Peribronchial cancer is characterized by a muft-like growth along the walls of the bronchus, for a long time without leading to a significant narrowing of its lumen. Radiodiagnosis of peribronchial cancer is most difficult, since its skiogical manifestations are very scarce. They can be limited for a considerable time only by strengthening the pulmonary pattern in the root zone. Subsequently, these changes become more pronounced and take the form of rough, heavy shadows, fan-shaped diverging from the root of the lung into the depth of the lung tissue. with a tomographic study, thickening of the walls of the bronchi and an extended uneven narrowing of their gaps may be noted. More clearly, this leading symptom of peribronchial cancer is determined bronchographically.
When identifying three separate forms of central cancer, it must be borne in mind that in most cases, especially in the advanced stages of the disease, the tumor process is mixed. A typical x-ray picture is characterized by the presence of a tumor in the root, signs of impaired bronchial patency and an increase in bronchopulmonary and various groups of mediastinal lymph nodes.
In a CT scan, central lung cancer is manifested by the same classic X-ray symptoms: narrowing of the lumen of the affected bronchus, thickening of its walls, the presence of a pathological formation in the lumen of the bronchus or out of it. But all of them are detected much earlier and more reliably than with linear tomography. Due to the ability to quantify the densitometric density of lung tissue, CT has an extremely high sensitivity in detecting the most minor changes in its pneumatization due to impaired bronchial patency.
Peripheral lung cancer arises from the epithelium of the small bronchi and grows in the lung tissue in the form of a node. Its value can be very different and therefore this
the indicator has no significant diagnostic value. An incomparably greater role is played by the fact of a rapid increase in the size of education. For peripheral cancer, the volume doubling time is on average 110 days. In this regard, retrospective analysis of previous x-rays or flurograms is of crucial importance in the diagnosis of peripheral cancer. However, the wait-and-see tactics of dynamic observation in cases of suspected malignant nature of the process should now be considered completely unacceptable.
Radiographically, peripheral cancer is usually displayed with a round shadow. Its contours, as a rule, are uneven, wavy, polycyclic. An important sign of malignancy is the presence along the contour of the shadow of the recess, the so-called “Riegler’s notch”, located in the area of entry of the bronchus and vessel into the tumor. Even more significant is the symptom of fuzzy, radiant contours, which is due to the lymphogenous spread of the tumor along the interlobular and intacinar septa. The heterogeneity of the shadow is also characteristic, which is a reflection of the multicentric growth of peripheral cancer, which consists, as it were, of several nodes merging with each other. Often, destruction cavities are determined in the thickness of the tumor. Their sizes can be different, and the shape is often irregular, the inner contours of the bumps. The thickness of the walls of the cancerous cavity is uneven, the largest, as a rule, in the area of the draining bronchus. In the surrounding peripheral lung cancer, the so-called “pathway” to the root of the lung is sometimes detected due to lymphangitis and peribronchial, perivascular spread of the tumor. With the location of the tumor in the cloak layer of the lung, such a “path” can be directed to the bony pleura. It occurs in connection with lymphostasis in tumor-blocked lymphatic vessels.
Bronchography in the diagnosis of peripheral cancer does not have independent significance.
In diagnostically unclear cases, CT should be preferred, which is much more informative than conventional tomography in identifying all symptoms of peripheral cancer. Morphological verification of the diagnosis is possible by transthoracic or transbronchial catheterization biopsy.