Rupture of the lung is a serious injury that occurs when the organ and pleura are injured by parts of broken bones. It is most often observed in severe fractures of the ribs (numerous, paired, with displacement of debris). In isolated cases, pathology is detected with other mechanical damage - incomplete separation of the lung from the root as a result of excessive tension, which can occur during a sudden impact or fall. The disease is complicated by pneumothorax, hemothorax and hemopneumothorax of different severity levels.
Lung ruptures are often found as part of a complex injury (polytrauma) in road accidents, falls from a height, criminal incidents, industrial or natural disasters. Almost always, the pathology is accompanied by fractures of the ribs, and combinations of trauma with a fracture of the sternum, collarbone, bones of the limbs, pelvis, spine, kidney damage, blunt abdominal trauma and TBI are also possible. Lung ruptures are treated by traumatologists and thoracic surgeons.
Clinical picture
Often this pathology is mixed with a defect in the visceral pleura (the membrane inside the pleura that envelops the lungs). The parietal (outer) layer of the pleura can be damaged or be intact. The severity of signs of lung rupture directly depends on the intensity, depth and localization of the injury. The farther from the root of the lung is the gap, the less symptoms are manifested in patients. This is due to the fact that when the peripheral zones of the lung are injured, the integrity of only small vessels and bronchi is violated. Nevertheless, such damage can provoke life-threatening consequences due to the development of pneumothorax, absolute collapse of the lung and the formation of acute respiratory failure.
Partial detachment of the lung from the root is fraught with pathology of the integrity of large vessels and bronchi. A defect in the large lobar bronchi is accompanied by a very rapid formation of a total pneumothorax with an absolute collapse of the lung, and blood flow from the segmental and subsegmental arteries can only provoke the formation of a significant hemothorax. In some cases, this becomes the basis for a sharp blood loss with the development of hypovolemic shock. Bleeding from the pulmonary artery, inferior or superior vena cava in medical practice almost never come across, because due to powerful blood loss, patients, as a rule, die even before the arrival of an ambulance.
Reasons
Injury to the anatomical integrity of the respiratory system is severe and dangerousfor human life disease. The causes of lung rupture, the consequences of which must be eliminated in a timely manner, are as follows:
- Mechanical injury. This group of adverse factors includes the following reasons: bodily injury with sharp or piercing objects in the chest, car accidents, falling from a height.
- Due to medical intervention. May occur as a result of a patient ventilation procedure.
- Having habits that are dangerous to he alth (smoking cigarettes, hookah).
- Clot formation and blockage of large pulmonary arteries.
- Tuberculosis.
- The rapid pace of development of respiratory diseases contributes to the appearance of damage to the organ and its cavities.
- Cancer.
- The spread of cancer gene cells in the lungs damages the organ at the cellular level.
- Emphysema.
- The presence of purulent or inflammatory diseases of the organ.
- The presence of hereditary diseases associated with the accumulation of mucus in the bronchi.
- Professions associated with hazardous production, work with hazardous chemicals or inhalation of dust and fumes of hazardous substances. All this can provoke damage to the anatomical integrity of the lungs due to the accumulation of inhaled particles in them.
Symptoms
Depending on the causes contributing to the development of pathology, doctors distinguish the following symptoms of lung rupture, indicating damage to the integrity of the organ:
- Availabilitypain in the chest and shoulder.
- The appearance of a cough with bloody secretions. The appearance of this sign of the disease indicates damage to the organ and the presence of bleeding.
- Occurrence of shortness of breath and signs of oxygen deficiency.
- Difficulty in swallowing. Develops due to blockage of the airways with mucus or purulent secretions.
- Having chronic weakness.
- Increasing the size of the neck and chest. This phenomenon is observed due to the expansion of intercostal joints.
- The appearance of violations of the timbre of speech and intonation of the voice.
- Arrhythmia.
- Skin blanching.
- Increased subfebrile body temperature. This phenomenon indicates the presence of an inflammatory process in the body.
- Change in the size of the lungs. Indicates the presence of inflammatory diseases of the lungs or the spread of oncology and damage to the cells of the organ by the oncogene.
- The appearance of characteristic sounds when taking a deep breath.
When the above manifestations of pathology appear, you must immediately contact the clinic for differential diagnosis and treatment.
Diagnosis
Rupture of the lung is a very terrible diagnosis that can even lead to death. It is necessary to treat such a disease only in medical institutions under the close attention of specialists. In no case should you self-medicate, because a lung rupture occurs due to fractures of the chest, ribs or a fall from a great height.
This terrible diagnosis can be identified in several ways:
- With the help of X-rays, which is the fastest, and you need to act quickly.
- MRI - magnetic resonance imaging, which can show specialists what is happening in a particular organ.
- Computed tomography.
Fluorography
The most common method for diagnosing a lung rupture is fluorography, but with its help it is not always possible to accurately determine the location of the rupture and the degree of its danger, so it is better, of course, to use the last two methods.
Self Diagnosis
In brief, it should be noted signs of rupture of the lungs, which can be used to determine the disease without medical intervention:
- shortness of breath, severe shortness of breath;
- spitting blood;
- severe hematoma in the chest area.
But it is best to go to the hospital as soon as possible after such injuries and immediately begin treatment under the supervision of doctors. Although it often happens that the ambulance simply does not have time to get there in such cases, especially if the rupture happens very close to the base of the lung.
Treatment
Injury to the lung is a life-threatening condition requiring emergency surgery. If the patient's condition is satisfactory, he is transported to the hospital, but experts recommend calling in doctors who will quickly determine the most optimal treatment algorithm and assess the condition of the victim.
Therapy Protocol
Treatment of a ruptured lung follows the following emergency protocol:
- Measures are being taken to prevent air from entering the pleural cavity.
- Restoring the integrity of the lung parenchyma.
When saving an organ, it is necessary to restore its functions as quickly as possible. If it is necessary to remove the damaged lung, the functions of the remaining part of the organ are developed. A positive effect is often given by hemostatic drugs (gelatin, calcium chloride) or blood transfusion. If the patient's condition worsens - shortness of breath increases, bleeding increases and stenosis appears, even despite the treatment started, it may be necessary to perform surgery on the lung parenchyma.
Usually, the patient is prescribed inpatient treatment, where drainage of the pleural cavity is performed to remove excess fluid and air from the lungs. With minor damage to the organ and a satisfactory condition of the patient, doctors can simply observe the patient. If the damage to the organ is severe, the patient is shown an operation with open access. A council of doctors decides whether it is possible to save some part of the lung, or is it impossible.
Surgery
When performing surgery, general anesthesia is usually used with the use of ether-oxygen anesthesia, which is administered by the intratracheal method. But in some cases, the operation can be performed under novocaine local anesthesia. Desirableanesthetize not only the skin, but also the subcutaneous tissue, mediastinal pleura, incision lines, the root of the lung and the thoracic nerve. Also, when the lungs are ruptured, they perform:
- videothoracoscopy with laser and electronic coagulation;
- the injured area is treated with fibrin or medical (cyanoacrylate) glue;
- impose a Roeder loop;
- hardware or manual stitch.
- thoracotomy - suturing the wound with two-row interrupted sutures.
The first two methods, to which marginal or typical resection of the affected organ is added, are the most popular. In any case, after the operation, drainage and mandatory sanitation of the pleural cavity are performed.
Consequences
The consequences of lung rupture can be divided into two groups. The first, early group includes respiratory failure, pain shock, pushing back of the chest organs. If, after a lung rupture, a collapsed organ is straightened excessively rapidly, a decrease in blood pressure is acceptable. Over time, it returns to normal.
Late results of lung rupture: infection, formation of an inflammatory process in open pneumothorax. With an open pneumothorax, blood often enters the chest, and hemopneumothorax may develop. There may be a secondary spontaneous closed rupture of the lung, as there are other dilated alveoli that can crack.
