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Mardiyeva Gulshod Mamatmurodovna, candidate of medical science, associate professor, Head of the Department of Radiation Diagnostics and Therapy Samarkand State Medical Institute E-mail: gulshod_1965@rambler.ru Narzikulov Shojakhon Farhodovich, resident of magistracy, radiation diagnosis and therapy Samarkand State Medical Institute E-mail: shohjahon.narzikulov@mail.ru Babayarov Akmal Saidkulovich, resident of magistracy, radiation diagnosis and therapy Samarkand State Medical Institute E-mail: babayarovakmal.@mail.ru Yanova Elvira Umarjonovna, assistant of the department of radiation diagnostics and Therapy
Samarkand State Medical Institute E-mail: kollibri8889 @gmail.com Fayzieva Dilorom Amonillaevna, assistant of the department of radiation diagnostics and therapy
Samarkand State Medical Institute
PECULIARITIES OF X-RAY SEMIOTICS IN EARLY AGE CHILDREN WITH PNEUMONIA
Abstract: The features of radiological semiotics of pneumonia were studied depending on the period of gestation at birth. In children born prematurely with pneumonia, radiographic signs characteristic of the continuing immaturity of the lung tissue are revealed. Characteristic for prematurity, low-intensity foci against the background of immature lung and relatively poor, and slow dynamics of inverse changes confirms the view that the risk of developing chronic pulmonary pathology prevails precisely when there is a history ofprematurity and a clear correlation of inflammatory changes in the lungs with perinatal pathology and lung maturity and the body as a whole. Keywords: pneumonia, immaturity, term of gestation, early age, radiography.
Diseases of the respiratory system are widespread among the child population and have a large proportion in the structure of the incidence, especially is the first 3 years of life. A common form of respiratory organs failure in children in all age groups is pneumonia.
Guided by the opinion [3; 6] of continuing signs of immaturity in premature babies and up to 3-4 years of age, the opportunity was used to investigate the presence of these signs in pneumonia in young children, depending on the gestational age. Acute pneumonia in children has clinical and morphological features due to the immaturity of the lung tissue and the response of local immunity [1]. The diagnosis of pneumonia is considered verified only in cases where the focal inflammatory lesion of the lungs is confirmed radiographically [2].
The purpose of the study is to study the features of radiological semiotics in pneumonia in young children, depending on the period of gestation at birth.
Material and research methods. A clinical X-ray examination of 110 young children with pneumonia was performed. Survey radiography of the chest was carried out in a straight line and, if necessary, in lateral projections, in an upright position, with maximum inspiration or at the height of a crying child to improve the contrast of the pulmonary fields with gonad screening. X-ray examination was performed on the apparatus of the brand KH0 50F - "Toshiba" (Japan). During chest radiography in children we adhered to the following technical specifications: voltage of 50-55 kV, current of 100-150 mA, exposure time 0.03-0.1 seconds. The effective equivalent dose (conditional dose of uniform irradiation of the whole body) per 1 image was 0.02-0.04 mSv, in accordance with the Radiation Safety Standards.
Depending on the age and duration of gestation at birth, the children surveyed comprised the following groups:
Section 2. Medical science
Ax - children aged 1 month to 1 year, from full-term history (42);
A2 - children aged 1 month to 1 year, from the history of preterm (36);
B1 - children aged 1 to 3 years, from the history of full-term (15);
B2 - children aged 1 to 3 years, from the history of preterm (17).
The results of the study and their discussion. The features of radiological semiotics of pneumonia were studied depending on the period of gestation at birth. Analysis of radiological manifestations and comparison of changes in acute pneumonia in children aged 1 month to 1 year, as well as in children from 1 year to 3 years of age showed that satisfactory parameters of pulmonary ventilation were better manifested in groups of children born full-term (groups Ax and B2). At the same time, in children with prematurity in history (groups Ax and B2), hypoventilation of the lungs (78% and 65%, respectively), including the frosted glass symptom, was dominant.
As for such a reliable radiological symptom of pneumonia, as shadowing, it is revealed that in all groups, limited shadowing dominated on radiographs (79%, 72%, 80%, 65%), i.e. the shadows, the area of which corresponded to a part of the lobe or segments of lungs. According to the structure, shadows usually had a heterogeneous character (79%, 69%, 80%, 76% respectively), more often with indistinct shadows (98%, 97%, 80%, 71%). Shadowing of the homogeneous structure was revealed less frequently. On radiographs for pneumonia between the ages of 1 and 3 years, along with shadowing, having weak intensity and indistinct contours, we also observed shadows of medium intensity (67%, 41%) with relatively sharp contours (20%, 29%), especially prevalent in term babies. This X-ray manifestation of some consolidation of the pulmonary parenchyma is most likely due to a tendency to chronic inflammation in these groups of children. Identification in isolated cases of the indicated symptoms in the group of full-term children may be explained by the severity of the patient's condition due to premorbid background (hypotrophy, rickets, exudative-catarrhal diathesis).
In parallel to the limited shadowing of a certain part of the examined children (10%, 39%, 20%, 12%), in the medial zones of the lung fields, single scattered the small-focal shadows, which also had indistinct contours, were often visualized. The common multiple small focal shadows were more often visualized on radiographs in children with prematurity in history. So, in children of group A2, they were revealed in 61% of cases, and in group B2, in 41% of cases. In children from 1 year to 3 years, from the history of full-term, this picture was not typical. It should be noted that focal shadows very often tended to merge, forming foci of shadowing.
Shadowing of the lung fields are often combined with areas of limited compensatory swelling of the adjacent sections of the lungs. Individual bullous swellings were noted with almost the same frequency in all studied groups of patients (40%, 39%, 47% and 47%).
Analysis of the x-ray morphological picture of the pulmonary pattern in all the examined groups revealed the prevalence of the characteristic symptom of the inflammatory process as an increase in the pulmonary pattern (100%, 75%, 67%, 88%). The pulmonary pattern along the lungs on both sides was enhanced due to swelling of the fibrous stroma along the vessels. In limited areas, reticulation was determined due to edema of the reticular stroma. The degree of detectability of such radiological signs of pulmonary immaturity, such as the limited reticular deformity of the pulmonary pattern and the symptom of "air bronchogram", was more common in children with a history of prematurity. Thus, the change in the pulmonary pattern of the net type dominated in the A2 and B2 groups (92% and 88%), as opposed to the Ax and Bx groups (38% and 47%). There was often a more homogeneous lesion of the lungs with multiple clear lace-like dense foci leading to the periphery.
The symptom of "air bronchogram" prevailed in children aged 1 to 3 years (80% and 71%) than in children aged 1 month to 1 year (24% and 50%), which most likely explains certain chronic character of inflammation in the airways. The resistance of the X-ray picture of the lungs is noted in the form of alternating areas of low transparency of the lung tissue, more often the middle-medial sections, of coarse interstitial pattern (fibrosis) and hyperaerial areas. The impoverishment of the pulmonary pattern in minor cases was visualized in a group of children with prematurity in history (8% and 12%) and was not typical of full-term babies.
Attention was drawn to a significant increase in the roots on both sides, revealed in all the examined groups of children. If the focal shadows were located in segments, the proj ection of which coincided with the root and root zone, the structure of the root changed dramatically. Additional shadow in the root zone due to involvement in the process of interstitial tissue very often created a picture of the expansion of the root zone.
In general, it can be noted that in children with pneumonia born prematurely, radiographic signs characteristic of the continuing immaturity of the lung tissue are revealed, namely, moderate pulmonary hypoventilation, common small-focal shadows, limited net deformity of the pulmonary pattern and the symptom of "air bronchogram". Moreover, at the age of 1 year to 3 years, the above symptoms are somewhat less marked, which is consistent with the available information about the response from the interstitial tissue in age dynamics [7].
The generalization of the results showed that in the older groups of children the pneumonic process proceeds less rapidly and captures a smaller area of the lungs, that is most likely, associated with the maturation of lung tissue. Characteristic for prematurity, low-intensity foci against the background of immature lung and relatively poor, and slow dynamics of inverse changes confirms the view that the risk of developing chronic pulmonary pathology prevails precisely when there is a history of prematurity and a clear correlation of inflammatory changes in the lungs with perinatal pathology and lung maturity and the body as a whole.
We would like to note that the above symptoms (intensification and deformation of the pulmonary pattern, reduced transparency of the pulmonary fields of the frosted glass type, small focal shadows), in their turn, are radiographic signs of the early stages, the so-called interstitial lung diseases, which have recently attracted attention of not only clinicians, but also radiologists, morphologists due to the increasing prevalence [4; 5; 7]. As the process progresses, some of the observed children show signs of interstitial fibrosis, appearance of cavities,
and a picture of the cellular lung is formed. Such information gives us the reason to assume that presence of such signs in children born premature does not exclude the probability of an age predisposition to interstitial lung diseases. This is consistent with the emphasis that in the general children's population there is a fundamentally separate age group - newborns and infants and it is in this group that there are interstitial lung diseases that have no equivalents in older children and adults, but are probably related to lung function in the next years of life [8].
Conclusions. Long-persisting signs of immaturity of the lung tissue in children born prematurely leave an imprint on the process of the further development of respiratory tract diseases in young children and do not exclude the probability of an age predisposition to interstitial lung diseases. X-ray examination for presence of continuing signs of immaturity in premature babies and up to 3-4 years of age for pneumonia, having a wide range of indicators, rich in morphological information, will contribute to the timely correction of complex treatment.
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