unconventional methods is best spent on visiting a doctor when the first signs of illness appear.

It is possible to see emphysema of the lungs on X-ray with a protracted course of pathologies of the respiratory system: obstructive pulmonary disease in smokers, bronchial asthma, silicosis and anthracosis of miners, pneumoconiosis and other chronic diseases. Changes are the result of pathological expansion of the alveoli, alveolar passages, bronchioles and bronchi. In this case, the structural structure of the parenchyma of the organ is disturbed, the changes often become irreversible.

What can be seen on a radiograph with emphysematous changes

To diagnose pulmonary pathology, it is necessary to analyze images in two projections: and a lateral projection, usually of the right section. With emphysema of the lungs, the radiologist detects the following changes in the lungs on x-rays:

horizontal position of the ribs;
barrel-shaped chest;
expansion of the intercostal space;
the sternum deviates forward;
kyphotic curvature of the thoracic spine;
increasing the transparency of the lung tissue;
displacement of the mediastinal organs (heart, esophagus, great vessels);
expansion and destruction of the roots of the lungs;
omission of the diaphragm;
strengthening of the pulmonary pattern mainly in the root zone - expansion of the vessels of the lungs;
prolapse (sagging) of the diaphragm to the side abdominal cavity, mainly on the left;
an increase in the diaphragmatic angle (from an acute one approaches a straight line).

With a long course of the disease, emphysema is complicated by the formation of bullae - air cavities in the lung. With an increase in tension when coughing, sneezing, tissue rupture is possible with the formation of a closed pneumothorax.

Diagnosis of functional disorders

Conducting functional tests during radiography is necessary for the differential diagnosis of irreversible changes in the lung tissue. With emphysema in the lungs, despite the increased volume, there is no functional exchange of the used air. The dilated alveoli contain the same air. This leads to a decrease in blood oxygenation and clinical signs of hypoxia.

To determine the radiological symptoms of irreversible functional changes, the following tests are used:

Sokolov's method: on a 13x18 cm x-ray film, a number of sequential images are taken in different phases of the respiratory cycle, and then the excursion of the diaphragm is compared using a ruler;
The method of sighting images - directed diagnostics on the area of local emphysema: several images are taken with a deep breath, then exhale, while holding the breath, then the results are compared;
Shield method: close the right lung so that the dome of the diaphragm is under the lower edge of the shield. Then a series of pictures is taken, according to the distance from the barrier to the diaphragm during the phases of inhalation, exhalation, and holding the breath, the excursion of the lung is determined.

Increasing transparency on x-rays: what is it

X-ray signs of emphysematous changes are often diffuse and affect the left and right lungs. But sometimes, with local bronchial obstruction, it is possible to identify compensatory emphysema in the form of increased pneumatization around pneumosclerosis and pulmonary fibrosis, areas of atelectasis and other non-functional formations. In this case, areas of increased airiness are formed on the radiograph around the local darkening.

Using radiographs, the following types of emphysema are determined:

Primary - formed as a result of narrowing of the lumen of the bronchi. This is an early form in which changes are regressed.
Secondary - chronic emphysema, in which there is obstruction of the bronchi with pathological contents.
Tertiary - local emphysema, in which airiness increases in some areas of the pulmonary field.

If an X-ray shows airflow in half of the chest, this condition is called pneumothorax. Pathology often complicates the course of bullosa emphysema. The lung is compressed to the root, due to which its structure is disturbed. The organs of the mediastinum (heart, great vessels, esophagus) are displaced into the healthy part of the chest. Clinically, a person shows symptoms of acute respiratory failure, and he needs surgical treatment: a puncture of the pleural cavity.

Lifestyle correction for patients with emphysema

If persistent emphysema is found on the radiograph, lifestyle adjustments should be made to facilitate overall well-being and improve the quality of life. The following activities are recommended:

Quit smoking, as smoking is the main cause of COPD.
Change labor activity (if it is associated with chemical, coal, flour-grinding and other industries that increase the risk of developing obstruction and other respiratory diseases).
Move to an ecologically clean region or at least undergo treatment in a sanatorium once a year, the climate should be dry and warm.
Follow a hypoallergenic diet, as sometimes food can cause bronchial asthma and lead to bronchial obstruction.
For any diseases of the upper respiratory tract, follow the doctor's recommendations, strictly follow the prescribed therapy.

Emphysema of the lungs is the logical conclusion of a chronic obstructive process. Pathology is accompanied by significant changes in the functional state of the lung tissue, clinically manifested by signs of respiratory failure. With the progression and decompensation of the process, cardiovascular disorders are formed. It is important to detect the first signs of emphysematous changes for the timely correction of lifestyle and prevention of serious complications.

Video

Emphysema of the lungs (translated as "swelling" from the Greek. "Emphysema") is a pathology belonging to chronic obstructive pulmonary disease (COPD), provoking the expansion of the alveoli - air sacs in the bronchioles, destruction of their walls and irreversible changes in lung tissue. The lungs expand and the rib cage takes on the shape of a barrel. This is a deadly disease, when every hour is important for taking urgent measures to provide medical care.

Men are twice as likely to suffer emphysema, especially those who have reached old age.

The disease has a high risk of disability, disability, development of complications in the heart and lungs for males at a younger age.

Pathology is characterized by progressive and chronic course.

The mechanism of the disease is:

the prevalence of the volume of incoming air over the volume of outgoing air, while the alveoli double when stretched;
accumulation of excess air - carbon dioxide and other impurities - disrupting the process of blood supply to the lungs, destroying tissues;
an increase in intrapulmonary pressure, at which the arteries, lung tissue are compressed, shortness of breath and other signs of the disease appear;
thinning of the vascular walls, stretched state of smooth muscles, impaired nutrition in the acinus (structural unit of the lungs);
the occurrence of oxygen deficiency.

With this mechanism of damage to the lungs, the heart muscle (right side) is under severe stress, as a result of which a pathology called chronic cor pulmonale appears.

It's important to know! Emphysema is a dangerous disease that affects the respiratory and heart systems, provoking a lack of oxygen in the lung tissue. The symptoms of shortness of breath as a result of untimely medical care are rapidly increasing, which leads to negative consequences and even death.

Classification system of emphysema

The nature of the flow:

Acute form (caused by increased muscle load, asthmatic attacks, the presence of a foreign body in the bronchi. The lung is swollen, the alveoli are stretched. It is necessary to urgently start treatment).
Chronic form (transformation in the lung occurs gradually, disability is possible without medical intervention, otherwise, you can completely recover at the initial stage of the disease).

Origin:

Primary emphysema. It is considered as an independent disease diagnosed in infants and sometimes in newborns. A rapidly progressing pathology that develops against the background of congenital characteristics of the body is practically not subject to treatment.
Secondary emphysema. The disease is associated with obstructive pulmonary pathologies in chronic course. The problem that has arisen can be overlooked, due to the intensified symptoms, the ability to work is lost.

Prevalence:

Diffuse. With this form, all lung tissue is affected, the alveoli are destroyed. Transplantation of a donor lung is possible after a serious illness.
Focal. Parenchymal transformations are studied at the sites of bronchial obstruction, scars and in the area of tuberculous foci. Symptoms of emphysema are not clearly expressed.

Anatomical features that distinguish the following forms of emphysema:

Hypertrophic (or panacinar / vesicular). It is registered as a severe form. With respiratory dysfunction, inflammation is not observed, as is the absence of healthy tissue among the acini, damaged and swollen.
Centrilobular. The acinus center is affected by destructive processes. The expanded lumens of the alveoli and bronchi provoke the onset of the inflammatory process. Mucus is separated in large quantities, the walls of the acini undergo fibrous degeneration. The pulmonary parenchyma, located among the areas that have undergone destructive changes, is not damaged.
Periacinar (distal / perilobular). Tuberculosis contributes to its development. The disease often ends with pneumothorax - a ruptured affected area of the lung.
Okolubtsovaya. The manifestation of pathology occurs next to fibrous foci and scars in the lung. The symptomatic picture has no obvious signs.
Bullous, or blistery. The entire parenchyma is affected by bullae, differing in different sizes (from a few millimeters to 21 centimeters), appearing at the sites of damaged alveoli. Tissues under the influence of bubbles are compressed, destroyed, and infected.
Interstitial. The ruptured alveoli form air bubbles under the skin. They migrate through the lymph and tissue lumens into the subcutaneous space of the neck and head. Blisters localized in the lungs contribute to pneumotorex.

Cause of occurrence:

Senile type. It appears due to the presence of an altered vascular system, destruction of the elasticity of the alveolar walls due to old age.
Lobar type. It is registered in children born into the world, the disease is facilitated by the obstruction of any bronchus.

It's important to know! Chronic emphysema is inherent in adults, children hardly suffer from this disease. Childhood is characterized by a disease of the so-called obstructive type, affecting either one or two lungs. Pathology of a unilateral type in a child is most often due to the ingress of a foreign body into the bronchi.

Factors affecting the development of emphysema

The onset of pathology can be facilitated by causes of external and internal origin associated with:

chronic obstructive bronchitis;
bronchial diseases;
bronchiolitis of a chronic course of an autoimmune nature;
interstitial pneumonia;
tuberculosis;
congenital features of the respiratory system;
poor environmental conditions, polluted air with harmful impurities;
active and passive smoking;
harmful conditions of professional activity;
unfavorable heredity;
imbalance of hormones in the body;
age-related changes;
respiratory tract infections;
overlapping the lumen of the bronchi with a foreign body.

To date, no definite cause contributing to the onset and progression of emphysema has been established. In scientific circles, it is believed that pathology manifests itself from the combined effects of several factors at once.

Symptomatic picture of lung emphysema

The picture of the developing disease is dynamic and fast.

The main signs of emphysema are the following:

severe and sharp pain that occurs in the chest region or in one of the halves of the chest;
a rapid decrease in blood pressure, shortness of breath, difficulty exhaling;
wheezing in the lungs;
the appearance of tachycardia, expansion of the heart to the right side;
breathing is carried out with the inclusion of the abdominal press and other muscles;
enlarged neck veins;
cough with hemoptysis;
expansion of the sternum, protrusion of the supraclavicular fossa and intercostal segments;
severe headaches, shortness of breath, sometimes loss of consciousness;
violations of speech, coordination of movement, the occurrence of shortness of breath with any physical effort;
rapid weight loss;
omission of an enlarged liver;
manifestation of paresis, paralysis;
deformation of the nail plates due to insufficient breathing;
abdominal pain, bloating, liquid feces come out with blood impurities;
the skin of the limbs is pale, pain is felt in them;
signs of cyanosis (cyanosis) on the face;
numbness of the affected area, which has a lower temperature to the touch than other areas;
the appearance of gangrene on the limbs, manifested by black spots, blisters filled with a liquid of a dark color.

These and other signs appear in different cases, depending on the type of pathology. The severity of their course is influenced by the duration of the developing ailment.

It's important to know! With emphysema, subpleural air cavities can rupture, as a result of which air penetrates into the pleural cavity. The risk of this complication is very high.

Diagnostic measures

At the first symptoms of emphysema or suspicion of a pathology, the patient is referred to a pulmonologist or therapist who collects an anamnesis. The doctor, with the help of leading questions, asks the patient information that is important for the diagnosis. By means of auscultation - listening to the chest with a phonendoscope, percussion - tapping fingers - the specialist determines and assesses the possible signs of the disease.

The doctor appoints the passage of the row instrumental methods diagnostics of pathology, consisting in:

Radiography.
MRI of the lungs.
Computed tomography of the lungs.
Scintigraphy (a gamma camera takes pictures of the lungs after radioactive isotopes have been injected into them).
Spirometry (using a spirometer that records the volume of air during exhalation and inhalation).
Peak flowmetry (measuring the maximum rate of outgoing air in order to determine the obstruction of the bronchi).
Taking blood from a vein to assess the ratio of gas components - oxygen and carbon dioxide.
Clinical blood test.

Pulmonary emphysema treatment

Treatment of emphysema should have an integrated approach and be aimed, first of all, at combating the main causes of the development of the disease. Forms of the disease that do not have a complicated course can be treated at home by regularly consulting a doctor. The stages are advanced, severe require hospital therapy in order to avoid complicated processes.

Treatment of emphysema is carried out medically (in order to reduce the progressive processes of heart and respiratory failure), in special cases - by surgical intervention, as well as by means of alternative medicine that improve respiratory function. The duration of therapy courses is in direct proportion to the existing complications.

For a significant and prompt expansion of the lumen of the alveoli and bronchi, preference in treatment is given to:

bronchodilators "Neophyllin", "Berodual", "Salbutamol", "Teofilin";
antitussive drugs with expectorant action "Ambroxol", "Bromhexin", "Libeksin", "Flavamed", "Gerbion";
antibiotics "Ofloxacin", "Sumamed", "Amoxiclav", "Amoxil" and others, prescribed in case of the development of complicated conditions of the disease;
glucocorticosteroids "Prednisolone", "Dexamethasone", which helps to reduce the inflammatory process in the lungs;
analgesics "Pentalgin", "Analgin", "Ketalong", "Sedalgin" - in cases of severe pain in the sternal region;
vitamins "Undevit", "Dekamevita", multivitamin complexes in order to strengthen the immune system.

It's important to know! All drugs are taken only as directed by a doctor and under his supervision in order to avoid complicating processes.

Smoking, drinking alcohol with emphysema of the lungs is strictly prohibited, as this aggravates the development of the disease.

Surgical application

The operation is resorted to in cases of unsuccessful drug treatment, a large area of lung damage, and also taking into account the absence of contraindications to intracavitary surgery.

A patient cannot be operated on if he:

severely emaciated;
has a deformity of the chest;
suffers from severe bronchitis, asthma, pneumonia;
in old age.

Surgical care is indicated in situations:

the formation of multiple bullae on an area that occupies a third of the chest;
the presence of severe shortness of breath;
pneumothorax, infectious / oncological processes, sputum discharge with an admixture of blood;
regular hospitalizations;
transformation of pathology into the most severe forms.

Surgical intervention is divided into several types, including:

donor lung transplant (with the formation of multiple bullae, a large area of the affected lungs);
elimination of lesions with a decrease in lung volume to 1/4 part by opening the sternum;
thoracoscopy (minimally invasive resection of the affected areas of the lungs);
bronchoscopy (carried out through the mouth if the damaged area is located near the large bronchi).

The surgical method of treatment restores ventilation of the lung, which is no longer compressed by the affected parts of the organ. An improvement in the condition is recorded after three months from the date of the operation. But shortness of breath may return seven years after surgery.

How to eat for emphysema

With this pathology, diets No. 11 and No. 15 are used, which can have a strengthening effect on the protective functions of the body, replenish energy reserves and remove toxins.

Diet food consists of the following principles:

daily calorie content should be at least 3600 KK with six meals a day in small portions;
daily fat content (as a result of the consumption of vegetable, butter, fatty dairy products) - up to 100 g;
the daily norm of proteins is 110-115 g (they contain eggs, meat of all sorts, fish, seafood, liver, etc.);
carbohydrates should supplement the daily diet in the amount of up to 0.4 kg (cereals, bread, honey, pasta, etc.);
the use of fruits, vegetables, bran to provide the body with vitamins and fiber;
drinking juices, koumiss, rosehip compote;
limiting salt to 5 g to prevent swelling, heart dysfunctions.

It's important to know! Patients with emphysema exclude alcoholic beverages, cooking fats, sweets, pastries, cakes, pastries and other foods containing a large percentage of fat from the diet.

The use of traditional medicine methods in the treatment of emphysema

As mentioned above, with uncomplicated forms of pathology, it is possible to be treated at home, using folk remedies in addition to medications. They have proven themselves well in practice and are easy to use.

freshly squeezed potato juice (drunk up to three times a day), effectively affecting the respiratory tract;
natural honey (a large spoonful three times a day), which has an anti-inflammatory effect;
lemon balm (for 30 g 0.5 liters of boiling water, insist during the day, use 30 ml twice a day);
walnuts (eat up to 2 g every day);
plantain (for 20 g of dry leaves, 500 ml of boiling water, leave for three days, strain, drink 15 ml twice a day for a month);
steam inhalation over potatoes (for anti-inflammatory effect).

Actually ethnoscience offers a huge selection of recipes for herbal decoctions and infusions for emphysema, but each patient, after consulting a doctor, stops at what is acceptable to him in order to avoid various complications, for example, of an allergic nature.

The patient is also advised to perform breathing exercises to improve oxygen exchange and restore impaired functions of the bronchi, alveoli. During the day, four times for 15 minutes, you should do the following exercise: deep breath, breath holding with periodic "fractional" exhalation.

Application of coursework (up to 20 days) therapeutic warming massage the chest helps to improve breathing by expanding the bronchi, coughing up, and expectoration of sputum. After the course, you need to take a break for 14 days.

It should be remembered that this disease is dangerous, it is related to bronchopulmonary pathologies. Consequently, the altered lung tissue is not restored. Treatment consists in slowing down the progressive process and reducing the signs of respiratory dysfunction by ensuring bronchial patency.

The prognosis of the disease is based on the timeliness and adequacy of therapy for the underlying pathology, the duration of the course of the disease, and the patient's adherence to the rules of “behavior”. It is impossible to completely get rid of emphysema, but medicine is able to influence the developing process. Subject to the recommendations of experts, a person can lead his usual way of life. This prognosis against the background of a stable course with maintenance of a minimum level of emphysema can be considered favorable.

With severe pathology, the prognosis cannot be favorable. Patients should use expensive medications to maintain the necessary respiratory parameters throughout their lives. There is no hope for such people to improve their condition.

Prolongation of life is in direct proportion to the age of the patient, the ability of the body to recover and compensate to the required degree of the pathological process.

Emphysema of the lungs characterized by increased airiness of the lungs, as a result of the expansion of the respiratory bronchioles, alveolar passages and alveoli. The most common in practice is diffuse pulmonary emphysema (bronchitic diffuse emphysema), caused by chronic obstructive bronchitis. With bronchospasm and cough shocks, exhalation is sharply impeded, the interalveolar pores expand and the alveolar walls break; capillaries are simultaneously compressed, which leads to dystrophy of the walls of the bronchi and alveoli. The pressure in the pulmonary artery rises, i.e. cor pulmonale is formed. Large blisters may appear - bullae, more often in the upper sections (bullous emphysema).

Clinic of pulmonary emphysema

With emphysema, there is dyspnea of an expiratory nature, swelling of the cervical veins, first in a horizontal position, then in a sitting position, and finally even in a vertical position. A persistent, unproductive cough is very characteristic, in which wheezing rales in the lungs are heard at a distance from the patient. Cyanosis is observed, in severe cases of "cast iron" shade (due to erythrocytosis). The ribcage is deployed, its anteroposterior size is increased, up to barrel-shaped, the costal angle is more than 90 °, the course of the ribs is almost horizontal, the neck is shortened due to the high standing of the shoulder girdle, the sclera are injected, the eyes are protruding ("frog face"). In the act of breathing, auxiliary muscles are involved: sternocleidomastoid (on inhalation), abdominal (on exhalation).

Characterized by a boxed percussion sound of unequal intensity in different zones under the lungs ("variegation"), lowering of the lower border of the lungs, a decrease in respiratory excursion of the pulmonary border. When listening, breathing is diffusely weakened ("cotton"), exhalation is lengthened, wheezing (usually few) rales are heard. With exacerbation of bronchitis, with bronchiectasis, moist rales are noted. With the long-term existence of pulmonary emphysema, in most cases cor pulmonale is formed.

X-ray with emphysema of the lungs: there is increased transparency of the lungs, depletion of the pulmonary pattern, barrel-shaped chest (in lateral projection), standing of the sternum, bulging of the lower parts of the chest up to the formation of an "hourglass", flattening and low standing of the domes of the diaphragm. The study of external respiration in pulmonary emphysema reveals an increase in the residual lung volume (an early sign) up to 35-55% VC (the norm is 25%), a decrease in the expiratory power and Tiffno's test, a progressive decrease in VC (a relatively late sign).