With a disease such as valvular pneumothorax, oxygen enters the pleural region, the amount of which begins to increase gradually. The manifestation of such a pathology is associated with a feature of the functioning of the valve. Its work is disrupted 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 rupture of the bulla.
Kinds
Pneumothorax valve is internal and external and it depends on the mechanism of formation. The internal appearance of pneumothorax occurs due to damage to the large bronchus and the presence of a patchwork wound to the lung. 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 while breathing in and while exhaling does not allow gas to escape back into the lung.
The external appearance of pneumothorax is characterized by the fact that the soft tissue of the damaged chest is the valve in this case. When you inhale, the edges of the wound begin to expand, air freely penetrates the pleural cavity, and when you exhale, the opening of the wound decreases, without releasing it back.
The causes of the disease
Valve pneumothorax has various 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 rupture of lung tissue or penetrating wound of the chest. In this case, a sufficiently fast “gluing” of the wound opening on the chest wall occurs, while the bronchial wound continues to gap. Injuries of this kind include:
- rib fractures;
- gunshot and stab wounds to the chest;
- damage to the bronchus or esophagus by a foreign body;
- falling from height;
- bronchial ruptures, etc.
Spontaneous pneumothorax is characterized by rupture of an altered area of lung tissue. The following diseases contribute to the development of this pathology:
- tuberculosis;
- bullous pulmonary emphysema;
- cystic fibrosis;
- lung abscess
- pneumoconiosis and others
Predisposing factors for the development of spontaneous pneumothorax are coughing, diving, physical stress, etc.
Symptoms
Usually, with valve pneumothorax, the patient is in an extremely serious condition. He becomes excited, 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, quickly accumulating in the pleural cavity, can cause heart or pulmonary failure, resulting in death. The late complications of pathology include empyema of the pleura and reactive pleurisy.
Diagnostics
The doctor, upon examination of the patient, 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, lung collapse and a shift to the healthy side of the mediastinal shadow are detected.
Pleural puncture with manometry makes it possible to distinguish between open, closed and valve pneumothorax. If fluid is present, aspirate and further examine the pleural effusion for cell composition and microflora. To identify the localization and size of the pleural fistula, diagnostic thoracoscopy and pleuroscopy are performed.
Treatment
First of all, treatment of valvular pneumothorax should be aimed at decompression of the mediastinum and lung, and do this as quickly as possible. For this, discharge puncture or transthoracic drainage of the pleural cavity is carried out with the mandatory imposition of passive drainage according to Byulau. Only after carrying out such manipulations, the patient is transported to a hospital for subsequent treatment.
In order to stabilize the patient's condition, he is administered non-narcotic and narcotic analgesics, cardiovascular drugs, antibiotics, antitussives.
It is very important to translate valve pneumothorax into closed. For this, it is necessary to constantly drain the pleural cavity. If air stops flowing through the drain, this indicates a cavity seal. Drainage is removed two days after the full expansion of the lung, if this is confirmed by x-ray.
If the lung could not be straightened, then surgical treatment of pneumothorax is performed. Damage to the chest requires wound closure and 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 pathology, segmentectomy, bilobectomy, marginal lung resection, lobectomy, pleurectomy, pleurodesis, and other interventions are performed.
Emergency care for the disease
There are such situations that the patient may need urgent help with valvular pneumothorax. To save his life, it is necessary:
- reassure a person;
- provide him with access to fresh air;
- urgently call a doctor.
First aid is a puncture with a thick needle on the chest wall. Thanks to this, it is possible to quickly reduce the high pressure inside the pleura.
Prevention and prognosis
Complications of valvular pneumothorax are shock lung syndrome, pyopneumothorax, and cardiopulmonary failure. Timely medical assistance provided helps to achieve recovery.
Disease prevention is aimed at preventing injuries. In addition, during a routine examination, a pulmonologist, TB specialist and thoracic surgeon identify patients with pulmonary pathology.
Output
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.