A pathological condition in which air or other gas mixtures accumulate in the pleural cavity (the slit-like space between the parietal and visceral pleura sheets surrounding each lung) is called pneumothorax. Symptoms, causes and treatment of this condition will be considered in the article.
General information
For the pleural cavity in the normal state, negative pressure is characteristic, this provides an adequate respiratory mechanism. If the pleura leaves are damaged (for example, as a result of a rupture of the lung or bronchus), and air enters the pleural cavity, the pressure is equalized with atmospheric pressure or exceeds it. Air entering the pleural cavity leads to compression of the lung, causing it to fall and turn off from the act of breathing. With a large volume of air, the intact lung is also subjected to compression, in addition, there is a displacement of the mediastinal organs (large vessels, heart). All this greatly violates the mechanism of blood circulation and respiration.
Pneumothorax: symptoms of pathology
This disease is manifested by the following symptoms:
Sudden chest pain - acute, worse during inspiration. Painful sensations can spread to the shoulder of the affected side.
Suddenly developing shortness of breath - shortness of breath, rapid surface breathing.
Dry cough.
Increased heart rate.
The appearance of cold sweat on the skin.
General weakness.
Feeling of fear.
Cyanosis of the skin (if circulatory and respiratory disorders are pronounced).
Forms of the disease
Open pneumothorax. Symptoms in this condition are as follows: air entering the pleural cavity through the damaged large bronchus or chest wound communicates with the environment, during inhalation, air enters the pleural cavity and comes back during exhalation. The pressure in the pleural cavity is compared with atmospheric pressure, which causes the lung to decline and turn it off from the breathing process.
Closed pneumothorax develops when air enters the pleural cavity due to pleural defect. There is no communication between the pleural cavity and the environment, and the entrained air does not increase in volume. Closed pneumothorax has the most mild course from a clinical point of view. Small amounts of air can dissolve on their own. If closed pneumothorax occurs, the symptoms in this case are as follows: pain on the damaged side of the chest, pallor of the skin, lack of air.
Tense (valve) pneumothorax. This type of pathology is the most difficult. A symptom of valvular pneumothorax is the formation of a medium-sized valve structure with a large wound and damage to the bronchus, which allows air to enter the pleural cavity when inhaling and prevents it from entering the external environment. The volume of air in the pleural cavity increases. This provokes the displacement and compression of the mediastinal organs with serious circulatory and respiratory disorders.
Pneumothorax: causes of the disease
Depending on the causes of occurrence, several types of ailment are distinguished.
Spontaneous pneumothorax
Symptoms of the pathology are due to rupture of the area of the lung or bronchus, which is not associated with mechanical damage to the chest or lung. Spontaneous pneumothorax can be:
1. The primary (idiopathic) that occurs for no apparent reason. Young men of high stature 20-40 years are more prone to this condition. Most often, pathology develops due to:
congenital weakness of the pleura, which can easily burst with laughter, severe coughing, intense physical exertion, deep breathing;
2. Secondary (symptomatic), when, against the background of an existing lung pathology, spontaneous pneumothorax develops. Symptoms of the disease occur due to:
respiratory diseases, for example, it can be a chronic obstructive pulmonary disease (a chronic inflammatory disease of the respiratory system that develops under the influence of various environmental factors, the main one being tobacco smoking, which provokes the development of chronic respiratory failure), cystic fibrosis (a hereditary disease for which a violation of the activity of glands of external secretion is characteristic), severe exacerbation of bronchial asthma;
infectious diseases of the lungs, for example, tuberculosis (an infectious disease caused by mycobacterium), lung abscess (a limited focus of inflammation of the lung tissue, which is characterized by melting of the lung tissue and the formation of a cavity filled with purulent contents), pneumonia (pneumonia) due to HIV infection;
lung diseases characterized by damage to the connective tissue: fibrosing alveolitis, lymphangioliomyomatosis, sarcoidosis, histiocytosis X;
systemic pathologies of connective tissue with lung damage: systemic scleroderma, rheumatoid arthritis, dermatomyositis;
tumors (lung cancer).
Traumatic pneumothorax
The causes of this phenomenon are chest injuries:
blunt trauma;
penetrating wound.
Iatrogenic pneumothorax
This pathology is a consequence of certain medical manipulations:
Diagnostics
In order to make a diagnosis of “pneumothorax”, the symptoms of pathology should be carefully studied by a specialist during the medical examination. Diagnostics includes the following activities:
Examination of the patient: auscultation (listening) of the lungs, examination of the chest.
Chest x- ray, with which you can detect air in the pleural region. The procedure is the main method for diagnosing pneumothorax.
Blood gas analysis.
Computed tomography, which allows to identify the causes of the development of secondary spontaneous pneumothorax. This diagnostic method is used if the radiography is not sufficiently informative.
Electrocardiography, with which it is possible to detect cardiac abnormalities with valvular (tense) pneumothorax.
Consultation of a pulmonologist and thoracic surgeon.
Urgent Care
You should know how to provide first aid in such a pathological condition as pneumothorax. Symptoms of it should be a signal for emergency medical action. First of all, it is necessary for the patient to provide free access of oxygen, calm him down and immediately call a doctor.
Open pneumothorax involves the application of an occlusive dressing, which hermetically closes the damaged area of the chest wall. A bandage that will not allow air to pass through can be made of polyethylene or cellophane and a thick cotton-gauze layer.
With valvular pneumothorax, immediate pleural puncture is required, which will help to straighten the lung, eliminate free gas and prevent displacement of the mediastinal organs.
Pathology Control
If pneumothorax is diagnosed, treatment involves the following measures:
Pleural puncture, in which air is aspirated from the pleural cavity.
Surgical suturing of ruptures of the bronchi, lung, wounds of the chest wall.
Drainage of the pleural cavity with the establishment of a drainage tube through which air will be removed from the pleural cavity.
If the pain is very pronounced with a pathology such as pneumothorax, treatment may include the use of pain medications.
Oxygen therapy (continuous oxygen supply through special tube systems).
Pleurodesis is a procedure of fusion of pleura sheets with the help of surgical intervention or the introduction of special medications into the pleural cavity (if pneumothorax is repeated frequently).
Complications and consequences
Pneumothorax is a serious condition that can cause:
Intrapleural bleeding.
Pleurisy is an inflammation of the pleura, which is characterized by the formation of adhesions, provoking impaired lung expansion.
Subcutaneous emphysema is a phenomenon in which air enters the subcutaneous fat. The condition is determined by the areas of swelling, swelling of the subcutaneous tissue: when you click on them, a characteristic sound appears, similar to a crunch of dry snow.
Air in the fiber of the mediastinum. In this case, compression of large vessels and the heart is observed.
In especially severe cases (with a large volume of damage, a significant penetrating wound of the chest), a fatal outcome is not excluded.
Prevention
To prevent pneumothorax, certain rules should be followed:
Timely treat lung diseases.
Stop smoking.
Avoid chest injuries.
If pneumothorax occurs quite often, it is recommended to conduct a pleurodesis procedure (fusion of pleura leaves).
Conclusion
In this article, we discussed a disease such as pneumothorax. Symptoms, causes and principles of treatment of pathology were examined by us. With any pneumothorax, immediate hospitalization of the patient is necessary for surgical treatment. With adequate modern therapy, the prognosis of spontaneous pneumothorax is usually favorable. The success of treatment for traumatic pneumothorax is affected by the nature of the accompanying chest injuries. Take care of yourself and be healthy!