The respiratory organs of a person 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 normal condition should be below atmospheric. If air suddenly enters the pleural cavity, then it increases significantly in size, which provokes the development of pneumothorax. Due to changes, the lungs cease to normalize 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 according to severity, place of distribution, communication with the external environment, volume of 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 coincidence - a traffic accident or robbery. Traumatic pneumothorax is characterized by an accumulation of excess air between the pleural lobes as a result of a penetrating (bullet, knife) or blunt wound in the chest area (shock, bruise).
In some cases, the protective membrane is damaged as a result of manipulations by treating specialists. In this case, iatrogenic pneumothorax of the lung is detected. It most often develops as a result of:
- puncture;
- artificial ventilation;
- biopsies;
- after installation of the subclavian catheter.
Spontaneous form of the disease
The described form of the lesion is further divided into two types: symptomatic and idiopathic. The first type appears in completely healthy people of different ages and its causes have not yet been precisely established. Factors that are suspected to lead to this condition:
- hereditary and congenital genetic abnormalities;
- in men;
- age from 20 to 40 years;
- tobacco abuse;
- high growth;
- classes that are associated with frequent pressure drops (flights on an airplane, diving, climbing and climbing mountains and other similar types of activities);
- excessive daily physical activity that are associated with a person's professional activities.
The symptomatic or secondary form of pneumothorax is quickly determined in people with diseases that spread to 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;
- lymphangioliomyomatosis.
In especially serious cases, the accumulation of excess air between the petals of the lung can provoke not only an increase in pressure, but also acute oxygen deficiency, as well as a rapid decrease in blood pressure in the arteries.
In this condition, doctors diagnose intense pneumothorax and prescribe a complex and prolonged course. It is important to remember that this form of the disease is considered the most dangerous. If you do not start timely treatment, then as a result the patient may experience serious problems that will jeopardize his life.
The artificial form of 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 for tuberculosis was the most effective method of treatment and diagnosis.
Partial subsidence of the infected lung leads to the disappearance of foci of tissue necrosis, as well as the resorption of fibrosis and granulation.
Professional pulmonologists rarely use the method of artificially introducing air into the pleural cavity. It is important to remember that for such a procedure there are indications:
- the presence of bleeding in the organ (while the specialist needs to know which side it started from);
- destructive tuberculosis with fresh caverns;
- if it is not possible to conduct modern chemotherapy.
In some cases, the disease appears suddenly in a young man who is predisposed to him because of his age, genetics, lifestyle or professional activities.
Open pneumothorax
This type of disease occurs as a result of severe damage to the chest. Open pneumothorax is an accumulation of air between the pleural lobes, which has an outlet. At the exit, gas fills the cavity, and at the outlet it flows back. The pressure in the shell is restored over time and in value becomes equal to atmospheric, which prevents the lung from properly normalizing. It is because of this that it ceases to take part in the respiratory process and supply the blood with oxygen.
One type of open pneumothorax is valvular. This condition is characterized by a shift in the tissues of the diseased organ, muscles and bronchi. As a result of this process, air fills the pleural cavity of the lung upon inspiration, but is not fully exhaled.
The pressure and volume of gas between the petals is constantly increasing, which leads to a displacement of the heart, large vessels and flattening of the lung and provokes impaired blood circulation, breathing problems and oxygen volume.
Signs of closed pneumothorax
Light 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 due to the fact that a small defect forms in the pleura.
Deformation of the cavity does not lead to the release of air outside, so the volume of gas in it remains the same. Over time, the air dissolves itself without the help of a doctor, and the defect disappears.
What are the symptoms?
Clinical signs of pneumothorax manifest themselves unexpectedly, for example, acute pain in the chest occurs, which is accompanied by shortness of breath. In some cases, a dry cough occurs. The patient cannot take a horizontal position due to severe pain, so he has to sit.
Signs of 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 heartbeat. Pneumothorax may not speak of itself with clinical signs and proceed without symptoms.
With pneumothorax of a traumatic type, the disease affects the condition of a person as a whole. The first signs of pneumothorax: rapid breathing (above 40 breaths per minute), blue skin, decreased blood pressure, increased heart rate, the appearance of acute cardiopulmonary failure.
From a wound on the chest wall during the respiratory process, blood is released with air bubbles. This condition is especially dangerous when air accumulates too quickly in the pleural cavity, which leads to lung collapse, 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 a skin area with subcutaneous emphysema inside, you can feel a characteristic sound suitable for a crunch of snow. The doctor will help determine the radiological signs of pneumothorax.
The course of the disease in children
The main signs of intense 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 years, the process can become a consequence of pneumonia.
Signs of spontaneous pneumothorax in elderly patients appear at the time of coughing with 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 it is often characterized by short-term respiratory arrest, and in difficult situations - frequent palpitations, 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 are 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, acute stabbing or constricting pains in half of the chest, acute shortness of breath are felt. The strength of pain can be very different (from intense to very strong). The intensification of pain begins when you try to take a deep breath or cough. Pain goes to the neck, shoulders, stomach, arms and lower back.
Over the next 24 hours, the pain becomes stronger or does not pass completely even when spontaneous pneumothorax disappears. 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.
Pneumothorax
Signs of intense pneumothorax are as follows:
- severe lacrimation;
- the appearance of a sudden feeling of panic fear;
- blanching of the skin;
- acute pain in the chest, which only becomes stronger at the time of inspiration;
- shortness of breath and palpitations;
- an attack of dry cough.
Description of Closed Symptoms
Signs of closed pneumothorax include pain, respiratory failure, circulatory problems, the severity of which depends on the amount of air accumulated in the pleural cavity.
The disease most often manifests 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 limited pneumothorax is diagnosed during routine fluorography.
In the presence of medium or total closed pneumothorax, the signs are as follows: stitching pains in the chest, passing to the neck and arms. The patient takes a 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 intense pneumothorax, the patient's condition is very serious. The patient is anxious, he feels fear due to suffocation, begins to catch air in his mouth. The pressure increases significantly, the skin of the face is colored, a collaptoid state may appear. The described symptoms are associated with a complete collapse of the lung and a shift in the mediastinum to the healthy side. If you do not provide the patient with timely assistance, then pneumothorax as a result can lead to asphyxiation and acute cardiovascular failure.
Help
First aid for signs of pneumothorax should be provided promptly, because human health and life will depend on this. To a greater extent this refers to the situation when air penetrates into the pleural cavity from the outside. The open form of pneumothorax requires its rapid change to closed. For this, a special tight bandage is applied to the patient 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 performed: drainage of the pleural cavity, thoracotomy, revision of the lung and surgical treatment of an open wound.
The 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 a malfunction of the respiratory system, then assistance will include strict adherence to bed rest and restriction of human mobility. If there is a strong cough, the doctor prescribes antitussive medications.
If there are other forms of the disease described, doctors draw up a more active treatment plan. The patient is prescribed cardiac glycosides, oxygen inhalations, a pleural cavity puncture in order to remove fluid and air from the organ. If the procedures done have not yielded any effect, then the doctors will have to take surgery.
The operation is performed 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 passes against a background of infection, then the patient is additionally prescribed antibacterial drugs.
To prevent a possible relapse, prophylactic methods are used in which irritating components (glucose, talc, silver nitrate solution) are introduced into the pleural cavity.
With the repeated development of pneumothorax and a severe course of the disease, a prognosis is made depending on all the symptoms and characteristics 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 doctor’s recommendations, 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 for further treatment.