Spontaneous pneumothorax is a pathological condition that is characterized by a sudden violation of the integrity of the pleura. In this case, air enters from the lung tissue into the pleural region. The appearance of spontaneous pneumothorax can be marked by acute chest pain, and in addition, patients experience shortness of breath, tachycardia, pallor of the skin, acrocyanosis, subcutaneous emphysema, and the desire to assume a forced position.
As part of the primary diagnosis of this disease, X-rays of the lungs and diagnostic pleural puncture are performed. In order to establish the causes of spontaneous pneumothorax (ICD J93.1.), the patient must undergo an in-depth examination, for example, computed tomography or thoracoscopy. The treatment process for spontaneous pneumothorax involves drainage of the pleural area with air evacuation along with video-assisted thoracoscopic or open intervention, which includes the removal of bullae, lung resection, and so on.
The causes of spontaneous pneumothorax will be discussed in this article.
What is this?
Under this condition in pulmonologyrefers to spontaneous pneumothorax, which is not associated with trauma or iatrogenic medical and diagnostic intervention. The disease, according to statistics, occurs more often in men, predominating among people of working age, which determines not only the medical, but also the social significance of the problem. In the traumatic and iatrogenic form of spontaneous pneumothorax, a causal relationship between the disease and external influences is clearly traced, which can be various chest injuries, puncture of the pleural cavity, vein catheterization, pleural biopsy or barotrauma. But in the case of spontaneous pneumothorax, there is no such conditionality. In this regard, the choice of adequate diagnosis and treatment tactics seems to be the subject of increased attention on the part of pulmonologists, phthisiatricians and thoracic surgeons.
Classification
According to the etiological principle, there are primary and secondary forms of spontaneous pneumothorax (ICD code J93.1.). The primary type is spoken of against the background of a lack of information about clinically significant pulmonary pathology. The occurrence of a secondary spontaneous form occurs as a result of concomitant lung diseases.
Depending on the collapse of the lung, there are partial and total spontaneous pneumothorax. With a partial lung, it falls by one third of its original volume, and with a total one, by more than half.
According to the level of compensation of the respiratory and hemodynamic disorder that accompanies the pathology, there are threethe following phases of pathological changes:
- Steady compensation phase.
- The compensation phase of the unstable nature.
- Uncompensated phase.
The phase of stable compensation is observed after spontaneous partial volume pneumothorax. It is marked by the absence of signs of respiratory and heart failure. The level of unstable compensation is accompanied by the development of tachycardia, and in addition, shortness of breath during physical exertion, along with a significant decrease in external respiration, is not excluded. The decompensation phase manifests itself in the presence of shortness of breath at rest, while there is also a pronounced tachycardia, microcirculatory disturbances and hypoxemia.
Reason for development
Primary spontaneous pneumothorax can develop in individuals who do not have clinically diagnosed lung disease. But when performing videothoracoscopy or thoracotomy in this category of patients, emphysematous bullae located subpleurally are detected in seventy percent of cases. There is a mutual relationship between the frequency of spontaneous pneumothorax and the constitutional category of patients. Thus, given this factor, the described pathology most often occurs among thin and tall young people. It is also worth noting that smoking increases the risk of the disease up to twenty times. What are the other causes of spontaneous pneumothorax?
Secondary form
The secondary form of the pathology can be formed against the background of a wide range of pathologies of the lungs, tofor example, this is possible with bronchial asthma, pneumonia, tuberculosis, rheumatoid arthritis, scleroderma, ankylosing spondylitis, malignant neoplasms, and so on. If a lung abscess enters the pleural region, as a rule, pyopneumothorax develops.
Rarer varieties of spontaneous pneumothorax include menstrual and neonatal. Menstrual pneumothorax is associated with breast endometriosis and can develop in young women in the first two days after the onset of menstruation. Help for spontaneous pneumothorax should be timely.
The chance of a recurrence of menstrual pneumothorax, even with conservative treatment of endometriosis, is about fifty percent, so immediately after diagnosis is made, pleurodesis is performed to prevent recurrence.
Neonatal pneumothorax
Neonatal pneumothorax is a spontaneous form that occurs in newborns. This type of pathology occurs in two percent of children, most often it is observed in boys. This disease may be associated with a lung expansion problem or the presence of a respiratory syndrome. In addition, the cause of spontaneous pneumothorax may be a rupture of lung tissue, malformations of the organ, and the like.
Pathogenesis
The degree of severity of structural changes directly depends on the time that has passed since the onset of the disease. In addition, it depends on the presence of an underlying pathological disorder in the lung and pleura. No less impactrenders the dynamics of the inflammatory process in the pleural region.
Against the background of spontaneous pneumothorax, there is a pulmonary-pleural communication, which determines the penetration and accumulation of air in the pleural region. There may also be partial or complete collapse of the lungs.
The inflammatory process develops in the pleura four hours after spontaneous pneumothorax. It is characterized by the presence of hyperemia, injection of pleural vessels and the formation of some exudate. For five days, swelling of the pleura may increase, mainly this occurs at the site of its contact with the trapped air. There is also an increase in the amount of effusion along with the loss of fibrin on the pleural surface. The progression of inflammation may be accompanied by the growth of granulations, and, in addition, fibrous transformation of the precipitated fibrin occurs. The collapsed lung is fixed in a contracted state, so it becomes unable to crack down. In case of infection, pleural empyema may develop over time. It is not excluded the formation of a bronchopleural fistula, which will support the course of pleural empyema.
Symptoms of pathology
According to the nature of the clinical symptoms of this pathology, a typical type of spontaneous pneumothorax and latent are distinguished. The typical spontaneous may be mild or violent.
In most situations, primary spontaneous pneumothorax can occur suddenly against the background of absolute he alth. For the first timeminutes of illness, there may be a sharp stabbing or squeezing pain in the corresponding half of the chest. Along with this, shortness of breath appears. The severity of pain varies from mild to extremely severe. Increased pain occurs when trying to take a deep breath, and, moreover, when coughing. Pain may radiate to the neck, shoulders, arms, abdomen, or lower back.
During the day, the pain syndrome, as a rule, noticeably decreases or disappears completely. Pain may resolve even if spontaneous pneumothorax (ICD 10 J93.1.) has not resolved. The feeling of respiratory discomfort, along with lack of air, appears only during physical exertion.
Against the background of violent clinical manifestations of the pathology, the pain attack with shortness of breath is extremely pronounced. There may be short-term fainting, pallor of the skin, and in addition, tachycardia. Quite often at patients at the same time there is a feeling of fear. Patients try to spare themselves by limiting their movements, taking a supine position. Often there is a development and progressive increase of subcutaneous emphysema along with crepitus in the neck, trunk and upper limbs.
In patients with a secondary form of spontaneous pneumothorax, due to the limited reserves of the cardiac system, the pathology is much more severe. Complicated options include the development of a tense form of pneumothorax along with hemothorax, reactive pleurisy and bilateral collapse of the lungs. The accumulation, and, in addition, the prolonged presence of an infectedsputum in the lung leads to abscesses, the development of secondary bronchiectasis, and in addition to repeated episodes of aspiration pneumonia, which can occur in a he althy lung. Complications of spontaneous pneumothorax, as a rule, develop in five percent of cases. They can pose a serious threat to the lives of patients.
Diagnosis of spontaneous pneumothorax
Examination of the chest can reveal the smoothness of the relief of the intercostal spaces, and in addition, determine the limitations of the respiratory excursion. In addition, subcutaneous emphysema can be found along with swelling and dilation of the neck veins. On the part of the collapsed lung, there may be a decrease in voice trembling. During percussion, tympanitis can be observed, and during auscultation, the complete absence or significant weakening of respiratory sounds. What are the main recommendations for spontaneous pneumothorax?
Priority attention in the framework of diagnostics is given to radiation methods. The most commonly used chest x-ray and fluoroscopy, which make it possible to assess the amount of air in the pleural region along with the degree of collapse of the lung, depending on the localization of spontaneous pneumothorax. A control x-ray examination is carried out after medical manipulations, whether it is a puncture or drainage of the pleural cavity. X-ray examination makes it possible to evaluate the effectiveness of treatment methods. Subsequently, with the help of high-resolution computed tomography, carried out along with magnetic resonance therapylungs, it is possible to establish the cause of the appearance of this pathology.
A highly informative technique used in the diagnosis of spontaneous pneumothorax is thoracoscopy. In the process of this study, specialists manage to identify subpleural bullae along with tumor or tuberculous changes on the pleura. In addition, a biopsy of the material for morphological studies is performed.
Spontaneous pneumothorax, which has a latent or erased course, must be able to differentiate primarily from the presence of a bronchopulmonary cyst, and in addition, from the presence of a diaphragmatic hernia. In the latter case, an x-ray of the esophagus is a great help in diagnosing.
Treatment of disease
Let's consider the emergency care algorithm for spontaneous pneumothorax.
Therapy of the disease requires, first of all, the fastest possible evacuation of air that has accumulated in the pleural cavity. The generally accepted standard in medicine is the transition from diagnostic tactics to therapeutic measures. Obtaining air within the framework of thoracocentesis serves as an indication for drainage of the pleural cavity. Thus, pleural drainage is installed in the second intercostal space at the level of the midclavicular line, after which active aspiration is performed.
Improvement of bronchial patency along with the evacuation of viscous sputum greatly facilitate the task of expanding the lung. Patients undergo therapeutic bronchoscopy, tracheal aspiration, inhalation with mucolytics, breathing exercises and oxygen therapy as part of the treatment of spontaneouspneumothorax.
In the event that the lung does not expand within five days, specialists turn to the use of surgical tactics. It, as a rule, consists in performing thoracoscopic diathermocoagulation of adhesions and bullae. In addition, in the treatment of spontaneous pneumothorax, bronchopleural fistulas can be eliminated along with the implementation of chemical pleurodesis. With the development of recurrent pneumothorax, depending on its cause and condition of the tissues, an atypical marginal lung resection, lobectomy, and in some cases pneumonectomy may be prescribed.
With spontaneous pneumothorax, emergency care should be provided in full.
Prognosis for patients with this pathology
In the presence of primary pneumothorax, the prognosis is usually favorable. As practice shows, lung expansion can be achieved by minimally invasive methods. With the development of secondary spontaneous pneumothorax, relapses of the disease can develop in fifty percent of patients. Which requires the obligatory elimination of the root causes, and in addition, it involves the selection of more effective treatment tactics. Patients who have suffered spontaneous pneumothorax should be under the strict supervision of a pulmonologist or thoracic surgeon at all times.
Conclusion
Thus, spontaneous pneumothorax is an ailment caused by the penetration of air into the pleural region from the environment as a result of a violation of the superficiallung integrity. This pathology is registered mainly among men at a young age. In women, this disease occurs five times less frequently. First of all, with the development of spontaneous pneumothorax, people mainly complain of pain that occurs in the chest. In this case, patients may experience difficulty breathing and a cough, which, as a rule, is dry. In addition, there may be a decrease in exercise tolerance. After a few days, an increased body temperature may appear.
Diagnosis usually does not cause any difficulties for experienced professionals. To accurately confirm this disease, a chest x-ray is performed, which is performed in two projections. If necessary, surgery is carried out, which is performed under general anesthesia.
