Microscopic examination of sputum

Microscopic examination of sputum allows to detect mucus, cellular elements, fibrous and crystalline formations, fungi, bacteria and parasites.

cells ■ Alveolar macrophages are cells of reticulogistocyte origin. A large number of macrophages in sputum is detected in chronic processes and at the stage of resolving acute processes in the bronchopulmonary system. Alveolar macrophages containing ge-mosiderin( "cells of cardiac defects") are detected with a mild infarct, hemorrhage, stagnation in a small circle of circulation. Macrophages with lipid droplets are a sign of obstructive process in the bronchi and bronchioles.

■ Xantom cells( fatty macrophages) are found in abscess, actinomycosis, lung echinococcosis.

■ Cells of cylindrical ciliated epithelium - cells of the mucous membrane of the larynx, trachea and bronchi;they are found in bronchitis, tracheitis, bronchial asthma, malignant neoplasms of the lungs.

■ Flat epithelium is detected when spittle enters the sputum, it has no diagnostic significance.

■ Leukocytes in one or another quantity are present in any sputum. A large number of neutrophils are detected in mucopurulent and purulent sputum. Eosinophils are rich in sputum in bronchial asthma, eosinophilic pneumonia, glottis lung lesions, and lung infarction. Eosinophils may appear in sputum for tuberculosis and lung cancer. Lymphocytes in large numbers are found in whooping cough and, more rarely, with tuberculosis.

■ Red blood cells. Detection of single red blood cells in sputum is not of diagnostic significance. If fresh blood is present in the sputum, unchanged erythrocytes are determined, but if the blood that has been in the respiratory tract for a long time leaves with sputum, then leached red blood cells are found.

■ Malignant tumor cells are detected in malignant tumors.

Fibers

■ Elastic fibers appear in the decay of lung tissue, which is accompanied by the destruction of the epithelial layer and the release of elastic fibers;they are found in tuberculosis, abscess, echinococcosis, neoplasms in the lungs.

■ Coronal fibers are detected in chronic lung diseases, such as cavernous tuberculosis.

■ Calcined elastic fibers - elastic fibers impregnated with calcium salts. Detection of them in sputum is characteristic for the breakdown of tubercular petrichitis.

Spirals, crystals

■ Kurshman spirals are formed in the spastic state of the bronchi and the presence of mucus in them. During a cough thrust, viscous mucus is released into the lumen of a larger bronchus, twisting in a spiral. Kurshman spirals appear with bronchial asthma, bronchitis, lung tumors, compressing bronchi.

■ Charcot-Leiden crystals are the products of the disintegration of eosinophils. Usually appear in a sputum containing eosinophils;are characteristic for bronchial asthma, allergic conditions, eosinophilic infiltrates in the lungs, pulmonary flukes.

■ Crystals of cholesterol appear with abscess, lung echinococcosis, neoplasms in the lungs.

■ Hematoid crystals are characteristic of abscess and gangrene of the lung.

■ Druises of actinomycetes are detected in the actinomycosis of the lungs.

■ Elements of echinococcus appear with echinococcosis of the lungs.

■ Dietrich plugs are yellowish-gray lumps that have an unpleasant smell. They consist of detritus, bacteria, fatty acids, droplets of fat. They are typical for an abscess of lung and bronchiectasis.

■ Ehrlich's Notebook consists of four elements: calcified detritus, calcified elastic fibers, cholesterol crystals, and mycobacterium tuberculosis. Appears in the decay of the calcified primary tubercular focus.

Mycelium and budding fungal cells appear in fungal lesions of the bronchopulmonary system.

Pneumocystis occurs with pneumocystis pneumonia.

Spheres of fungi are detected in coccidioidomycosis of the lungs.

Ascarid larvae are detected with ascariasis.

Larvae of the intestinal ugritis are identified with strongyloidiasis.

Eggs of the pulmonary fluke are identified with paragonimosis.

Elements found in sputum in bronchial asthma. When bronchial asthma is usually separated by a small amount of mucous, viscous sputum. Macroscopically you can see the Kurshman spiral. When microscopic research is characteristic of the presence of eosinophils, cylindrical epithelium, there are crystals of Charcot-Leiden.