With a disease such as valvular pneumothorax, oxygen enters the pleural region, the amount of which begins to gradually increase. The manifestation of such a pathology is associated with the peculiarity of the functioning of the valve. Its work is disturbed due to the penetration of air from the lungs into the pleura and the impossibility of its reverse movement. Because of this, severe pain occurs in the chest area, because there is a significant decrease in lung volume and the process of inhalation is difficult.
This pathological condition has been known for a very long time, and its occurrence was associated with the consequences of pulmonary tuberculosis. But relatively recently it was found that the disease appears suddenly. Often this pathology is diagnosed if breathing problems are associated with bulla rupture.
Views
Valvular pneumothorax is internal and external, and it dependsfrom the mechanism of education. The internal view of pneumothorax occurs due to damage to the large bronchus and the presence of a patchy lung wound. The pleural cavity is filled with air through a defect in the visceral pleura. At the same time, a flap of lung tissue acts as a valve, which allows air to pass through on inspiration, and on exhalation does not allow gas to escape back into the lung.
The appearance of pneumothorax is characterized by the fact that in this case the soft tissues of the injured chest act as a valve. When inhaling, the edges of the wound begin to expand, air freely enters the pleural cavity, and when exhaling, the opening of the wound collapses without releasing it back.
Causes of disease
Valvular pneumothorax has different causes. Most often, we are talking about the traumatic and spontaneous nature of the disease.
The cause of wound (traumatic) pneumothorax is a closed chest injury, accompanied by a rupture of lung tissue or a penetrating wound to the chest. In this case, there is a fairly rapid "gluing" of the wound opening on the chest wall, while the bronchus wound continues to gape. These types of injuries include:
- rib fractures;
- gunshot and stab wounds to the chest;
- damage to the bronchus or esophagus by a foreign body;
- falling from a height;
- bronchial ruptures, etc.
Spontaneous pneumothorax is characterized by a rupture of an altered area of lung tissue. Contributethe development of this pathology the following diseases:
- tuberculosis;
- bullous emphysema;
- cystic fibrosis;
- lung abscess;
- pneumoconiosis and others
Predisposing factors for the development of spontaneous pneumothorax are coughing, diving, physical exertion, etc.
Symptoms
Usually, with valvular pneumothorax, the patient is in an extremely serious condition. He becomes agitated, there is a pronounced pain in the chest, radiating to the shoulder blade, shoulder, abdominal cavity. Shortness of breath, weakness, cyanosis begins to progress rapidly, loss of consciousness is observed, intercostal spaces expand, the affected side of the chest increases in volume. Rapid shallow breathing, arterial hypotension, tachycardia are also signs of valvular pneumothorax.
Air, rapidly accumulating in the pleural cavity, can cause heart or lung failure, resulting in death. Late complications of the pathology include pleural empyema and reactive pleurisy.
Diagnosis
When examining a patient, the doctor reveals subcutaneous emphysema, lag during breathing of the affected side of the chest, smoothness of the intercostal spaces. With the help of X-ray of the lungs, a collapse of the lung and a shift to the he althy side of the mediastinal shadow are detected.
Pleural puncture with manometry allows you to distinguish between open, closed and valvularpneumothorax. If fluid is present, aspiration is performed and further examination of the pleural effusion for cellular composition and microflora. To identify the location and size of the pleural fistula, diagnostic thoracoscopy and pleuroscopy are performed.
Treatment
First of all, the treatment of valvular pneumothorax should be directed to the decompression of the mediastinum and lung, and to do this as quickly as possible. To do this, unloading puncture or transthoracic drainage of the pleural cavity is carried out with the obligatory imposition of passive drainage according to Bulau. Only after such manipulations the patient is transported to the hospital for further treatment.
To stabilize the patient's condition, non-narcotic and narcotic analgesics, cardiovascular drugs, antibiotics, antitussives are administered to him.
It is very important to convert valvular pneumothorax into a closed one. For this, it is necessary to constantly drain the pleural cavity. If air stops flowing through the drain, this indicates that the cavity is sealed. The drainage is removed two days after the lung is completely expanded, if this is confirmed radiographically.
If the lung could not be straightened, then surgical treatment of pneumothorax is performed. Injury to the chest requires suturing the wound and performing a thoracotomy. If there is a threat of re-formation of spontaneous valvular pneumothorax, then surgical treatment of the underlying disease is used. Depending on the pathologyperform segmentectomy, bilobectomy, marginal lung resection, lobectomy, pleurectomy, pleurodesis and other interventions.
Urgent Illness Care
There are situations that the patient may need urgent help with valvular pneumothorax. To save his life, you must:
- calm the person;
- provide him with access to fresh air;
- calling a doctor urgently.
First aid is to pierce the chest wall with a thick needle. Thanks to this, it is possible to quickly reduce the high pressure inside the pleura.
Prevention and prognosis
Complication of valvular pneumothorax is shock lung syndrome, pyopneumothorax, cardiopulmonary failure. Timely medical care helps to achieve recovery.
Disease prevention is aimed at preventing injuries. In addition, during a preventive examination, a pulmonologist, a phthisiatrician and a thoracic surgeon identify patients with pulmonary pathology.
Conclusion
Thus, valvular pneumothorax is considered a very dangerous disease, in which untimely assistance is fatal. Therefore, a patient with such a pathology should definitely consult a doctor, and as soon as possible.
