The human respiratory organs are protected by a special pleural cavity, which includes two petals and an empty space between them. The pressure in the outer shell of the lungs in a normal state should be below atmospheric. If air suddenly enters the pleural cavity, it increases significantly in size, which provokes the development of pneumothorax. The lungs, due to changes, cease to expand normally and do not take an active part in breathing.
Varieties of pneumothorax
There are a large number of varieties of this disease. All of them are classified depending on the severity, place of distribution, communication with the external environment, the volume of the collapse and other features.
The most understandable is the classification, which is carried out in accordance with the causes of the development of the disease:
- spontaneous;
- traumatic;
- artificial pneumothorax.
Traumatic form of pneumothorax
This form of the disease often occurs as a result of an unfortunate set of circumstances - road traffictraffic accident or robbery. Traumatic pneumothorax is characterized by the accumulation of excess air between the pleural lobes as a result of a penetrating (bullet, knife) or blunt wound in the chest area (blow, bruise).
In some cases, the protective shell is damaged as a result of the manipulations of the treating specialists. At the same time, iatrogenic pneumothorax of the lung is detected. It most often develops as a result of:
- punctures;
- artificial ventilation;
- biopsy;
- after insertion of the subclavian catheter.
Spontaneous disease
The described form of the lesion is further divided into two types: symptomatic and idiopathic. The first type appears in absolutely he althy people of different ages and its causes have not yet been precisely established. Factors that may presumably lead to this condition:
- hereditary and congenital genetic anomalies;
- for men;
- ages 20 to 40;
- tobacco abuse;
- high growth;
- activities that involve frequent pressure drops (air travel, diving, rock climbing and mountain climbing and other similar activities);
- excessive everyday physical activity that is associated with a person's professional activities.
Symptomatic or secondary form of pneumothorax is quickly determined in people with diseases that spread to the organs of the respiratory system. The following diseases can lead to the accumulation of excess air in the pleural cavity:
- pneumonia;
- sarcoidosis;
- exacerbated form of bronchial asthma;
- cystic fibrosis;
- tuberculosis;
- Histiocytosis X;
- fibrosing alveolitis;
- chronic obstructive pulmonary disease;
- lung abscess;
- oncological diseases;
- rheumatoid arthritis;
- dermatomyositis;
- lymphangioleiomyomatosis.
In especially serious cases, the accumulation of excess air between the lobes of the lung can provoke not only an increase in pressure, but also an acute lack of oxygen, as well as a rapid decrease in blood pressure in the arteries.
In this condition, doctors diagnose tension pneumothorax and prescribe a complex and long course. It is important to remember that this form of the disease is considered the most dangerous. If timely treatment is not started, then as a result, the patient may experience serious problems that will endanger his life.
Artificial pneumothorax
A disease of this nature is considered a special medical manipulation. Before the creation of new chemical medicines, minimally invasive methods of surgical intervention and computed tomography, artificial pneumothorax in tuberculosis was the most effective method of treatment and diagnosis.
Partial collapse of the infected lung leads to the disappearance of foci of tissue necrosis, as well as the resorption of fibrosis andgranulation.
Professional pulmonologists rarely use the method of artificial introduction of air into the pleural cavity. It is important to remember that there are indications for such a procedure:
- the presence of bleeding in the organ (in this case, the specialist needs to know from which side it started);
- destructive tuberculosis with fresh caverns;
- if modern chemotherapy is not available.
In some cases, the disease appears suddenly in a young man who is predisposed to it because of his age, genetics, lifestyle or occupation.
Open pneumothorax
This type of disease occurs as a result of severe damage to the chest. An open pneumothorax is an accumulation of air between the pleural lobes, which has an outlet to the outside. At the exit, the gas fills the cavity, and at the exit it flows back. The pressure in the shell is restored over time and becomes equal in value to atmospheric pressure, which prevents the lung from expanding normally. It is because of this that it ceases to take part in the respiratory process and supply oxygen to the blood.
One of the varieties of open pneumothorax is valvular. This condition is characterized by displacement of the tissues of the diseased organ, muscles and bronchi. As a result of this process, air fills the pleural cavity of the lung on inspiration, but is not exhaled in full.
The pressure and volume of gas between the petals is constantly increasing, which leads to displacement of the heart, large vessels and flattening of the lung and provokesimpaired circulation, breathing problems and oxygen volume.
Signs of closed pneumothorax
Slight bruises and superficial injuries can provoke the disease. Along with this, spontaneous pneumothorax may appear, the causes of which have not yet been fully studied. The accumulation of air between the petals of the lung occurs because a small defect is formed in the pleura.
Deformation of the cavity does not lead to the release of air to the outside, so the volume of gas in it remains the same. Over time, the air resolves itself without the help of a doctor, and the defect disappears.
What are the symptoms?
Clinical signs of pneumothorax manifest themselves unexpectedly, for example, there is acute pain in the chest, which is accompanied by shortness of breath. In some cases, a dry cough occurs. The patient cannot lie down due to severe pain, so he has to sit up.
Signs of an open pneumothorax are as follows: severe and frequent shortness of breath, blue face, increased weakness, and possible loss of consciousness.
With a small amount of air entering the pleural cavity, the pain quickly disappears, but the patient continues to have frequent shortness of breath and increased heart rate. Pneumothorax may or may not present with clinical signs or symptoms.
In case of traumatic pneumothorax, the disease affects the condition of the person as a whole. The first signs of pneumothorax: rapid breathing (above 40 breaths per minute), blue skin, lower blood pressure,increased heart rate, the appearance of acute cardiopulmonary insufficiency.
From a wound on the chest wall during the respiratory process, blood is released with air bubbles. This condition is of particular danger when air accumulates too quickly in the pleural cavity, which leads to collapse of the lung, displacement and compression of the mediastinal organs (bronchi, large vessels and heart).
In the case of a traumatic form of pneumothorax, air in some cases accumulates in the subcutaneous tissue of the face, chest wall and neck. As a result of this process, parts of the body become larger and swell. If you touch an area of skin with subcutaneous emphysema inside, you can feel a characteristic sound, suitable for the crunch of snow. The doctor will help determine the x-ray signs of pneumothorax.
The course of the disease in children
The main signs of tension pneumothorax in children manifest themselves in an acute form. This condition develops as a result of uneven expansion of the respiratory organs, especially in the presence of malformations. In children under the age of three, the process can be the result of pneumonia.
Signs of spontaneous pneumothorax in elderly patients appear at the time of coughing during an acute attack of bronchial asthma, inhalation of a foreign body. As a rule, it appears as a complication as a result of a recent surgical intervention.
Pneumothorax in a child may not provoke obvious symptoms, but is often characterized by short-term respiratory arrest, and in difficult situations - rapid heartbeat,convulsions and blue skin. Treatment of pneumothorax in this case is carried out in the same way as in an adult.
Symptoms of spontaneous pneumothorax
According to the clinical picture, spontaneous and latent pneumothorax is classified. A typical clinical picture may include violent and moderate symptoms at the same time.
Signs of spontaneous pneumothorax appear suddenly. Already in the first minutes, sharp stabbing or squeezing pains are felt in half of the chest, acute shortness of breath. The strength of pain can be very different (from intense to very strong). Increased pain begins when you try to take a deep breath or cough. Pain radiates to the neck, shoulders, abdomen, arms and lower back.
Over the next 24 hours, the pain gets worse or doesn't go away completely even when the spontaneous pneumothorax goes away. X-ray signs of pneumothorax will help to identify the attending physician after the examination. The feeling of respiratory discomfort and lack of air is especially pronounced at the time of playing sports.
Tension Pneumothorax
Signs of tension pneumothorax are as follows:
- strong lacrimation;
- the appearance of a sudden feeling of panic fear;
- skin blanching;
- sharp pain in the chest that only gets worse at the moment of inhalation;
- shortness of breath and palpitations;
- an attack of dry cough.
Description of closed symptoms
Signs of a closed pneumothorax include pain, respiratory failure, and circulatory problems, the severity of which depends on the amount of air accumulated in the pleural cavity.
The disease most often manifests itself unexpectedly for the patient himself, but in 20 percent of all cases an atypical and erased beginning is determined. In the presence of a small amount of air, the signs of the disease do not manifest themselves, and a limited pneumothorax is diagnosed during routine fluorography.
In the presence of an average or total closed pneumothorax, the signs are as follows: stabbing pains in the chest, passing to the neck and arms. The patient takes the position that brings the least pain - sits down, rests his hands on the bed, and his face is covered with cold sweat. Subcutaneous emphysema passes through the soft tissues of the neck, trunk and face, which is caused by the ingress of excess air into the subcutaneous tissue.
With the development of tension pneumothorax, the patient's condition is very serious. The patient shows anxiety, he feels fear due to suffocation, begins to catch air with his mouth. The pressure increases significantly, the skin of the face is stained, a collaptoid state may appear. The symptoms described are associated with complete collapse of the lung and mediastinal displacement to the he althy side. If timely assistance is not provided to the patient, then pneumothorax as a result can lead to asphyxia and acute cardiovascular failure.
Help
First aid for symptomspneumothorax should be promptly, because the he alth and life of a person will depend on it. To a greater extent, this applies to the situation when air enters the pleural cavity from the outside. An open form of pneumothorax requires its rapid change to a closed one. To do this, the patient is put on a special sealed bandage for a while.
If there is no special medical material, then you can use several layers of simple gauze, on top of which an oilcloth or compression paper is applied. After the patient is delivered to a medical institution, the following procedures are urgently carried out: drainage of the pleural cavity, thoracotomy, lung revision and surgical treatment of an open wound.
Spontaneous form of pneumothorax, which does not occur due to mechanical damage to the chest, is also quite dangerous for the life and condition of the patient and requires mandatory hospitalization.
If the disease is not accompanied by pronounced symptoms and disruption of the respiratory system, then assistance will include strict adherence to bed rest and restriction of human mobility. If there is a severe cough, the doctor prescribes antitussive medicines.
In the presence of other forms of the described disease, doctors make a more active treatment plan. The patient is prescribed cardiac glycosides, oxygen inhalations, puncture of the pleural cavity in order to remove fluid and air from the organ. If the proceduresdid not give any effect, then doctors will have to use surgery.
The operation is carried out by suturing the wound formed in the lung, removing the parietal pleura and reserving pathological changes in the tissues of the organ. If the disease goes away against the background of infection, then the patient is additionally prescribed antibiotics.
To prevent a possible relapse, preventive methods are used, in which irritating components (glucose, talc, silver nitrate solution) are injected into the pleural cavity.
With the re-development of pneumothorax and severe course of the disease, the prognosis is made depending on all the symptoms and features of the course of the lesion, including its nature and severity. If the treatment of the disease is started on time in compliance with all the recommendations of the doctor, then as a result the disease passes quickly and does not lead to complications. You need to visit a doctor immediately after the first symptoms of the disease appear. He will prescribe an examination and determine the radiological signs of pneumothorax, give recommendations on further treatment.
