Recently, there have been more and more discussions about "what is white lung". Some people have posted their own "white lung" experience on the Internet, accompanied by CT or X-ray photos. On a black background film, the lungs are shrouded in white smoke.
Various speculations arose all of a sudden. Anyone who has been coughing for several days is in danger: I don’t have white lung, right? Are my lungs okay? Do I need to have a CT scan to check the condition of my lungs?
Stop it - the radiology department in the hospital is already overloaded. Let's make a judgment first, don't rush to the hospital, and leave resources to more people in need. Today Zhejiang Hospital Chief Physician Li Zhijun, Deputy Director of the Department of Respiratory Medicine, and Chief Physician Feng Yue, Deputy Director of the Radiology Department of Zhejiang Hospital are here to tell you about white lung.
01
"White lung": generally refers to severe pneumonia
It is not called white lung as long as inflammation occurs in the lungs. White lung should be a more serious manifestation of pneumonia.
Generally speaking, when the lung inflammation is relatively severe and there is a lot of exudation, that is, when the white image area reaches 70% to 80%, it is colloquially called white lung in clinical practice. At this stage, patients will experience hypoxemia or respiratory distress.
This type of patients may appear clinically, especially in elderly patients with serious underlying diseases, but the proportion of such patients is very low.
Healthy lungs are composed of alveoli with normal ventilation function. Such alveoli are filled with air, are transparent on X-rays and CT, and appear "black".
But if there is a serious disease in the lungs, such as pneumonia or lung tumors, or there is a large amount of fluid accumulation, the healthy alveolar tissue will be destroyed. The density in the lungs increases and the light transmittance becomes worse. At this time, it appears as a smoky white color on X-ray CT.
As more and more parts of the lungs are damaged, the white area will gradually expand.
02
Severe pulmonary infection may cause white lungs
There are actually many reasons for white lungs. As long as the normal alveoli are destroyed, the gas in the alveoli is replaced by liquid, or the alveoli collapse, white lungs will occur.
Not only the new coronavirus, but also multiple pathogens can cause lung inflammation, such as respiratory syncytial virus and influenza virus, including some bacteria such as Legionella , which can cause inflammation of the lungs. In severe cases, inflammation can occur.
In terms of treatment, we now have mature expert consensus and treatment plans, mainly prone position ventilation, and oxygen therapy, including non-invasive ventilator , invasive ventilator , and ECMO, which is called a life-saving tool by netizens. By strengthening the treatment of the cause of the primary disease, a considerable number of white lung patients can improve.
03
These five groups of people are prone to white lung
Everyone is now more concerned about pneumonia caused by new coronavirus . There are the following five categories that need attention:
①Age over 65 years old;
②Immune suppression status, such as long-term use of hormones, etc. Immunosuppressed state refers to the normal immune function that has been affected by disease or drugs, such as patients with AIDS, organ transplants, etc. People who have taken immunosuppressants for a long time, take hormones, and people with rheumatoid diseases are all immunosuppressed.
③Patients with a history of chronic diseases of important organs (such as heart, brain, kidney, lung, etc.), heart disease, stroke, history, chronic kidney disease, , patients undergoing dialysis, emphysema, patients, and some people who need ventilators to help breathe for a long time.
④ There are a variety of coexisting diseases. Although some patients are not as serious as the above, they have multiple diseases, such as heart disease and lung disease, and their kidneys are not good, so they need to be careful.
⑤ For patients whose disease progresses rapidly, if the patient's blood oxygen saturation drops rapidly to less than 94% after infection, especially if it occurs in the above high-risk groups, more caution is needed, indicating that the damage has accumulated to the lungs, and close monitoring is required in the hospital.
04
Coughing won’t stop after being positive.
Is it necessary to do chest CT?
Not all people who have experienced "yang" need to have lung CT. The vast majority of "positive" patients have mild or common symptoms, which can manifest as fever, fatigue, dry throat, sore throat, nasal congestion, runny nose, cough and other symptoms of upper respiratory tract infection, without involving the lungs. Therefore, no special examination of the lungs is needed.
For patients with "yang" health, that is, the symptoms have improved significantly or there are no obvious symptoms, the self-test of antigen is negative twice in a row (the interval between the two tests is greater than 24 hours). There is no need for examination. Even if there is a slight infection in the lungs, it will slowly heal on its own.
When may I need CT to check whether I have pneumonia?
1. After 3 days of drug treatment, the body temperature is still higher than 38.5℃;
2. Breathing difficulty or shortness of breath, breathing ≥24 times/min, blood oxygen saturation ≤93%;
3. Chest tightness, precordial discomfort, rapid heart rate;
4. Persistent cough, excessive phlegm, etc. should pay attention to the possibility of involving the lungs;
5. The patient has symptoms such as acute allergic reaction, angioedema.
While being vigilant, I also hope that everyone will not be overly anxious.
If it is just a simple cough without dyspnea, fever, or poor mental status, it is not recommended to have a CT scan.
Yellow sputum is not a sign to check for pneumonia, and there is no need to do a CT scan.
(Zhejiang Hospital)
