Extremely valuable guidance gives history, it appears granuloma annulare that in the early stages,

Extremely valuable guidance gives history, it appears granuloma annulare that in the early stages, with more scant sputum, cough intensity varies depending on the patient's position (horizontal, vertical); at the same time and also mucus released unevenly depending on the position of the patient. Questioning discovers that the cough is worse when standing on the healthy side and in the same position granuloma annulare is marked more sputum. Then the patient lies on the other side or back and in this position can easily sleep through the night but in the morning, as soon as he gets up and starts cough that lasts as long as the secret granuloma annulare is highlighted, which met for the night in bronchiectasis. Patient to expectorate sputum "mouthful"; this symptom is a relatively early sign of bronchiectasis. Later noted copious sputum, which is done easily and, as before, is amplified in the horizontal position of the patient, on the healthy side: but sometimes sputum already has an unpleasant smell. Finally, there may come later sustained release of extremely smelly phlegm. Stinky smell sputum is an optional feature of bronchiectasis; its appearance indicates that the area under the influence granuloma annulare of bronchiectasis secondary infection developed granuloma annulare putrid putrid bronchitis.
In an earlier stage of phlegm small, it is liquid and has purulent; granuloma annulare usually little mucus and phlegm in the spittoon has the form of individual coins ("monetoobraznaya phlegm"). Later, when allocated a lot of phlegm, it has a grayish or serovatobury color and consists of three layers: the upper foam, sometimes with separate matter how ragged strands hanging down in the middle turbid serous fluid layer under which there is a layer containing abundant pus, sometimes with ditrihovskimi stoppers. Elastic fibers are found only occasionally in the form of individual instances that indicates ulceration granuloma annulare of the bronchial wall. Under the microscope, found many festering granuloma annulare cells, sometimes quite a lot of fatty acid crystals and crystals gematoidina
Very common symptom is blood Harkany bronchiectasis. Periodic appearance of a small amount of blood in the form of veins observed in almost granuloma annulare all cases. Furthermore, there is a special form of bronchiectasis with periodic granuloma annulare abundant hemoptysis, we can say with bleeding, which can even lead to death from loss of blood. This form is called dry bronchiectasis French authors, because it is not accompanied by sputum. Hemoptysis is the only reason for seeking granuloma annulare such patients to the doctor. Other patient complaints does not show. Clean periodically bleeding bronchiectasis may long proceed granuloma annulare without sputum, but with time and they usually acquire the features typical of the disease.
Appearance and general condition of patients granuloma annulare may remain unchanged for a long time. In some cases, appearance and overall condition hardly changed even when patients are already granuloma annulare providing a lot of phlegm. More often, however, during the release of large amounts of sputum, especially putrid, patients lose weight, pale, puffy face is sometimes develops cyanosis. Relatively early fingers take the form of "drumsticks". Rarely (usually only in seriously ill and at a young age) develops generalized periostitis (osteoarthropatie hyperthrophiante pneumique), granuloma annulare bears the name of the disease Pierre Marie-Bamberger.
Percussion light in the early stages of the disease may not produce any changes, except for a small emphysema and limited mobility of the lower edge of the lung on the affected side due to concomitant dry pleurisy. Sometimes revealed shortening of percussion sounds in the lower part of the lung, usually closer to the spine, due pneumosclerosis. In more rare localization in the upper lobe may show vintrihovskoe change percussion sound. Auscultation quite early (before the change of percussion) reveals a small amount of finely wheezing, listened with great constancy usually lower lung located in the paravertebral area. Even greater granuloma annulare diagnostic value has the appearance of the same portion granuloma annulare of large bubbling rale. Later stages of the disease is characterized by a large number of moist rales (krupnopuzyrchatyh) under the shoulder blade, and often in the underarm area (closer to the anterior axillary line). Souffle mostly weakened in some cases and even bugged bronchial granuloma annulare amphoric breath.
X-ray examination of the lungs reveals several quite polymorphic changes depending on the form of bronchiectasis (cylindrical or saccular) and the degree of filling their secret. Cylindrical bronchiectasis have the form of linear or blackouts, or light stripes double circuit. Saccular bronchiectasis usually give a cellular or cell pattern. At the same time filled with secret bronchiectasis have the form of rounded opacities; bronchiectasis made air are