Edema of the diaphragm

Acute edema of the lungs in children is a serious complication,the cause of which can be acute inflammatory processes of viral and bacterial origin or caused by their associations, severe burn injury, toxicosis of various origin.

At the heart of the development of pulmonary edema liehemodynamic disorders including microcirculatory disorders. Changes in hemodynamics, increased porosity of the vascular wall cause the sweat of the liquid part of the blood into the alveolar and interstitial tissue. No less importance in this process is attached to the defeat of the surfactant [Esipova IK 1976].

Clinical manifestations of a beginning edema are notare always expressed because of the symptoms of the underlying disease, but the signs of increasing dyspnoea, cyanosis, coughing, increasing crepitating wet wheezing, and sometimes the appearance of foamy sputum, are characteristic of edema and should serve as an indication for immediate X-ray examination. With a rapid increase in symptoms that threaten the life of the child, it is necessary to immediately update the diagnosis.

Radiographic display of pulmonary edema maybe different depending not only on the child's age, but also on the phase of edema. In children up to the age of 1 due to tissue immaturity, including the presence of an airgel barrier, the first signs of edema appear in the form of small (I-2 mm) focal shadows of medium and low intensity localized mainly in the central regions and in the basal zones of the lungs. Their pathomorphological substrate is lobules filled with transudate, ie this phase of edema corresponds to an acinozo-lobular edema and is detected in the absence of massive inflammatory infiltration in the lungs. It should be noted that radiological signs of edema may appear earlier than clinical symptoms and be eliminated later, after their disappearance.

Simultaneously with the appearance of focal shadowschanges in the structure of vascular shadows; they become broad and indistinct, which indicates the appearance of edema in the interstitial tissue (Figure 113). If the swelling does not increase, the number of focal shadows decreases from the periphery to the center. With the growth of edema, large, uniform in density shadows appear, localized mainly in the basal zones. Symmetrically located areas of such edema are compared with butterfly wings (Figure 114). At the same time, symmetry is broken when the child's position changes. When tested in lateroposition, a more intense shade of edema is detected in the underlying lung (Figure 115).

In the terminal phase, edema is spreadinguniformly in both lungs, giving them the appearance of frosted glass; all structures of the lungs cease to be traced, including the contours of the median shadow and diaphragm (Figure 116). With a rapid increase in diffuse edema and ineffectiveness of the treatment measures, a fatal outcome usually occurs. In young children in the initial period of edema, when the transudate fills the alveoli and a small foci appears, accompanied by a change in the vascular pattern caused by perivascular edema, the changes should be differentiated from the viral lesion of bronchopulmonary structures complicated by focal bacterial pneumonia.

Equal focal shadows, symmetrytheir location is predominantly in the medial parts of the lungs, characterized by edema, with perivascular changes occurring simultaneously with alveolar edema, while viral lesions begin with changes in the vascular pattern, and focal shadows, different in magnitude, first appear within one or two segments.

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