3.9.1 Radiographic picture of a primary tubercular complex


The classical primary complex consists of three basic components: pulmonic, lymphadenitis and lymphangitis connecting them. However a phase of infiltration passes before bipolarity becomes distinct on anterio-posterior radiograph. An infiltration represents rather intensive opacity connected to a lung root, sometimes it is deposited on the lung root. As a rule, infiltration is not homogeneous. It’s borders are dim. The vessels and bronchi appear through infiltration. The sizes of infiltrations are various and depend on a degree of lung’s damage; they can be lobar, segmental and bronchopulmonary. The primary complex is located in the top and middle lung segments more often. At dissolving the sub-pleural localization of infiltration more distinctly is visible.

The primary complex has four stages of development:

I a stage – pneumonic. On X-ray general view three components of a complex are visible:

  1. the focus in lung tissue by the size 2-4 cm. in diameter or more, of oval or irregular form, various intensity (more often – average and even high), with an indistinct, obscure contour;
  2. the flow out to a root – lymphangitis, which is defined as linear tension bars from focus to the root;
  3. in a root – enlarged infiltrated lymphatic nodes. The root is represented to be extended, it’s structure) is blurry, the intensity is increased. The contours outlining lymphatic nodes, or are dim, or more precisely depict the increased nodes.

II stage – resorption. The size of the focus in lung tissue decreases, its intensity raises, the contours become precise. The flow out to a root and infiltration of lymphatic nodes decreases.

III a stage – condensation. On a place of focus area remains with the size up to 1 cm, inside of it inclusions of calcinations appear as fine spots of sharp intensity. Same spots of calcinations are noticeable and in lymphatic nodes of the lung root. Thin tension bars are determined between the focus and the root.

IV a stage – calcinations. The focus in lung tissue becomes even smaller, more densely, of high intensity, with distinct contour, frequently rugged and rough. Calcinations are intensified also in root lymphatic nodes. Calcinations in certain cases are represented by solid, dense formations, in others – they have less intensive shadows of inclusions, which testify about incomplete cacifications of the focus and preservation of caseation regions in it.

When primary complex is revealed in time and the patient receives valuable treatment, frequently could be achieved complete dissolution of pathological changes in lung tissue and root, with complete restoration of their initial structure. The greatest difficulties arise at diagnosing tubercular intoxication and small forms of lymphatic nodes tuberculosis. At absence on chest x-ray obvious pathological signs of lymphatic nodes high profile is given computer tomography, allowing to visualize insignificantly increased lymphatic nodes and deposits of calcium salts. At the minor forms of lymphatic nodes tuberculosis rontgenologic diagnosis is based on revealing of deformation and enrichment of central lung structure as reflections of stagnant lympangitis, infringement of structure of the root and obscure contours.

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