The main respiratory organs are protected by a pleural cavity consisting of 2 petals and an empty space between them. The pressure in the outer shell of the lungs should be below atmospheric. If air enters the pleural cavity, it increases, and pneumothorax begins. Lungs do not straighten out and cease to participate in the process of breathing.
Pneumothorax - classification
There are many options for typing the pathology under consideration: severity, localization, communication with the external environment, the volume of collapse and other criteria. The classification according to the causes of the disease is considered as clear as possible. It includes the following types of pneumothorax:
- traumatic;
- spontaneous;
- artificial.
Traumatic pneumothorax
This form of the disease often accompanies accidents, road accidents and armed assaults. Traumatic pneumothorax is the accumulation of air between the pleural lobes due to penetrating (bullet, knife) or blunt injuries of the chest (bruises, strokes). Sometimes damage to the protective shell develops against the backdrop of medical manipulation. In such situations, iatrogenic pneumothorax of the lung is determined. It can occur after:
- puncture;
- biopsy;
- artificial ventilation;
- installation of a subclavian catheter.
Pneumothorax of spontaneous form
The described type of the disease is separately classified into an idiopathic and symptomatic subtype. The first form occurs in absolutely healthy and young people, the exact causes of this phenomenon are not clear. Predisposing factors are:
- heredity and congenital genetic abnormalities;
- male;
- age from 20 to 40 years;
- addiction to tobacco;
- high growth;
- occupations that presuppose pressure differences (traveling in an airplane, diving, climbing mountains and the like);
- excessive physical activity.
Symptomatic or secondary pneumothorax of the lung is diagnosed in people with pathologies affecting the functions of the respiratory system. Provoke the accumulation of air in the pleural cavity may the following diseases:
- cystic fibrosis ;
- exacerbation of bronchial asthma;
- pneumonia;
- sarcoidosis;
- fibrosing alveolitis;
- chronic obstructive pulmonary disease;
- tuberculosis;
- histiocytosis X;
- systemic scleroderma;
- rheumatoid arthritis;
- abscess of the lung;
- cancer;
- lymphangioleiomyomatosis;
- dermatomyositis and others.
In severe cases, the excess air between the pleural lobes causes not only an increase in pressure in the shell of the lungs, but also an acute oxygen deficit, a rapid decrease in blood pressure in the arteries. This condition is called intense pneumothorax and is considered one of the most dangerous variants of the course of the disease. Without emergency therapy, it can provoke serious complications that threaten human life.
Artificial pneumothorax
The presented condition is a special medical manipulation. Before the invention of modern chemical preparations, minimally invasive methods of surgical intervention and computed tomography, artificial pneumothorax in tuberculosis (collapsotherapy) was the most effective method of treatment and diagnosis. Forced partial collapse of the affected lung contributes to the disappearance of foci of tissue necrosis, resorption of granulations and fibrosis.
Progressive pulmonologists rarely apply artificial air to the pleural cavity. To this manipulation there are strict indications:
- internal bleeding (if known, from which lung it occurs);
- destructive tuberculosis with fresh caverns;
- impossibility of modern chemotherapy.
Pneumothorax - the causes of
Sometimes the pathology under consideration arises spontaneously, especially in young men, predisposed to it due to age, heredity, lifestyle or hobby. The main causes of pneumothorax:
- injuries;
- respiratory system diseases;
- medical interventions.
Open pneumothorax
This form of the disease occurs with severe damage to the chest. An open pneumothorax is an accumulation of air between the pleural lobes, which has an outlet to the outside. When breathing in, the gas fills the cavity, and on exhalation comes back. The pressure in the shell is gradually equated to the value of atmospheric, so the lung can not straighten. Because of this, it ceases to participate in respiratory processes and supplies blood with oxygen.
The open valve is a pneumothorax lung. This condition is characterized by a displacement of the tissues of the injured organ, bronchi, or muscles. As a result, air fills the pleural cavity on inhalation, but does not completely exhale. The pressure and volume of gas between the petals are constantly increasing, which leads to displacement of the heart and large vessels and flattening of the lung. There is a strong violation of blood circulation, breathing and oxygen exchange.
Closed pneumothorax
Provocators of this type of pathology can be minor bruises and superficial injuries. Similarly, it is observed when there is a spontaneous pneumothorax, the causes of which have not yet been established. The accumulation of air between the petals of the lung membrane is formed because a small defect appears in the pleura. Damage to the cavity has no outlet to the outside, and the volume of gas in it does not increase. Gradually the air dissolves itself even without medical intervention, and the defect is closed.
Pneumothorax - symptoms
The clinical picture depends on the shape and severity of the condition, the volume of air that accumulates in the pleural area. Sometimes signs of pneumothorax are practically absent. This is especially true of the spontaneous primary pathology. In other cases, pneumothorax of the lung may have the following symptoms:
- pain in the chest, giving to the shoulder from the damaged side;
- dry cough;
- dyspnea;
- more frequent heartbeats;
- panic fear of death;
- the release of cold viscous sweat;
- weakness in the body;
- purple-blue skin tint;
- whistling during breathing (with open lung pneumothorax);
- protruding gaps between the ribs;
- prominent chest protrusion;
- swelling under the skin (emphysema), when you click on which you hear a crunch, like from snow;
- lowering blood pressure;
- fainting.
Pneumothorax - diagnosis
First, the pulmonologist conducts a physical examination of the patient using percussion techniques (finger tapping) and auscultation (phonendoscope listening). The main way to diagnose pneumothorax is X-rays. It helps to see free air in the pleural membrane, to assess the degree of lung decay, displacement of the mediastinal organs. If the X-ray examination is not sufficiently informative, the methods of auxiliary diagnostics are used:
- computed tomography ;
- thoracoscopy;
- Exudate analysis from the pleural zone (puncture is performed with pneumothorax);
- study of the gas composition of blood;
- electrocardiography.
Pneumothorax - treatment
Simple cases of closed form of pathology do not require special therapy. In the absence of severe symptoms on the part of the respiratory and cardiovascular system, only the observation of the condition of the lung with the help of radiography is supposed. In other situations, the decision on how to treat pneumothorax is taken by the thoracic surgeon. Prior to the arrival of the victim in the hospital, it is important to prevent the development of complications, for this you need to perform a few simple activities.
Pneumothorax - emergency aid
The first thing to do when you suspect a condition in question is to call a medical team and calm a person. Valve and heavy closed pneumothorax requires immediate drainage of the pleural cavity. This manipulation will provide the accumulating air outward and help reduce the pressure between the petals of the protective shell of the respiratory organs.
If the patient has an open form of pathology, the pneumothorax of the damaged lung is audible, like whistling with inspiration and exhalations from the wound. The victim is important to calm and provide him with free access to oxygen, this will restore the breathing process a little. The first help in open-air pneumothorax is the application of a sealed occlusive dressing . It prevents the flow of air into the pleural cavity.
Drainage of pneumothorax
It is desirable that this manipulation performed by a qualified specialist. Professional pleural puncture with pneumothorax contributes to an immediate decrease in pressure in the shell of the lungs and normalization of respiration. If the patient's condition rapidly deteriorates, you can conduct an emergency drainage . To do this, pierce the wall of the chest on the damaged side with a disinfected thick needle, a thin tube with a sharp end or a similar object.
In the surgical department, pumping out excess air from the pleural cavity is carried out by special devices, for example, Bobrov's apparatus. Under local anesthesia, the doctor performs a puncture of the thorax with a sterile trocar. In the hole is installed drainage with an output in a glass container of a certain volume (Bobrov's bank). If the air is still too slow, it is practiced by actively pumping it with a vacuum aspirator (suction).
Occlusion bandage with pneumothorax
The main method of emergency treatment of an open form of pathology is to stop air access to the wound. The bandage for pneumothorax can be made from a thick layer of cotton wool wrapped with a sterile bandage, or improvised materials - clothes, towels and other things. It must completely cover the damage and prevent the penetration of gas into the hole. For maximum tightness, the bandage with an open pneumothorax is covered with a plastic film or cellophane bag.
In the hospital, the victim will be provided with qualified assistance, which includes:
- oxygen therapy;
- anesthesia;
- surgical stitching of open wounds, lung ruptures and its membranes;
- splicing of pleural petals with special preparations (pleurodesis).
Pneumothorax - complications
Approximately half of the patients described the condition causes dangerous consequences. The most severe is valve pneumothorax, surgery with chest cavity opening, air sucking and suturing of wounds is not always effective. In some cases, it ends with a fatal outcome. Other common complications of pathology:
- suppurative inflammation of the pleura (pyopneumothorax);
- subcutaneous emphysema ;
- compression of large vessels and heart;
- bleeding inside the pleural cavity;
- acute respiratory failure;
- stiffness (loss of function) of the lung.
Consequences of pneumothorax
The result of the accumulation of air in the pleural membrane depends on the form of the disease, its severity, concomitant damage to the chest. Valve pneumothorax has the most unfavorable prognosis, especially with serious wounds in the lungs. Other types of pathology respond well to treatment, but can provoke dangerous consequences and are prone to relapse. In uncomplicated pneumothorax lungs, the predictions are favorable.