Indawo yokuphupha imiphunga yindawo engummango kwinqanaba eliphambili lompompo ngamnye, elikwempembelelo (emaphakathi) yompompo ngamnye. I-hilum yilapho i- bronchi , i-arrium, i-veins, kunye neentsholongena zingena kwaye ziphuma emaphaphu.
I-Anatomy ye-Hilum
Bobabini i-right and left-lung lung ne-hilum elala ngapha nangapha emiphakeni, kunye nxamnye ne-back (kufuphi ne-vertebrae kune-front of the chest).
Umpompo ngamnye ungabonwa njenge-pepe (phezulu) isiseko (ngasezantsi) ingcambu kunye ne-hilus.
I-bronchi enkulu, imithambo ye-pulmonary, i-pulmonary veins, kunye neentsholongwane zizakhiwo ezingenayo kwaye ziphume emiphumeni kule ndawo. I-lymph nodes , ezibizwa ngokuba yi-hilar lymph nodes, zikhoyo kule ndawo. Bobabini i-hilum zifana nobukhulu, kunye ne-hilum eseleyo ifunyanwa ngokuthe ngqo phezulu esifubeni kune-hilum efanelekileyo.
Ukucinga
Kwi-x-ray yesifuba, ummandla we-hilar ubonisa isithunzi esiqulethe ukudibanisa i-lymph nodes, imithambo yamapulmonary, kunye nemivilini ye-pulmonary. Ngenxa yokugqithwa kwezi zakhiwo, ngamanye amaxesha kunzima ukufumanisa ukwandiswa kwezi zine-lymph nodes okanye ubukhulu bendawo kule ndawo. Esi sizathu sezizathu zokuba i- x-rays eziqhelekileyo zikwazi ukuphelelwa ngumdlavuza wamaphaphu .
Ukujonga iimvavanyo ezifana ne-CT scans (ngokukodwa ngokuchaseneyo) kunokukhokelela ekubonakalisweni okungcono kwezi zakhiwo.
Ngamanye amaxesha, uvavanyo oluqhubekayo olunjenge- PET scan , i- bronchoscopy kunye ne- endobronchial ultrasound , okanye i- mediastinoscopy ingadinga ukujonga kakuhle indawo okanye ukufumana isampuli ye-biopsy.
Ukungavumelekanga
Lo mmandla wendima yomphunga unokuchaphazeleka ngamathumba kwindawo (kubandakanye izicathulo eziphambili kunye neengxube zethemastra), ukwandiswa kwee-lymph nodes ze-hilar, kunye nokungaqhelekanga kwemipuphu ye-pulmonary or veins.
I-Hilar Ukukhulisa / i-Hilar Masses
Kukho izizathu ezine eziphambili zokuba i-hilum enye okanye zombini imiphunga ibonakala ikhuliswe kwi-x-ray. Ezi ziquka:
- Izidumbu kunye ne-lymphadenopathy. Amagciwane anesifo somhlaza wamaphaphu kunye ne-lymphomas, kunye nomhlaza osasazeka kulo mmandla ukusuka kwezinye iindawo zomzimba (umhlaza wesifo se-metastatic) ungabangela abantu abaninzi kule ndawo. Izizathu ezinokuthi zandiswe i-hilar lymph nodes (i-lymphadenopathy) zixutyushwa ngezantsi.
- I-pulmonary venous hypertension (uxinzelelo oluphezulu kwiimvumba zepulmoni). I-pulmonary venous blood pressure ingenzeka ngenxa yeemeko zonyango ezifana nokungaphumeleli kwentliziyo kunye neengxaki ze-valve ezinjenge-mitral stenosis kunye nokubuyiswa kwe-mitral.
- I-pulmonary blood pressure (PAH), uxinzelelo oluphezulu kwimithambo ye-pulmonary. I-PAH iyakwenzeka njengesifo esisisiseko (kungekusekondari kwenye ingxaki) okanye njengengxaki yesibini leyo eyona nto ibangelwa yi - STOP.
- Ukwanda kwegazi lompompo. Imiqathango enjenge-cyanotic isifo senhliziyo esisifo (intliziyo yesifo esikuyo ekuzalweni okubangela i-blue tinge kwesikhumba ngenxa yokunciphisa umthamo we-oksijeni) kunokubangela ukwanda kwegazi lokuphuma kwegazi.
UHilar Lymphadenopathy (Ukwandiswa kweHilar Lymph Nodes)
I-lymph nodes ekhulisiwe kwi-hilum inokuvela kwi-hilum efanelekileyo kunye nekhohlo (i-lymphadenopathy ephakathi) okanye kwicala elilodwa (i-lymphadenopathy.) Izizathu zingabandakanya:
- Umhlaza wemiphunga. Umdlavuza womlenze yimbangela eqhelekileyo yokungalingani kwemimandla yesikhokelo kubantu abadala, zombini ngenxa yobunzima be-tumor kunye nobukho be-lymph nodes.
- Amanye amachiza. Umdlavuza webele we-Metastatic ungakhokelela kwi-hilar lymphadenopathy ngenxa yokusasazeka komhlaza kulo mmandla kwaye ngenxa ye-lymph nodes. I-lymphoma kunye nezinye izicubu zomzimba zingakhokelela ekuveliseni i-hilar lymph nodes.
- Isifo sofuba. Ehlabathini lonke, isifo sofuba sisona sizathu esiqhelekileyo se-hilar adenopathy kubantwana.
- Ukuvutha. Imiqathango efana ne-sarcoidosis, i- amyloidosis , ne-silicosis ingabangela i-hilar lymphadenopathy. I-Sarcoidosis iyona nto ibangela kakhulu ukukhulisa i-lymph node yamazwe ngamazwe, ngakumbi kubantu abadala. Ukwandiswa kwe-lymph node kunye ne-sarcoidosis ngokuqhelekileyo iyingqamaniso ngokuphambene nezinye izizathu eziqhelekileyo. Ukuphendula kwezidakamizwa kubangelwa yinto eqhelekileyo ye-hilar adenopathy.
- Ezinye izifo. Izifo ezifana ne-mycobacteria, iintsholongwane zentsholongwane ezifana ne-infectous mononucleosis, i-berylliosis, i-tularemia, i-histoplasmosis kunye ne-coccidiomycosis inokubangela ukuba kubekho i-lymph nodes kule ndawo. EUnited States, i-histoplasmosis iyaqheleka kwi-Ohio ne-Mississippi River Valleys, kunye ne-coccidiomycosis eqhelekileyo kwiindawo ezisemzantsi-ntshona.
- Ezinye izizathu. Isifo sikaS Castleman sisimo esichazwe yi-lymph tissue engavamile. Ukungaphumeleli kwintliziyo kunokukhokelela ekuhlaleni kwe-hilar adenopathy.
Okukwintsusa
Kukho inani leemeko ezinokubangela ukubonakala okungavumelekanga kwe-hilum kwizifundo zengcamango, ezininzi zazo ezinzulu. Isinyathelo sokuqala, nangona kunjalo, kukuqinisekisa ukuba nayiphi na ifunyaniso ayifumanekanga ngenxa yokungcoliswa komzimba xa uthatha le ifilimu. Ngenani lezakhiwo ezidlula kule ndawo, nokuba ujikelezo olunobungqina lunokubangela ukubonakala okungaqhelekanga xa kungekho mntu ukhona.
Izibilini, zombini eziprayimari kunye nemetastatic, ziyimpembelelo ebonakalayo kakhulu yezibini zomntu kunye ne-lymphadenopathy. Izizathu eziqhelekileyo ziquka jikelele isifo sofuba emhlabeni wonke, kunye neemeko ezifana ne-histoplasmosis, coccidiomycosis, kunye ne-sarcoidosis e-United States.
Ukuba ugqirha wakho ubhala into engavumelekanga kwiimviwo zakho, uvavanyo olongezelelweyo luya kuboniswa. Uya kuphinda abuze umlando oqapheleyo ukukhangela nayiphi na impawu ebonisa ukuxhamla, isifo, okanye ukuvutha. Ininzi yexesha i-biopsy iya kufuneka ukuze ifumane ukuxilongwa ngokucacileyo.
Umzekelo: UJohn watshelwa ukuba umhlaza osekunene umphunga wawusasazelele kwii-lymph nodes zakhe, i-lymph nodes kufuphi nommandla apho i-bronchi ingena emaphaphu.
> Imithombo:
> Nin, C, de Souza, V., yenza Amaral, R. et al. I-Lracphadenopathy eTraign Izifo: I-State of Art Art Review. Amachiza okuphefumula . 2016. 112: 10-7.
> Sarkar, S., Jash, D., Maji, A., kunye no-P. Anupam. Indlela yokungalingani kwe-hilum kwi-X-ray esifubeni. I-Journal of Association of Physicians Chest . 2013. 1 (2): 32-37.