. Roentgen interpretation; a manual for students and practitioners . osis at both apices. tuberculosis, the changes are permanent. The demarcation betweenthe normal and the pathological is not sharp and it takes consider-able experience in the observation of plates, combined with all thatcan be found by clinical methods, to establish a correct the process continues, small bead-like masses appear alongthe course of the thickened bronchial shadows and fan-shaped areasof filmy density may be seen w4th their bases on the pleura andapices, extending inward toward the thickened markings
. Roentgen interpretation; a manual for students and practitioners . osis at both apices. tuberculosis, the changes are permanent. The demarcation betweenthe normal and the pathological is not sharp and it takes consider-able experience in the observation of plates, combined with all thatcan be found by clinical methods, to establish a correct the process continues, small bead-like masses appear alongthe course of the thickened bronchial shadows and fan-shaped areasof filmy density may be seen w4th their bases on the pleura andapices, extending inward toward the thickened markings. Thesefan-shaped areas are probably the earliest evidence of definite LUNG FIELDS 137 involvement of the lung parenchjTaa, but unfortunately they arenot commonly seen and they may occur m other infections. The next stage is the appearance through the diseased area offinely stippled grayish spots, apparently independent of the bronchialmarkings now extended to the periphery of the lung. These spotsmean definite involvement of lung tissue and at this time rales are. Fig. 113.—Miliary tuberculosis of the lungs. The changes are most markedin the upper lobes. beginning to be evident upon clinical examination. This charac-teristic fine mottling is the only sure basis for a roentgen diagnosisof active tuberculosis. It is seen in its most typical form in thecases of miliary tuberculosis. With the further progress of the disease there occurs an enlarge-ment and effusion of these spots and their extension to new areas,resulting in coarse mottling and finally evidence of cavity formation. 138 THE CHEST Areas of healing may occur at any stage, or progress and healingmay be simultaneous so that it may be impossible to decide fromroentgen evidence alone whether a case is active or quiescent. Ingeneral, active lesions are dim, gray and blurred; healed ones aremore dense and sharply outlined. The only condition which must be differentiated from extensivetuberculosis is that seen in pneumono
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