In the later stages of tumor progression of CLL, the lymph nodes in the chest cavity acquire a dense texture, lymphoid infiltration appears in the lungs and pleura (with the development of specific lymphoproliferative pleurisy), a compression syndrome develops, leading to impaired bronchial patency and pulmonary ventilation, as a result of the pulmonary pulsations of the pulmonary pulmonary regimen. – gain a heavy and long current. These changes contribute to a decrease in pO2 and an increase in pressure in the aircraft system. This explains the higher value of SrDLA in patients of group III. As CLL progresses, myocardial dystrophy develops in such patients, which contributes to impaired hemodynamics of the ICC and an increase in pressure in the PA.
Thus, four mechanisms of LH development in patients with CLL who do not have a concomitant bronchial obstruction process can be distinguished: 1) thoracodiaphragmatic due to decreased excursion of the diaphragm, when it is compressed with enlarged liver and spleen and leukemic lesion ; 2) bronchopulmonary – severe and prolonged course of infectious and specific leukemic processes; 3) vascular due to impaired blood rheology in the vessels of the ICC; 4) myocardial degeneration.
For the first time, a comprehensive examination of the bronchopulmonary system (spirography, traditional X-ray, regional lung rheography) was performed in 1997 (at that time stage B according to the Binet classification was at that time). On radiographs and tomograms, an increase in mediastinal lymph nodes was determined. No other pathology was identified.
In 2006, the patient was diagnosed with stage J. according to J. Binet’s classification: hemoglobin – 75g / l, erythrocytes – 2.6 × 10 12 / l, platelets – 70 × 10 9 / l, leukocytes – 280 × 10 9 / l, lymphocytes – 98%, segmented – 2%; marked lymphadenopathy – lymph nodes of all groups up to 3-4 cm in diameter, with a densely elastic consistency; splenomegaly was the leading clinical syndrome — the spleen occupied the entire left half of the abdominal cavity; the liver was significantly enlarged .
As a result of a comprehensive examination of the bronchopulmonary system of patient A. in 2006, the following changes were diagnosed. With CT of the lungs – a significant increase in lymph nodes in the chest cavity, the high position of the dome of the diaphragm. During spirography, there were no impairments in the ventilation function of the lungs. During peak flow measurements, the PSV indicators were as follows: in the morning hours – 96% D, in the evening hours – 101% D. During pneumotachography, an increase in bronchial inhalation resistance was observed (3.3 cm.vod.st / l / s) and on exhalation (3.6 cm.v.st./l / s). When fibrobronchoscopy was diagnosed with bilateral diffuse endobronchitis, IV Art. LDF data: PM – 23.09 PE, σ – 10.89 PE, Kv – 47.16%, Ae – 6.2 PE, An – 3.93 PE, Am – 3.18 PE, Ad – 2.7 PE, Ac – 1.6 PE.