CAVITY (Latin. caverna cave, cavity) — the cavity arising in body as a result of partial necrosis of its fabric with the subsequent fluidifying of dead masses and their rejection.
Etiologically To. it can be connected with purulent and gangrenous nonspecific processes — purulent, putrefactive To. (fig. 1 and 2), tuberculosis — tubercular To. (fig. 3), syphilis, a pneumoconiosis (a silicosis, an anthracosis), is more rare with tumoral growth — cancer K. Sushchestvuyut also patol. educations — so-called pseudocaverns — bronchogenic cysts, bubbles at emphysema of lungs, and also spontaneous pheumothorax and an empyema (fig. 4).
On localizations it is accepted to allocate To. pulmonary, renal, hepatic, bone, etc. bodies. However most often mean by the term «cavity» tubercular To. in lungs. To number of diseases which rather often are followed by development To., nonspecific diseases of lungs from the outcome in a so-called nonspecific pulmonary tuberculosis, fungus diseases — an actinomycosis, histoplasmosis, a sporotrichosis belong hron. Development is considered very rare To. at syphilis of lungs.
Pathogenetic nonspecific pulmonary To., as well as at tuberculosis, are connected with a necrosis or purulent fusion of pneumonic focus or bronchiectasia. Their ground mass develops in the outcome of caseous pneumonia. Curdled necrotic masses is liquefied under the influence of proteolytic enzymes, leukocytes and macrophages, and also the proteinases which are contained in inflammatory exudate: forms so-called pnevmoniogenny To. During the involvement in tubercular inflammatory process of a bronchial tube or a bronchiectasia so-called bronkhoektatichesky or bronchogenic K. Razlichit this two look are formed To. it is possible only at early stages of development. Tubercular To. develop most often in upper parts of a lung, can be single or multiple (fig. 3). On formation they are exerted impact by reactivity of an organism, a tone of the neuromuscular device of lungs, size of the necrotic pulmonary center, elastic draft of a lung, a condition of the draining bronchial tubes and surrounding pulmonary fabric, etc. To. can be rounded, slit-like, irregular shape. Round thin-walled To. (fig. 5) at a symmetric arrangement in upper parts of lungs call also stamped (-point).
In size distinguish To. small — with a diameter up to 2 cm, are more often monosegmented, average and large — with a diameter up to 7 cm, usually polysegmented, and huge — the St. 7 cm in the diameter which are quite often occupying a share or all lung (fig. 6).
Wedge, prescription of process and feature morfol, structures of a wall are the cornerstone of distinction To. acute and chronic. Acute To. represent the fresh centers of fusion and a cavity in the field of caseous pneumonia; they can have the thin fibrous capsule adjoining on not changed pulmonary fabric, are easily fallen down. Carry to them so-called round To. at primary tuberculosis, at infiltrate and stamped To. at hron, hematogenous tuberculosis.
A wall hron, (the sacculated rigid) To. has a three-layered structure: the inner layer consists from is purulent - the necrotic masses and fibrin; average — from granulyatsionny fabric rich with vessels, sometimes with existence of epithelial and colossal cells; the periblast is formed by fibrous connecting fabric with small number of veins. At gistokhy, a research in the inner layer To. a large amount of proteins and polysaccharides is defined, availability of CHIC-positive substances comes to light; activity of oxidation-reduction enzymes is absent. In cells of the interlayer accumulation of CHIC-positive substances, high content of RNA and DNA, an intensification of enzymatic metabolism is also noted. In process of maturing of granulations and formation of connecting fabric intensity of indicators of fabric metabolism in a wall To. decreases. Old fibrous To. have connective tissue walls, smooth, with sites of the remained granulyatsionny fabric an inner surface. On an inner surface the remained sclerosed bronchial tubes and blood vessels in the form of beams and crossbeams in which vascular aneurisms sometimes form act; the gap conducts them to plentiful, sometimes to fatal bleeding. Walls old To. are fallen down hardly. In tubercular To. contain: a significant amount of tubercular mycobacteria, pyogenic and putrifactive microorganisms, is more rare yeast and other fungi. In the presence in To. the draining bronchial tubes which number can reach 5 — 6 and more, speak about open, or true («breathing»), To., in the absence of the message with a bronchial tree — about closed (blocked) To.
Disturbance of drainage function of a bronchial tube can be followed by development of some kind of ventilating obstacle at an exhalation and education so-called inflated To., increase in contents in it, increase in receipt in blood of bacterial toxins with increase a wedge, symptoms of intoxication. Reparative processes in a wall To. come down to thinning and rejection of a necrotic layer, pasting of the fallen-down granulating walls To. and to growth of granulyatsionny fabric in a cavity To. Process comes to the end with formation of a hem. At the big sizes K. turns into the encapsulated curdled center or into the cystiform cavity which is reported with a bronchial tube with fibrous, a part the epithelized wall more often. Calcification of contents closed K.
Morfol, features is possible To. usually do not allow to judge about etiol, the factor which caused their emergence: at histoplasmosis, e.g., features of display of a disease are identical observed at tuberculosis. Ways of involution nespetsifich. To. the same, as at tuberculosis.
Clinical manifestations of a cavity are defined by the general condition of the patient, a form, the sizes and K. Otkrytye K. localization are followed by department of a significant amount of the phlegm containing tubercular mycobacteria. Healing To. occurs under the influence of causal and pathogenetic treatment. According to special indications it is carried out cavernotomy (see), lobectomy (see), segmentectomy (see) and other operations on bodies. See also Tuberculosis of a respiratory organs .
Bibliography: The multivolume guide to pathological anatomy, under the editorship of A. I. Strukov, t. 9, page 549, M., 1964; Puzik V. I., Uvarova O. A. and Averbakh M. M. Patomorfologiya of modern forms of pulmonary tuberculosis, M., 1973, bibliogr.; Rabukhin A. E. Tuberculosis of a respiratory organs at adults, M., 1976, bibliogr.; The guide to tuberculosis of a respiratory organs, under the editorship of S. M. Knyazhetsky, L., 1972; With tr A. I. uk and To about to l ov and I. M. Hronicheskiye nespetsificheskets of a disease of lungs, M., 1970; Q of t r at к^о in A. I. and Solovyov I. P. Morphology of tuberculosis in modern conditions, M., 1976; H and with t about in and the p A. H. Pathological anatomy and pathogeny of tuberculosis, L., 1973; H u e b s with h m a n n P. Pathologische Anatomie der Tuberku-lose, B. 1928; Lehrbuch der speziellen Pathologie, brsg. v. L. H. Kettler, S. 223, Jena, 1970.
I. P. Solovyova.