pulmonary fibrous focus



OVERVIEW

Definition

Pulmonary fibrous foci (PFF) are fibrotic lesions that remain after the natural healing of damage to the lungs.

Pulmonary fibrous foci are usually the result of scars left by lung diseases, such as lung infections, pulmonary fibrosis caused by various reasons, lung tumors, etc., which form after healing.

It is the result of the remodeling of the damaged part of the lungs, which is equivalent to the healing of the lesion, just like the scar left by a knife cut on the skin.

Pulmonary fibrotic lesions are irreversible, but the lesion itself does not expand over time and cannot be eliminated with medication.

Onset of the disease

Current authoritative data on the incidence of pulmonary fibrotic lesions. Because pulmonary fibrosis often leaves behind pulmonary fibrotic foci, reference can be made to the incidence of pulmonary fibrosis.

Overall situation

There are no results of epidemiological surveys on pulmonary fibrosis on a large scale, but there is a clear trend of increasing incidence of pulmonary fibrosis in general.

High prevalence

The prevalence in the general population ranges from 2/100,000 to 29/100,000, and the onset of the disease is in middle age or older, more common in older men who are heavy smokers.

Causes

Pulmonary fibrotic foci are a common pathological change that can be caused by a variety of reasons such as disease factors and environmental pollution factors [1-3].

Causes

Disease factors

Pneumonia: most pneumonias do not leave scarring after cure, but there are still a few pneumonias that cause necrosis of lung tissues will leave scarring after cure, which manifests as fibrosis, such as aspiration pneumonia or severe pneumonia caused by certain gram-negative bacilli.

Physical injury: lung trauma, surgery, and radiation therapy can damage lung tissue. After the body repairs these injured tissues, lung fibrotic foci will remain.

Active tuberculosis: after the local inflammation subsides after treatment, the body will repair itself and leave fibrous foci after cure.

Lung cancer: it can cause lung fibrosis and leave behind pulmonary fibrotic foci.

For example, asbestosis, silicosis, coal dust lung, heavy metal lung, etc., can cause lung damage and leave lung fiber foci.

Environmental life factors

Highly developed industry leads to environmental pollution and ecological damage, such as factories, automobiles, power plants and other polluting gases, people breathe polluted air every day, in the long run, may cause respiratory diseases, cause pulmonary fibrosis and left lung fibrotic foci.

In daily life, long-term smoking, second-hand smoke, etc., will increase the probability of pulmonary fibrosis.

Pathogenesis

Normal lung interstitium consists of interstitial macrophages, fibroblasts, myofibroblasts, non-collagenous proteins and so on.

When the lung tissue is damaged, collagen and other substances are secreted to repair the interstitial tissue, causing significant thickening of the alveolar septum as well as pulmonary fibrosis, loss of pulmonary capillaries, etc., and ultimately forming pulmonary fibrotic foci [4-5].

Symptoms

Large pulmonary fibrotic foci mainly cause symptoms such as chest tightness, shortness of breath and dyspnea.

Main symptoms

Smaller fibrous foci

When the scope of fibrotic foci is small, other lung tissues can play a compensatory function, which basically has no effect on the body and lung function, so there are usually no clinical symptoms.

Large fibrous foci

If the scope of the lesion is large and the patient is accompanied by other underlying lung diseases, it may lead to reduced lung function and the following symptoms.

Chest tightness: a subjective uncomfortable feeling of blockage and suffocation in the chest.

Shortness of breath: refers to shorter-than-normal breathing, the patient consciously inhales not to the end, not enough air.

Poor breathing or even dyspnea.

Seek medical attention

When symptoms such as chest tightness, shortness of breath and dyspnea occur, it is recommended to organize relevant information and go to the Department of Respiratory Medicine.

Department of Medicine

Department of Respiratory Medicine

When symptoms such as chest tightness, shortness of breath, breathlessness or even dyspnea occur, please consult the Department of Respiratory Medicine.

Emergency Department

Please consult the Emergency Department if you have sudden onset of symptoms such as difficulty in breathing or breathlessness.

Preparation

Information on how to get to the doctor: registration, preparation of documents, and frequently asked questions.

Tips for Medical Treatment: Registration, Preparation of Documents, Frequently Asked Questions

Chest X-rays or CT scans may be required. Avoid wearing metal clothing such as shirts with buttons, blouses with sequins, and dresses with zippered buttons.

Record the symptoms, duration and other relevant information for your doctor’s reference.

It is recommended that a family member accompanies you to the doctor’s office.

Checklist for preparation for medical consultation

Pay particular attention to the time of onset of symptoms, special manifestations, etc.

Do you feel tightness and shortness of breath in the chest and for how long?

Is there any breathlessness or even dyspnea?

Are there any other uncomfortable symptoms?

Are you a regular smoker or second-hand smoker?

What is your occupation?

Is there any history of other diseases, such as lung cancer, tuberculosis, pneumonia, etc.?

Any history of lung trauma, surgery, radiation therapy?

Are there any allergies to drugs or food?

Test results in the last six months, which can be brought to the doctor’s office

Laboratory tests: routine blood tests, biochemical tests, serum antibodies.

Imaging tests: X-ray, CT examination.

Diagnosis

Initial diagnosis needs to be combined with medical history and clinical manifestations, and the results of imaging tests can confirm the diagnosis.

Diagnosis is based on

Medical history.

The patient may have a history of the following, but not all of them will develop pulmonary fibrotic foci.

A history of smoking and passive smoking (secondhand smoke).

History of pneumonia, tuberculosis, or lung cancer.

History of trauma, surgery, or radiation damage to the lungs.

History of occupational exposure to asbestos, silica, soot, etc.

Clinical manifestations

There are no clinical symptoms when the pulmonary fibrotic foci are small.

Larger foci may cause chest tightness, shortness of breath, dyspnea and even dyspnea.

Usually there are no abnormal physical signs.

Some patients with pulmonary fibrotic foci may have barrel-shaped chest and pestle-shaped fingers.

Laboratory Tests

Before treatment, patients need to undergo blood routine, liver and kidney function, electrolytes, coagulation analysis and other necessary general examinations.

Most of the tests have no specific findings, but they can determine the general condition of the patient, and know whether the patient has infection, anemia, thrombocytopenia, abnormal liver and kidney functions, electrolyte disorders, abnormal coagulation function, etc. The tests can help determine whether the body has cancer or not.

It can help to determine whether there is cancer in the organism, and some lung cancers can cause the formation of pulmonary fibrous foci.

For example, serum antibodies to various viruses, bacteria, mycoplasma, tuberculin, fungi and other pathogens can help to clarify whether there are viral, bacterial, tuberculosis, fungal and other pathogen infections in the lungs.

Imaging

It is a common method to show pulmonary fibrotic foci, which can clarify the location and nature of the lesion and its relationship with clinical symptoms.

It can detect smaller lesions and is more accurate than X-ray.

It can better determine the condition of the lungs.

Differential diagnosis

Pulmonary fibrotic foci need to be differentiated from pulmonary malformation tumor, tuberculosis ball, lung cancer and other diseases.

Lung malformation tumor

Similarities: Smaller lesions are asymptomatic, while severe cases may present with dyspnea.

Differences: Lung malformation tumor is a solitary, smooth-margined, isolated lesion with regular round, round-like or shallow lobular shape, no burrs, no cavities and no pleural depression sign.

Tuberculosis ball

Similarities: the imaging appearances are relatively similar.

Differences: Tuberculosis balls are often located in the apical posterior segment of the upper lobe or the dorsal segment of the lower lobe of the lung, and there may be fissure-like small cavities present in the tumor with calcification, surrounded by scattered satellite foci and scarring focal emphysema [6-7].

Lung cancer

Similarities: The imaging manifestations are relatively similar.

Differences: Lung cancer mostly has imaging features such as burr margins, lobulation, vascular cluster sign, pleural depression sign, etc. Calcification is less likely to occur, and some lung cancer foci may form cavities inside, which may have pleural depression sign.

Treatment

Aim of treatment: asymptomatic patients should be observed regularly, while symptomatic patients should focus on relieving symptoms and improving quality of life.

Treatment principle: control the primary disease and supplement with symptomatic supportive treatment.

Control of primary diseases

Pneumonia

Patients with pneumonia who have formed pulmonary fibrotic foci are usually in the repair stage, and should be actively treated with anti-infective therapy to avoid necrosis of lung tissue and formation of fibrotic foci.

Tuberculosis

The formation of pulmonary fibrotic foci in patients with tuberculosis is also a manifestation of the repair stage, at this time should continue to complete standardized anti-tuberculosis treatment.

Lung cancer

Generally, surgery is the mainstay to remove diseased lung tissues. If there is no indication for surgery or contraindication to surgery, radiotherapy, chemotherapy and targeted therapy can be used to control the progression of the disease.

Commonly used chemotherapy drugs include vincristine, platinum, paclitaxel, gemcitabine, pemetrexed and so on.

Commonly used targeted drugs include gefitinib, afatinib, ositinib, crizotinib and so on.

Symptomatic supportive treatment

Reasonable oxygen therapy

Mainly used to relieve shortness of breath and dyspnea.

Nasal catheter oxygen administration is suitable for mild to moderate hypoxemia.

Mask oxygenation is generally used for patients who need higher oxygen concentration.

Do not adjust the oxygen flow rate or stop oxygen therapy.

Rest

Avoid exertion, pay attention to appropriate rest, and closely monitor respiration, heart rate, blood pressure, etc. in order to understand the condition.

For bedridden patients who have been ill for a long time, they should pay attention to turning over and patting the back regularly to keep the airway open.

Prognosis

There is no cure for pulmonary fibrotic foci. Active treatment of the primary disease will help to control symptoms, delay progression and improve prognosis.

Cure

At present, there is no good treatment for pulmonary fibrotic foci. If the factors causing lung tissue damage are removed and there are no clinical symptoms or the symptoms are mild, no special treatment is needed and the prognosis is good, with regular review.

If the damaging factors persist and have caused obvious clinical symptoms that seriously affect lung function, the prognosis will be poorer. If the disease progresses in a sustained manner, death may eventually occur due to respiratory failure.

Daily routine

Patients with pulmonary fibrotic lesions should stay away from risk factors, quit smoking and drinking, have a regular routine, eat a scientific diet, and monitor their condition with regular checkups.

People with underlying diseases such as pneumonia, tuberculosis, lung cancer and those who are easily exposed to asbestos, silica and coal dust at work need to focus on prevention and regular checkups.

Daily Management

Lifestyle

Quit smoking and drinking, avoid strenuous work, have a regular routine, avoid staying up late and get enough sleep.

Maintain a healthy weight, take appropriate activities such as slow walking, tai chi, qigong, breathing exercises, etc., and avoid crowded places.

Diet management

Reasonable dietary arrangements, so as to achieve a light diet, balanced nutrition, and a variety of food types.

Intake of vitamin-rich fresh fruits and vegetables can supplement the vitamins needed by the body to promote recovery.

Eat more protein-rich food, such as eggs, milk, lean meat and fish.

Psychological support

Maintain a good mood and mindset and face the disease positively.

Learn to confide in friends and family members to avoid excessive pressure, which may cause mental illness, and seek help from psychiatrists if necessary.

Patients should establish a correct understanding of the disease, accept treatment positively, and do work and housework to the best of their ability during and after treatment, so as to reintegrate into their social roles.

Family members should provide adequate companionship to the patient, create a cozy family atmosphere, comfort the patient and help him/her to tide over the difficult times.

Disease monitoring

Patients should pay attention to their own situation, and seek medical advice if symptoms such as chest tightness, shortness of breath, breathlessness or even dyspnea suddenly appear.

Follow-up examination

The main purpose of follow-up is to dynamically observe the changes of pulmonary fibrotic foci and intervene in a timely manner.

It is recommended to follow the doctor’s instructions for regular review, and if there is any discomfort, please consult the doctor at any time.

Prevention

Prevention of pulmonary fibrotic foci should start from the cause of the disease, and the main points are as follows.

Active treatment of primary diseases

For patients suffering from lung diseases such as pneumonia, tuberculosis, lung cancer, etc., they should be actively treated to control the progress of the disease.

Adopt a good lifestyle

Insist on quitting smoking and drinking.

People at risk of occupational exposure should take protective measures to avoid contact with asbestos, silica, coal dust and other substances.

Avoid passive smoking, open-flame coal heating, and exposure to oil fumes.

Try to do regular work and rest, moderate exercise, weight control and balanced nutrition.