Pneumothorax is a dangerous disease, which, with untimely diagnosis and incorrect therapeutic measures, can lead to death of the patient. Therefore, it is very important at the first signs of pathology to consult a doctor and take an X-ray of pneumothorax, so that it will be possible to detect the disease in time and save the patient's life.
Pathology classification
Types of pneumothorax:
- Spontaneous. This type of pneumothorax occurs mainly due to damage to the lung tissue. The disease can be primary and secondary. The X-ray image of spontaneous pneumothorax is characterized by the absence of a pulmonary pattern. The organ itself during inspiration straightens and takes the correct position, and when you exhale, you can again see its pathological location.
- Tense. This type of pneumothorax is also characterized by the absence of a pulmonary pattern, as well as a deviation of the upper part of the diaphragm and a shift of the mediastinum towards a healthy organ.
- Cloisonne. This type of pathology develops secretly and in most cases is detected during fluorography performed as a preventive measure. If suspected of cloisonne pneumothorax, diagnosis should be carried out only in an upright position, since all other positions will not show the proper information, as a result of which the doctor will not be able to make the correct diagnosis.
- Left-handed. On the x-ray of the left-sided pneumothorax, the visceral edge of the pleura is clearly visible, which forms in the form of a thin white strip, separated from the parietal leaf by gas or air space.
Pneumothorax for tuberculosis
Pneumothorax is one of the complications of tuberculosis, but it is extremely rare. Pathology is formed spontaneously in violation of the integrity of the pleural leaf, located in the inner part of the lung. Such a lesion can lead to the formation of a fistula in the pleural cavity, as a result of which air penetrates into the lung.
Other reasons
There are a number of other reasons that can also trigger the development of pneumothorax:
- infectious diseases;
- chronic respiratory diseases - bronchitis, asthma;
- malignant tumors and metastases from other affected organs;
- purulent foci of lung tissue;
- sharp change in climatic conditions.
Symptomatic manifestations
Signs of pneumothorax depend on the severity of the underlying disease, in most cases it is tuberculosis. If the disease proceeds in a long latent stage, then the signs of pneumothorax may not be detected, since in most cases they are referred to as tuberculosis. However, if proper therapy is not performed with tuberculosis or the disease progresses, then specific signs may appear.
Pain sensation is the main symptom of the development of pneumothorax. The pain can be compressive or stitching and develops in the affected part of the chest. In most cases, pain is localized in the upper chest, but is sometimes given to the lower back, arm, shoulder, abdomen or neck. Along with pain, the following unpleasant symptoms of pathology occur:
- Arrhythmia, breathing becomes deeper and more frequent.
- Strong dry cough.
- Shortness of breath, which increases as the pathology develops.
- From an excess of carbon dioxide in the circulatory system, the skin takes on a bluish tint.
- With pneumothorax, the patient experiences compression in the chest.
- Due to the development of pneumothorax, the patient may begin to panic and anxiety.
Diagnostic measures
X-ray of pneumothorax is the most informative diagnostic method in this case. Pathology can be determined using modern fluoroscopy devices that do not cause any harm to the patient. An x-ray is usually carried out in direct and lateral projections, after which a description of pneumothorax on the x-ray is carried out.
Alternative Diagnostics
If the photo of pneumothorax on an x-ray does not show a complete picture of what is happening, the doctor may prescribe an ultrasound examination of the lung and blood gas measurement as additional diagnostic measures.
An alternative to x-ray is computed tomography of the lung, which is most advisable in the following cases:
- In order to identify what was the true reason for the development of pneumothorax. This can be determined using emphysematous bullae detected during diagnosis.
- If it is necessary to detect the localization of not extensive pneumothorax in size.
- Determine the cause of the secondary development of pathology.
After carrying out these diagnostic methods, along with the radiograph, the doctor gets a complete picture of how badly the organ is affected.
With the accumulation of air in the upper part of the lung, fluoroscopy is performed, that is, the diagnosis is made in real time by the fact that the patient is examined from several sides. During the rotation of the patient, the doctor determines the movement of air in the lung. Such an analysis is carried out if the pressure in the chest of the patient does not change, despite the confirmation of pneumothorax. If the disease is not detected on time, then the pressure will increase significantly, there will be a strong decline in the lung, resulting in a lack of oxygen in the human body.
Pneumothorax Classification
In the process of diagnosis, three types of pathology are identified, each of which has a number of features:
- Open. With open pneumothorax, a channel forms in the patient, which connects the pleural cavity and the external environment. The pressure in the chest is equal to atmospheric pressure, as a result of which the lung tissue begins to subside and the organ ceases to function. In the X-ray photo of open pneumothorax, you can see that the lung tissue is compressed, the dome of the diaphragm becomes flat, and the middle wall of the lung is shifted to the side. The prognosis for open pneumothorax is unfavorable.
- Closed. With closed pneumothorax, the movement of air to the organs of the chest is much more difficult. Often in the pleural cavity there may be no damage, but in some cases it is covered with tissue particles, small blood clots or pus. An X-ray pneumothorax of the closed type lacks a pulmonary pattern, and the edges of the organ are clearly visible. The closed type of pneumothorax of the lungs lends itself well to therapy and does not leave behind any consequences or complications.
- Valve. This type of pathology is characterized by the formation of a valve that passes air into the lung, but does not release it. In this regard, the internal pressure rises significantly and becomes much greater than atmospheric pressure, while the patient's vessels of the heart and trachea are compressed, as a result of which breathing is much faster and the person falls into a shock state. In the X-ray image of pneumothorax of the valve-type lungs, it is clearly visible that the middle wall of the lung is shifted to the side opposite to that in which the pathological process began to develop. A characteristic feature of this type of pathology is that the degree of danger to human life depends on how fast atmospheric air penetrates into the lungs.
What is the importance of diagnosis?
Since the pathology develops rather slowly, with an x-ray, you can identify the initial stage of pneumothorax. This can save the patient’s life, since in the event of a lung rupture, the doctors have very little time to do this.
An x-ray with suspected pneumothorax is one of the main diagnostic methods for pathology. One of the basic manifestations of the disease is air in the pleural cavity. In the X-ray picture of pneumothorax pulmonary pattern is not detected. Along with this, the presence of air in the lung appears as a white spot. Due to the specifics of the manifestations on the x-ray of pneumothorax, one can determine the type of pathology that can be classified as open, closed and valve pneumothorax.
In addition to radiography, the doctor conducts a visual examination of the patient, and blood gasometry and ultrasound may also be required.
The basic principles of therapy
Therapy of pneumothorax developed as a result of tuberculosis is complex. During treatment, the doctor conducts chemotherapy and puncture of the pleural cavity. During the puncture, all the accumulated air is eliminated from the lungs.
If tuberculosis proceeds at an early stage, then the patient may develop artificial pneumothorax, in which 300 ml of gas is injected into the organ. Thanks to this procedure, the lung is quickly restored and straightened.
If pneumothorax is detected, treatment should be started immediately, otherwise it can lead to the rapid progression of pathology and the development of irreparable complications.
The consequences of pneumothorax
With inadequate and untimely therapy, the disease can go into a neglected form, as a result of which the affected part of the chest begins to protrude, becomes less mobile and cannot participate in the respiratory process in the proper amount.
If pneumothorax developed against the background of an injury, then emphysema may appear under the skin.
The disease should be tried to diagnose and treat at an early stage, as otherwise the patient's life may be in jeopardy. The slow development of pathology can lead to such consequences:
- pleural cavity inflammation;
- compaction of lung tissue;
- hemorrhage;
- unilateral or bilateral pneumonia;
- accumulation of fibrin in the tissues of the pleura;
- impaired respiratory function.
With all this, the lung tissue is greatly weakened and even the smallest physical exertion (cough) can lead to rupture of the organ. With a lung rupture , the patient has very few chances to survive, since the hemodynamics of the heart are severely disturbed, heart failure and sudden organ arrest appear.
Pneumothorax cannot be determined without concomitant diagnosis, based only on patient complaints and physiological examination. It is possible to determine and establish a diagnosis only by means of an X-ray examination.