Inhaled mycobacteria are absorbed by alveolar macrophages, transporting them to regional lymph nodes. Phagocytic reactions are incomplete, since the cord factor tuberculosis pathogen damages mitochondrial membranes and inhibits phagosomal-lysosomal fusion; The pathogen survives in the cytoplasm of macrophages.
Besides, tuberculosis cord factor inhibits the migration of polymorphonuclear phagocytes, which determines the weak severity of the inflammatory response. Along the regional lymphatic pathways, it forms primary tuberculosis complex with the development of granulomas in the form of tubercles [hence the name “tubercle”, or “ tuberculosis"(Latin tuberculum, tubercle)].
There is no formation of granulomas characteristic features and represents the HRT response. In the center of each tubercle there is an area of cheesy necrosis (caseosis), in which Koch's sticks are located. The center of the necrotic focus is surrounded by epithelioid and giant (multinuclear) Pirogov-Langhans cells, and along the perimeter by lymphocytes (including plasma cells) and mononuclear phagocytes.
Most often the formation of primary tuberculosis complex observed in the lungs ( outbreak of Gon). In granulomas, the reproduction of the pathogen usually slows down or stops. In most cases, primary lesions heal with complete degradation of the contents, its calcification and fibrosis of the parenchyma. Primary tuberculosis is characterized by tissue sensitization by mycobacterial metabolites. During the healing of the primary lesion increased sensitivity disappears, but becomes more pronounced immune reactions. Under these conditions, dissemination of the pathogen from primary foci (especially lymph nodes) and the formation of screening foci (post-primary foci of reinfection) are possible. They are usually localized in the lungs, kidneys, genitals and bones.
When the immune system is weakened, the lesions become more active and develop secondary process of tuberculosis. Reactivation is most often observed in individuals who have reached 55-60 years of age. It is provoked by stress, nutritional disorders and general weakening of the body.
Certain contribution to pathogenesis of tuberculosis introduces sensitization to the body, causing a variety of toxic-allergic reactions in patients. Cavities form in the lungs, bronchi and small pulmonary vessels, from which necrotic cheesy masses containing the pathogen are actively expectorated.
Clinically reactive tuberculosis manifests itself as a cough, often with hemoptysis; loss of body weight, profuse night sweats, chronic low-grade fever.
Less commonly, in weakened individuals and patients with immunodeficiencies, disseminated tuberculosis with the formation of granulomas in various organs. The condition usually develops after the granuloma contents rupture into the bloodstream. Manifestations are similar to those of secondary tuberculosis, but they are often accompanied by lesions of the brain and its membranes. The prognosis is unfavorable.
Manifold forms of tuberculosis process made its classification difficult. Currently clinical classification distinguishes three main forms: Tuberculosis intoxication in children and adolescents
Tubercle diseases of the respiratory system, including the primary tuberculosis complex, lesions of the intrathoracic lymph nodes, pleura, upper respiratory tract; focal, infiltrative, cavernous, fibrous-cavernous, cirrhotic pulmonary tuberculosis, tuberculoma, etc. Tuberculosis of other organs and systems, including lesions meninges, eyes, joints and bones, intestines and peritoneum; skin and subcutaneous tissue; organs genitourinary system etc.
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Question: Good afternoon I did fluorography. The doctor said that there is a focus of rutting in the right lung, but I remember exactly for recent years 7 - 10 I was not ill with anything serious, I was not treated for tuberculosis and I was not given such a diagnosis. I never had a cough for more than a week. Tell me whether tuberculosis can be asymptomatic and whether it can be contagious. Thank you.
Doctor's answer: Hello! You need to contact a phthisiologist for a face-to-face consultation.
Medical services in Moscow:
Question: My grandson has a Gon lesion. Fluorography and X-ray showed the problem. When examining the RSCT, the doctor said that this rib was close to the rib, everything was fine, but he himself wrote everything that was recommended. And they admitted grandson 16 to the tubal dispensary. for 2 months. The tests are all normal. Then they suggested wed. pick it up, but give you a handful of tablets to take. What should I do???
Doctor's answer: Hello! The course of treatment must be completed. Take the tablets as prescribed by your doctor.
Question: Hello, I am 35 years old, on a CT scan of my lungs I can see Gon's lesion. Previously, there were no Gon lesions in the photographs. Question: Does this all mean that I have had tuberculosis. Is the outbreak of Gon being treated? Or is it for life? what does the future threaten? Thank you.
Doctor's answer: Hello! Hello! Gon's hearth - hearth previous tuberculosis lungs. Does not require treatment.
The outbreak of Gon usually passes without causing any concern. The diagnosis needs to be clarified. Unfortunately, without inspection it is impossible to determine accurate diagnosis and prescribe treatment. You should consult a TB doctor.
Question: Hello, we had a CT scan on 06.06.14 on a series of tomograms in S2 right lung the main interlobar pleura has a rounded dense focus up to 6 mm with clear contours.
Conclusion: a single dense focus in S2 of the right lung near the main interlobar pleura. We don’t have a pulmonologist in our city. Tell me what this could mean? Best regards Denis!
Doctor's answer: Hello! There may be calcification or a Gon lesion. You need to see a phthisiologist.
Question: Hello, doctor. My husband was diagnosed with Gon's hearth does he continue to smoke? Tell me how this will affect his health? How to convince him? Is treatment necessary?
He answered all your questions.
Please help!!! What should I do???
Doctor's answer: Hello! Gon's lesion is the focus of past pulmonary tuberculosis. Does not require treatment.
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– a form of secondary tuberculosis that occurs with the formation of foci of specific inflammation in the lungs no more than 10 mm in diameter. It is asymptomatic or minimally symptomatic. In some patients, focal pulmonary tuberculosis may be accompanied by malaise, low-grade fever, pain in the side, and dry cough. In diagnostics focal tuberculosis The most informative are chest x-rays and detection of MBT in sputum or bronchial washings. In the initial period, patients with focal pulmonary tuberculosis are prescribed a combination of three to four main anti-tuberculosis chemotherapy drugs, followed by a reduction to two names.
In the pathogenesis of reactivation of endogenous infection, as the cause of focal pulmonary tuberculosis, the lymphohematogenous dispersion of mycobacteria throughout the body plays a decisive role. Focal pulmonary tuberculosis is predominantly localized in the upper lobe. Numerous studies in the field of phthisiology and pulmonology explain this various factors: limited mobility of the apex of the lung, its weak aeration, slow blood and lymph flow in this area, vertical position the human body and even hypersensitization, which promotes selective fixation of mycobacteria in the apex of the lungs.
Depending on the duration of the course, focal pulmonary tuberculosis can be fresh (soft-focal) and chronic (fibrous-focal).
In its development, focal tuberculosis goes through the phases of infiltration, decay and compaction. Depending on the size, there are small (up to 3 mm in diameter), medium (up to 6 mm), large (up to 10 mm) lesions.
Feature clinical course Pulmonary tuberculosis is the erasure or absence of symptoms, therefore most cases are detected during preventive fluorography. About a third of patients have a mild intoxication syndrome and signs of damage to the respiratory system.
Signs of intoxication include low-grade fever in the evenings, a feeling of heat, followed by short-term chills, sweating, malaise, decreased appetite, sleep disturbance. Sometimes, with focal pulmonary tuberculosis, as a manifestation of specific intoxication, signs of hyperthyroidism occur: an increase in size thyroid gland, tachycardia, bright eyes, weight fluctuations, irritability. Women may experience menstrual irregularities such as opsomenorrhea or proyomenorrhea.
Complaints of pain in the side, between the shoulder blades, and in the shoulders are possible. The cough is usually intermittent and may be dry or accompanied by scanty sputum production. Occasionally, hemoptysis occurs.
Physical findings revealed during an objective examination of a patient with suspected focal pulmonary tuberculosis are nonspecific. Palpation reveals slight soreness and stiffness of the muscles of the shoulder girdle; lymph nodes are not enlarged. The percussion sound over the lesion is muffled, and can be heard on auscultation hard breathing, when the patient coughs, isolated fine wheezes are detected.
If the data is questionable, test therapy is resorted to: the patient is prescribed anti-tuberculosis drugs for 2-3 months and clinical, radiological and laboratory dynamics are monitored. When the lesions decrease or partially resolve, the diagnosis of focal tuberculosis is undoubted.
Treatment of active focal pulmonary tuberculosis is carried out in an anti-tuberculosis hospital, inactive - in outpatient setting under the supervision of a phthisiatrician. The standard chemotherapy regimen involves prescribing at least three anti-tuberculosis drugs (rifampicin, isoniazid, pyrazinamide, ethambutol) for a period of 2-3 months. Streptomycin can also be used initially. In the continuation phase, which lasts 4-6 months, two drugs are continued (rifampicin + isoniazid, isoniazid + ethambutol). The total duration of therapy for focal pulmonary tuberculosis is 6-9 months, and in some patients - up to one year. Rehabilitation after a course of treatment is carried out in an anti-tuberculosis sanatorium.
Exodus focal form pulmonary tuberculosis is usually safe. As a result of complete treatment, fresh lesions completely resolve, and a complete clinical cure occurs. At chronic course focal tuberculosis may transform into less prognostically favorable forms (infiltrative, cavernous, disseminated). The most common outcome is pneumosclerosis with the formation of foci of fibrosis or calcification. Such patients require chemoprophylaxis for 1-2 years. The greatest challenge is treating chemotherapy-resistant cases. Prevention of focal pulmonary tuberculosis consists of conducting an X-ray examination of the population, sanitary education, and increasing the body’s nonspecific resistance. In reducing the number of cases of secondary pulmonary tuberculosis great value has
Focal formations in the lungs - tissue compaction caused by various diseases. They are usually detected by X-ray examination. Sometimes an examination by a specialist and diagnostic methods are not enough to make an accurate conclusion. For final confirmation you need to carry out special methods examinations: blood tests, sputum tests, . This happens with malignant tumors, pneumonia and impaired fluid exchange in the respiratory system.
A lesion is a small spot that is revealed by radiography, round or irregular shape, located in the lung tissue. They are divided into several varieties: single, single (up to 6 pieces) and multiple.
There is a definite difference between the internationally established concept focal formations, and what is accepted in domestic medicine. Abroad, these include compactions in the lungs measuring about 3 cm. Domestic medicine sets limits of up to 1 cm, and classifies other formations as infiltrates.
Computed tomography is more likely to determine the size and shape of the compaction lung tissue. This study also has a margin of error.
Focal formations in the respiratory organs are presented as degenerative changes in the tissues of the lungs or the accumulation of fluid in the form of sputum or blood. Many experts consider their establishment one of the important tasks.
Up to 70% of single lesions in the lungs are classified as malignant neoplasms. Using CT (computed tomography), and based on specific symptoms, a specialist can assume the occurrence of such dangerous pathologies like tuberculosis or lung cancer.
However, to confirm the diagnosis, a test is required necessary tests. In some cases, a hardware examination is not enough to obtain a medical opinion. Modern medicine does not have a single algorithm for conducting research in all possible situations. The specialist considers each case separately.
The imperfection of the equipment does not allow a clear diagnosis of the disease using the hardware method. When taking an X-ray of the lungs, it is difficult to detect focal changes, the size of which does not reach 1 cm. Interposition of anatomical structures makes larger formations invisible.
The specialist offers patients to undergo examination using computed tomography. It allows you to view fabrics from any angle.
Computed tomography to diagnose the location of the lesion
The main factors of pathology include the occurrence of compactions on the lungs. Such symptoms are inherent dangerous conditions, which in the absence proper therapy may cause death. Diseases that provoke this condition include:
Most often, compactions occur due to inflammatory processes (acute pneumonia, pulmonary tuberculosis) or cancer.
A third of patients have minor signs of respiratory damage. A feature of pulmonary tuberculosis is the absence of symptoms or their minimal manifestation. It is mainly detected when preventive examinations. The main picture of tuberculosis is given by chest radiography, but it differs depending on the phase and duration of the process.
To determine focal changes, it is necessary to undergo special examination(radiography, fluorography or computed tomography). These diagnostic methods have their own characteristics.
When undergoing an examination in the form of fluorography, it is impossible to detect a compaction smaller than 1 cm in size. It will not be possible to analyze the entire picture completely and without errors.
Many doctors advise their patients to undergo a CT scan. It's a way of research human body, allowing to identify various changes and pathologies in internal organs sick. It is one of the most modern and accurate diagnostic methods. The essence of the method is to influence the patient’s body x-rays, and subsequently, after passing through it, computer analysis.
With its help you can install:
This method also has weaknesses. Even with CT examination, focal changes are missed. This is explained by the low sensitivity of the device for lesions up to 0.5 cm in size and low tissue density.
Experts have found that with initial CT screening, the probability of not detecting pathological disorders in the form of focal formations is possible with a size of 5 mm in 50% of cases. When the diameter is 1 cm, the sensitivity of the device in this case is 95%.
The conclusion indicates the likelihood of developing a particular pathology. The location of the lesions on the lungs is not given decisive importance. Special attention pay attention to their contours. If they are uneven and unclear, with a diameter of more than 1 cm, then this indicates the occurrence of a malignant process. In case of diagnosing clear edges focal changes, we can talk about development benign neoplasms or tuberculosis.
During the examination, pay attention to the density of the tissues. Thanks to this sign, a specialist is able to distinguish pneumonia from changes caused by tuberculosis.
Another nuance of computed tomography is the determination of the substance collecting in the lungs. Only fat deposits make it possible to determine pathological processes, and the rest cannot be classified as specific symptoms.
After obtaining CT images of the lungs, in which the compactions are visible, they are classified. Modern medicine distinguishes the following varieties according to size:
Focal formations in the lungs are usually classified by density:
Classification by quantity:
Single seals. May be a factor in serious pathology ( malignant tumor) or refers to ordinary age-related changes that do not pose a threat to the patient's life.
Multiple seals. They are mainly characteristic of pneumonia and tuberculosis, but sometimes numerous and quite rarely diagnosed cancers are also caused by the development of a large number of compactions.
In humans, the lungs are covered with a thin film called pleura. Seals in relation to it are: 
Modern medicine has several methods for diagnosing tuberculosis and other lung diseases. It is widely used to identify subpleural lesions. computed tomography, while fluorography and radiography are not completely in effective ways determining the patient's condition. They are located under the pleura, their location is characteristic of tuberculosis and cancer. Only this diagnostic method allows you to correctly determine the disease that has arisen.
Focal changes are caused not only by diseases that are easily treatable (pneumonia), but sometimes by more serious pathologies - tuberculosis, malignant or benign in nature. Modern methods diagnostics will help to detect them in a timely manner and prescribe correct and safe therapy.
IN everyday life a person repeatedly encounters the causative agent of pulmonary tuberculosis without even noticing it. This is confirmed by “accidental” findings during annual routine fluorography, which represent Gon’s lesions. How they are formed and whether they pose a danger to the body will be discussed in this article.
Ghon lesions in the lungs are the result of primary human infection with Mycobacterium tuberculosis. The duration of its formation is on average up to 3 years. Ghon's lesion is an oval formation, sometimes with uneven radiant contours. Its structure is represented by connective tissue, collagen fibers, and calcium deposits. Dimensions can reach 2 cm.
Mycobacterium tuberculosis (MBT), penetrating into lung tissue, causes local inflammation of its tissue. Due to the damaging effects of the microorganism on the epithelium of the respiratory tract, the affected areas increase in size. The result of such processes is tissue necrosis - caseous necrosis. When a secondary infection is added to it, pneumonia develops.
The consequence of such an aggressive effect of MBT on lung tissue is the activation immune system and the body's response. It is expressed by delimiting damage from surrounding structures by certain cells that fight inflammation - lymphocytes. Subsequently, specific granulomas are formed from these areas, in the center of which there is an area of caseous necrosis.
If at this stage the disease is not detected, then the tuberculous tubercles merge with each other, the lymph nodes are affected lung root. Inflammation can spread to the nearby pleura.
This is how the primary tuberculosis complex is formed, which includes:
Further development of the complex can follow 3 paths:
The healing of specific granulomas is associated with their resorption and the processes of proliferation of cells from various tissues. This is expressed in several processes:
Most frequent path formation of a Ghon lesion in the lung – fibrous transformation. The essence of this mechanism is the germination of the granuloma with connective tissue and the subsequent formation of a scar. Perifocal inflammation gradually passes.
The transformation proceeds from the edges of the capsule to the center, fragmenting the tuberculous tubercles. In such cases, intermediate forms of MBT are detected, which plays an important role in the recurrence of infection. After complete calcification of the lesions, the pathogen is not released.
The healing process of the primary tuberculosis complex with the formation of a Ghon lesion is characterized by a long duration. As a rule, it is not affected timely diagnosis and adequate chemotherapy.
Ghon's lesions in the lungs rarely manifest themselves clinically. During its formation, a person may experience:
More severe symptoms observed in children. This is due to the imperfection of the immune response, which is manifested in the appearance of primary tuberculosis complexes and their simultaneous transition to the active process and focus of Gon. Therefore, most often such formations are diagnosed in a timely manner in young patients.
Gon's lesion cannot be identified during a general examination and laboratory research. The only methods that allow it to be diagnosed are x-rays.
These include:
At X-ray studies Ghohn's lesion is a darkening of an oval (less often round) shape with sharp outlines, measuring up to 5 mm. Formations can be single or multiple. Their favorite localization is the lower and middle sections of the lungs. Sometimes the contours of the lesion may be uneven. The pulmonary pattern is unchanged, the root is not expanded.
On different stages Petrification (calcification) of the Gon lesion changes, its structure can be:
Identifying a Gon's lesion on X-ray images is not difficult. However, due to the lack clinical manifestations, is often discovered by chance.
When performing a CT or MRI, you can get a more informative picture.
As a result of such studies, residual phenomena of perifocal inflammation, caseous masses, changes in lymph nodes. Such examinations are prescribed if a relapse of tuberculosis is suspected in the case of a completely unformed focus of Gon.
Complications after identifying this pathology are very rare. At large quantities Gon foci, large in size (for example, after disseminated tuberculosis), the following may develop:
Such conditions lead to disruption of the normal functioning of the lungs, which is accompanied by the development of respiratory failure.
The identified pathology does not require any specific therapy. The doctor can give general recommendations:
For people with a Gon lesion identified in the lungs, annual X-ray examinations to assess the dynamics of the process. It is advisable to undergo such examinations in the same place with one doctor. The focus of Gon is not a death sentence and is not a sign of developing tuberculosis. It only indicates that the infection has been defeated by the body.
