I-hilum yamaphaphu yindawo engumkhawulo oyingxenye eyinhloko yamaphaphu ngalinye, esesithombeni esiphakathi (esiphakathi) samaphaphu ngamunye. I-hilum yilapho i- bronchi , i-arteries, i-veins, ne-neriber ingena futhi iphuma emaphashini.
I-Anatomy ye-Hilum
Kokubili amaphaphu angakwesokudla nesobunxele ane-hilum ephakathi cishe emaphakathi emaphashini, futhi kancane emuva emuva (eduze kwe-vertebrae kune-front of the chest).
Amapayipi ngamunye angabonwa njengenophawu (phezulu) isisekelo (ngezansi) impande ne-hilus.
I-bronchi enkulu, imishanguzo ye-pulmonary, imithanjeni yamapulmoni, nezinzwa yizakhi ezifaka futhi ziphume emaphashini kule ndawo. Ama-lymph nodes , okuthiwa ama-lymph nodes ama-hilar, nawo akhona kule ndawo. Zombili i-hilum zifana nosayizi, i-hilum yesokunxele ivame ukutholakala kancane esifubeni kune-hilum efanele.
Ukucabanga
Esikhathini se-x-ray esifubeni, isifunda se-hilar sibonisa isithunzi esakhiwa yinhlanganisela yama-lymph nodes, imishanguzo ye-pulmonary, nemithanjeni ye-pulmonary. Ngenxa yokuqoqwa kwalezi zakhiwo, ngezinye izikhathi kungase kube nzima ukubona ukukhuliswa kwalezi zinhlanzi zamantombazane noma ukutholakala kwesisindo kule ndawo. Lesi esinye sezizathu zokuthi ama- x-rays ajwayelekile esifubeni angahle alahle umdlavuza wamaphaphu .
Ukuhlola ukuhlolwa okufana nokuhlola kwe-CT (ikakhulukazi ngokuphambene) kungaholela ekubukeni okungcono kwalezi zakhiwo.
Ngezinye izikhathi, ukuhlolwa okuqhubekayo okufana ne- PET scan , i- bronchoscopy ne- endobronchial ultrasound , noma i- mediastinoscopy ingadingeka ukuze ibuke kangcono isifunda noma ithole isampula ye-biopsy.
Ukungahleleki
Lesi sifundeni se-hilar samaphaphu singathinteka yizicubu esifundeni (kufaka phakathi kokubili izicubu ezisemqoka kanye nezicubu zesimetri), ukwandiswa kwama-lymph nodes, kanye nokungajwayelekile kwezimbangela ze-pulmonary or veins.
Ukukhuliswa kwe-Hilar / Imisindo ye-Hilar
Kunezizathu ezine eziyinhloko zokuthi kungani i-hilum yeyodwa noma zombili amaphaphu ingabonakala ikhulisiwe kwi-ray ray. Lokhu kufaka:
- Izicubu kanye ne-lymphadenopathy. Amanqamu anjenge-cancer yamaphaphu nama-lymphomas, kanye nomdlavuza osakaze kule ndawo kusuka kwezinye izingxenye zomzimba (umdlavuza wemetastatic) kungabangela abantu abaningi kule ndawo. Izimbangela ezikhona ze-hilar lymph nodes ezikhulisiwe (lymphadenopathy) zixoxwa ngezansi.
- I-hypertension ye-pulmary pulmonary (impumuzo ephakeme emithanjeni ye-pulmonary). I-hypertension ye-pulmonary veousousous may be kwenzeka ngenxa yezimo zezokwelapha ezifana nokuhluleka kwenhliziyo nezinkinga ze-valve senhliziyo njenge-mitral stenosis nokuphindaphinda kwe-mitral.
- I-pulperary arterial hypertension (PAH), ingcindezi ephakeme emithanjeni ye-pulmonary. I-PAH ingenzeka njengesifo esiyinhloko (hhayi esesibili kwesinye inkinga) noma njengenkinga yesibili okubangelwa kakhulu yi- chronic obstructive pulmonary disease (COPD).
- Ukwanda kwegazi kwamapulmonary. Izimo ezinjenge-cyanotic isifo senhliziyo (ukukhubazeka kwenhliziyo okwamanje ekuzalweni okubangelwa i-tinge eluhlaza okwesibhakabhaka esikhumbeni ngenxa yokunciphisa oksijeni) kungaholela ekukhuleni kwegazi kwegazi.
U-Hilar Lymphadenopathy (Ukwandiswa kwe-Hilar Lymph Nodes)
I-lymph nodes ekhulisiwe ku-hilum ingenzeka kokubili kwesokudla nokushiya kwesokunxele (i-lymphadenopathy ebantwini) noma eceleni kwedwa (i-lymphadenopathy engalingani.) Izimbangela zingabandakanya:
- Umdlavuza we-Lung. Umdlavuza we-Lung yiyona imbangela ejwayelekile kunazo zonke zezifunda ze-hilar ezingalingani kubantu abadala, kokubili ngenxa yobuso be-tumor kanye nokuba khona kwama-lymph nodes abathintekayo.
- Amanye kansela. Umdlavuza wesifuba we-Metastatic ungaholela ku-hilar lymphadenopathy ngenxa yokusabalalisa umdlavuza kulesi sifundazwe ngenxa ye-lymph nodes. I-lymphoma nezinye izicubu zomzimba zingase ziholele nasezikhungweni ze-hilar lymph nodes.
- Isifo sofuba. Emhlabeni wonke, isifo sofuba yisisusa esivame kakhulu se-hilar adenopathy ezinganeni.
- Ukuvuvukala. Izimo ezifana ne-sarcoidosis, i- amyloidosis , ne-silicosis zingabangela i-hilar lymphadenopathy. I-Sarcoidosis iyimbangela evame kakhulu yokukhulisa i-lymph node yamazwe ngamazwe, ikakhulukazi kubantu abadala. Ukukhuliswa kwe-lymph node nge-sarcoidosis ngokuvamile kuvamise ukuphambene nezinye izimbangela ezivamile. Ukusabela kwezidakamizwa nakho kuyimbangela evamile ye-hilar adenopathy.
- Ezinye izifo. Izifo ezinjenge-mycobacteria, ukutheleleka ngegciwane lesandulela ngculazi, njenge-mononucleosis ezithathelwanayo, i-berylliosis, i-tularemia, i-histoplasmosis, ne-coccidiomycosis kungaholela ekwenzeni i-lymph nodes ekhulisiwe kule ndawo. E-United States, i-hertoplasmosis ivame kakhulu e-Ohio nase-Mississippi River Valleys, ne-coccidiomycosis ejwayelekile emazweni aseningizimu-ntshonalanga.
- Ezinye izimbangela. Isifo sika-Castleman yisimo esibonakala ngamathambo angavamile. Ukuhluleka kwenhliziyo kungase kuholele ekutheni i-hilar adenopathy.
Ngaphansi
Kunemibandela eminingi engabangela ukubukeka okungavamile kwe-hilum ekufundiseni izithombe, eziningi zazo ezimbi. Isinyathelo sokuqala, noma kunjalo, ukuqinisekisa ukuthi noma yikuphi okutholakele akukona ngenxa yokulimala komzimba uma uthatha la mafilimu. Ngenani lezinhlaka ezidlula kule ndawo, ngisho nokushintshaniswa okuncane kungenza kube khona ukungajwayelekile uma kungekho muntu okhona.
Amathumba, kokubili okuyisisekelo kanye nemetastatic, yimbangela evamile kakhulu kokubili izibalo ze-hilar kanye ne-lymphadenopathy. Izimbangela ezivamile kakhulu zihlanganisa isifo sofuba emhlabeni jikelele, kanye nezimo ezifana ne-histoplasmosis, coccidiomycosis, ne-sarcoidosis e-United States.
Uma udokotela wakho ebona ukungavamile kokuhlolwa kwakho, ukuhlolwa okuqhubekayo kuzoboniswa. Uzophinde ucele umlando oqaphele ukubuka noma yiziphi ezinye izimpawu ezibonisa ukubola, ukutheleleka, noma inqubo yokuvuvukala. Iningi le-biopsy liyodingeka ukuze uthole ukuxilongwa okucacile.
Isibonelo: UJohn watshelwa ukuthi umdlavuza ongakwesokudla wakhe wawusakazelele emaceleni omzimba wakhe we-hilar, ama-lymph nodes eduze nendawo lapho i-bronchi ingena emaphashini.
> Imithombo:
> Nin, C., De Souza, V., do Amaral, R. et al. I-Lymphadenopathy ye-Thoracic ku-Benign Diseases: I-State of the Art Review. Imithi yokuphefumula . 2016. 112: 10-7.
> Sarkar, S., Jash, D., Maji, A., noP. Anupam. Indlela yokungafani kwe-hilum e-X-ray esifubeni. I-Journal of Association of Chest Physicians . 2013. 1 (2): 32-37.