The clinical characteristics of the bronchopulmonary system in patients with MM, without exacerbation of AML, depended on the stage of tumor progression. Patients of group I had no osteodestructive syndrome. In patients of this group who did not abuse smoking and who did not have concomitant bronchopulmonary pathology, the chest was regular in shape, painless on palpation, percutaneous over the entire lung surface was determined by a clear pulmonary sound, during auscultation listened to vesicular breathing, adverse respiratory sounds not noted.
Patients of group II are characterized by a pronounced osteodestructive syndrome, including in the bones that form the chest. In 24 patients of group II, percussion over the entire lung surface was determined clear pulmonary sound, vesicular breathing was heard, there were no side respiratory sounds. In 10 patients with a significant deformation of the chest, who were in a forced position during percussion and auscultation of the lungs, the changes were interpreted as interpreted as manifestations of circulatory failure, emphysema, and pulmonary fibrosis; lower parts of the lungs. In 8 patients, MM was complicated by myelomatous lesion of the pleura with the development of exudative pleurisy; in the affected area, weakening of breathing, dulling of the pulmonary sound, and increased voice tremor were observed.
In 17 patients with MM of group III (stage IIIB), a pronounced osteo-destructive process of the chest occurred. In 8 people (IB and stage IIB), the osteodestructive syndrome was absent. In patients with MM of group III, with the initial manifestations of renal failure, with percussion and auscultation of the lungs there were no significant violations. In the terminal stage of chronic kidney disease, all had nephrogenic pulmonary edema. Clinical manifestations of nephrogenic edema were shortness of breath, bouts of shortness of breath, or choking with increased respiration, occurring with a rapid increase in body weight. During bouts of nephrogenic edema, a boxed shade of percussion sound or shortening of sound over the lower parts of the lungs and in the interscapular region was determined. Auscultation noted weakened or hard breathing, dry scattered rales, less often moist fine wheezing, with uremic lesions of the pleura – pleural friction noise (5 patients).
All 123 patients with multiple myeloma were x-rayed. The study began with traditional radiography of the lungs in two projections or large-frame x-ray of the chest, later on, when detecting pathological changes in the lungs, ERTG and CT were performed.
In the majority of cases (72 people — 58.5%), when conducting traditional X-ray diffraction, interstitial changes were detected: increased vascular pattern, pneumosclerosis and emphysema. Radiographic signs of damage to the intestinal lung tissue were more often recorded in patients with stage III disease, especially in the presence of myeloma nephropathy and renal failure. Very rarely, interstitial changes were found in the early stages of tumor progression (IA, IIA stages according to the classification of B. Durie and S. Salmon, 1975). Gain and deformation of the pulmonary pattern in MM is explained by stagnation of blood in small vessels and the development of pneumosclerosis, since blood flow in the pulmonary capillaries is slowed down due to increased plasma viscosity. Analyzing the group of patients with MM with interstitial changes in the lungs, it was found that in most cases these were patients over the age of 50 years (52 people — 72.2% of the total number of patients with interstitial changes in the lungs), with pronounced monoclonal secretion (G or A) and high serum total protein content (45 people – 62.5%). In 25 patients with interstitial changes in the lungs, renal failure was diagnosed (34.7%).