Chimake cha mapapo ndi malo omwe ali pakati pa mapapu, omwe ali pamkatikati mwa mapapo. Chipinda chotchedwa bronchi , mitsempha, mitsempha, ndi mitsempha imalowa ndi kuchoka m'mapapo.
Anatomy ya Hilum
Mapapu onse abwino ndi omanzere amakhala ndi kanyumba kamene kali pafupi pakati pamapapo, ndipo kumbuyo kumbuyo (pafupi ndi ma vertebrae kusiyana ndi kutsogolo kwa chifuwa).
Mapapu onse akhoza kuwonetsedwa ngati ali ndi mutu (pamwamba) maziko (pansi) muzu ndi hilus.
Mankhwala akuluakulu a bronchi, mitsempha ya pulmonary, mitsempha ya mitsempha, ndi mitsempha ndizomwe zimalowa ndi kutuluka m'mapapu m'dera lino. Zilonda zamatenda , zomwe zimatchedwa hilar lymph nodes, zimapezeka kumadera amenewa. Zitsulo zonsezi zimakhala zofanana, ndipo mbali ya kumanzere imakhala yowonjezereka kwambiri m'chifuwa kusiyana ndi hilum yolondola.
Kujambula
Pa chifuwa cha x-ray, dera lamapiri likuwulula mthunzi umene umaphatikizapo kuphatikiza ma lymph nodes, mitsempha ya pulmonary, ndi mitsempha ya pulmonary. Chifukwa cha kugwirana kwa nyumbazi, nthawi zina zimakhala zovuta kuzindikira kuwonjezeka kwa maselo amtunduwu kapena kupezeka kwa misa m'dera lino. Ichi ndi chimodzi mwa zifukwa zomwe chifuwa chachikulu chimatha kupweteka khansa yamapapo .
Mayesero ojambula ngati CT opima (makamaka mosiyanitsa) angapangitse kuwoneka bwino kwa nyumbazi.
Nthawi zina, kuyesedwa kwina monga PET kanthana , bronchoscopy ndi endobronchial ultrasound , kapena mediastinoscopy mungafunike kuti muwone bwino dera lanu kapena kupeza chitsanzo cha biopsy.
Zovuta
Dera lamapiri la mapapoli likhoza kukhala ndi zotupa m'deralo (kuphatikizapo zotupa zoyambirira ndi zotupa zam'mimba), kutambasula kwa mitsempha ya ma hila, komanso kuwonongeka kwa mitsempha ya mitsempha kapena mitsempha.
Kukula kwa Hilar / Misala ya Hilar
Pali zifukwa zinayi zomwe zimapangitsa kuti phokoso lamodzi kapena mapapo awiri liwonekere pa x-ray. Izi zikuphatikizapo:
- Matenda ndi mimba. Khansa monga khansa ya m'mapapo ndi malimphini, komanso khansara yomwe yafalikira kudera lino kuchokera kumbali zina za thupi (khansara ya mthupi) ingayambitse anthu ambiri m'dera lino. Zomwe zingayambitse mitsempha yamakono yowonjezera (lymphadenopathy) ikufotokozedwa pansipa.
- Zozizira zam'mimba zowopsa kwambiri (zovuta kwambiri m'mitsempha ya pulmonary). Matenda othamanga kwambiri amayamba chifukwa cha matenda monga mtima wosalimba ndi mavuto a mtima monga valve mitral stenosis ndi mitration.
- Kupanga mankhwala oopsa (PAH), kuthamanga kwa mitsempha ya pulmonary. PAH ingawoneke ngati matenda oyambirira (osati achiwiri kuwonjezera pa vuto lina) kapena ngati vuto lachiwiri lomwe limayambitsidwa kawirikawiri ndi matenda osokoneza bongo (COPD).
- Kuwonjezera magazi a pulmonary. Zinthu monga cyanotic matenda okhudza ubongo wa mtima (kubadwa kwa mtima pakabereka komwe kumayambitsa khungu la buluu ku khungu chifukwa cha mpweya wotsikira) kungachititse kuti magazi ayambe kutuluka.
Hilar Lymphadenopathy (Wowonjezera Hilar Lymph Nodes)
Zilonda zamakono zowonjezereka m'zinyumbazi zikhoza kuchitika kumbali yowongoka komanso ya kumanzere (lymphadenopathy) kapena mbali yokhayo (yosavomerezeka ya lymphadenopathy.) Zifukwa zingaphatikizepo:
- Matenda a khansa. Matenda a khansa ndi amodzi omwe amachititsa kuti anthu ambiri asamakhale ndi mitsempha yosawerengeka , chifukwa chokhala ndi chotupa komanso kukhalapo kwa mitsempha yambiri.
- Ma khansa ena. Kansera yamatenda ya m'matenda imatha kuyambitsa hila lymphadenopathy chifukwa cha kufalikira kwa khansa ku dera lino komanso chifukwa cha maselo a mitsempha. Lymphoma ndi zotupa zina zamkati zimapangitsanso mitsempha yowonjezera mazira.
- Chifuwa chachikulu. Padziko lonse, chifuwa chachikulu cha TB chimayambitsa matenda a hilar ana.
- Kutupa. Zinthu monga sarcoidosis, amyloidosis , ndi silicosis zingachititse hila kupatsirana m'mimba. Sarcoidosis ndiyo njira yowonjezera yowonjezera kwa maiko ena awiri, makamaka achinyamata. Kukulitsa kwa minofu ya hila ndi sarcoidosis nthawi zambiri kumakhala kosiyana kwambiri ndi zifukwa zina zomwe zimayambitsa. Kugwiritsa ntchito mankhwala osokoneza bongo ndi chifukwa chofala cha hila adenopathy.
- Matenda ena. Matenda monga mycobacteria, matenda opatsirana monga matenda opatsirana mononucleosis, berylliosis, tularemia, histoplasmosis, ndi coccidiomycosis angapangitse mitsempha yowonjezereka m'dera lino. Ku United States, hertoplasmosis ndi yowonongeka m'mapiri a Mtsinje wa Ohio ndi Mississippi, ndipo amakhala ndi chiwerengero cha coccidiomycosis chomwe chili chofala kwambiri kum'mwera chakumadzulo.
- Zifukwa zina. Matenda a Castleman ndi matenda omwe amachititsa kuti thupi likhale lopweteka kwambiri. Kulephera kwa mtima kungapangitsenso kuti munthu asatengeke.
Pansi
Pali zifukwa zingapo zomwe zingayambitse maonekedwe osadziwika a masewero a masewero, ambiri mwa iwo ndi ofunika kwambiri. Njira yoyamba, komabe, ndikuonetsetsa kuti zopeza zilizonse sizikuchitika chifukwa cha kuwonongeka kwa thupi pamene mutenga mafilimu awa. Ndi chiwerengero cha nyumba zomwe zimadutsa kudera lino, ngakhale kutembenuka mofatsa kungawonongeke ngati palibe alipo.
Ziphuphu, zonse zoyambirira ndi zamthambo, ndizofala kwambiri chifukwa cha masewera onse a hila ndi ma lymphadenopathy. Zomwe zimayambitsa zonsezi zimaphatikizapo chifuwa chachikulu cha TB, padziko lonse lapansi, komanso zinthu monga histoplasmosis, coccidiomycosis, ndi sarcoidosis ku United States.
Ngati adokotala akulemba zosawerengeka pa mayeso anu, kuyesetseratu kuyesetseranso. Afunsanso mbiri yabwino kuti ayang'ane zizindikiro zina zomwe zimapangitsa kuti pakhale vutoli, matenda, kapena kutupa. Nthaŵi zambiri chiwerengero cha biopsy chidzafunika kuti mupeze chitsimikizo chotsimikizira.
Chitsanzo: John adamuwuza kuti kansa yomwe ili m'mapapo ake abwino imafalikira kumatenda ake am'mimba, omwe ali pafupi ndi malo omwe bronchi amapita m'mapapo.
> Zotsatira:
> Nin, C, de Souza, V., do Amaral, R. et al. Thoracic Lymphadenopathy mu Benign Matenda: State of the Art Review. Mankhwala Opuma . 2016. 112: 10-7.
> Sarkar, S., Jash, D., Maji, A., ndi P. Anupam. Njira yosayerekezera chifuwa pa chifuwa cha X-ray. Journal of Association of Chest Physicians . 2013. 1 (2): 32-37.