Rupture of the lung is a serious damage that occurs when injuring an organ and pleura with parts of broken bones. Most often seen in severe fractures of the ribs (numerous, paired, with the displacement of fragments). In isolated cases, pathology is detected with other mechanical injuries - incomplete separation of the lung from the root as a result of excessive tension, which can occur with a sudden impact or fall. The disease is complicated by pneumothorax, hemothorax and hemopneumothorax of different levels of severity.
Pulmonary ruptures are often detected as part of a complex injury (polytrauma) in road accidents, falls from a height, criminal incidents, industrial or natural disasters. Almost always, pathology is accompanied by fractures of the ribs, combinations of trauma with a fracture of the sternum, collarbone, limb bones, pelvis, ridge, kidney damage, blunt abdominal trauma and head injury are also likely. Therapy for lung ruptures is performed by traumatologists and thoracic surgeons.
Clinical picture
Often this pathology is mixed with a defect of the internal pleura (a membrane inside the pleura that envelops the lungs). The parietal (external) layer of the pleura is capable of being damaged or being intact. The severity of signs of lung rupture directly depends on the intensity, depth and location of the wound. The farther the gap is from the root of the lung, the less symptomatic the patient is. This is due to the fact that when injuring the peripheral zones of the lung, the integrity of only small vessels and bronchi is violated. Nevertheless, such damage can provoke unsafe consequences for life due to the development of pneumothorax, absolute lung decay and the formation of acute respiratory failure.
Partial detachments of the lung from the root are fraught with pathology of the integrity of large vessels and bronchi. The defect of the large lobar bronchi is accompanied by a very rapid formation of total pneumothorax with absolute subsidence of the lung, and blood flow from segmental and subsegmental arteries can only provoke the formation of significant hemothorax. In some cases, this becomes the basis for sharp blood loss with the development of hypovolemic shock. Bleeding from a pulmonary artery, inferior or superior vena cava is almost never found in medical practice, because due to powerful blood loss, patients usually die before the ambulance arrives.
Causes
Damage to the anatomical integrity of the respiratory system is a serious and life-threatening disease. The causes of lung rupture, the consequences of which must be addressed in a timely manner, are as follows:
- Mechanical injuries. This group of unfavorable factors includes the following reasons: bodily injuries with sharp or sharp objects in the chest, car accidents, falling from a height.
- Arising from medical intervention. May occur as a result of the procedure for ventilation of the patient.
- The presence of habits hazardous to health (smoking cigarettes, hookah).
- Blood clots and blockage of large pulmonary arteries.
- Tuberculosis.
- The rapid pace of the development of respiratory diseases contributes to the appearance of damage to the organ and its cavities.
- Oncological disease.
- The spread of cancer cells in the lungs damages the organ at the cellular level.
- Emphysema.
- The presence of purulent or inflammatory diseases of the body.
- The presence of hereditary diseases associated with the accumulation of mucus in the bronchi.
- Occupations associated with hazardous production, working with hazardous chemicals, or inhaling dust and fumes from hazardous substances. All this can provoke damage to the anatomical integrity of the lungs due to the accumulation of respirable particles in them.
Symptoms
Depending on the reasons that contribute to the development of pathology, doctors distinguish the following symptoms of lung rupture, indicating damage to the integrity of the organ:
- The presence of pain in the chest and shoulder.
- The appearance of a cough with blood secretions. The appearance of this symptom of the disease indicates organ damage and the presence of bleeding.
- The occurrence of shortness of breath and signs of oxygen deficiency.
- Difficulty swallowing. It develops due to obstruction of the airways by mucus or purulent secretions.
- The presence of chronic weakness.
- An increase in the size of the neck and chest. This phenomenon is observed due to the expansion of intercostal joints.
- The appearance of violations of the timbre of speech and intonation of the voice.
- Arrhythmia.
- Blanching of the skin.
- Increased subfebrile body temperature. This phenomenon indicates the presence of an inflammatory process in the body.
- Resize lungs. It indicates the presence of inflammatory diseases of the lungs or the spread of oncology and oncogen damage to organ cells.
- The appearance of characteristic sounds with a deep breath.
If the above manifestations of pathology appear, you must immediately contact the clinic for differential diagnosis and treatment.
Diagnostics
Rupture of the lung is a very terrible diagnosis, which can even lead to death. It is necessary to treat such a disease only in medical institutions under the close attention of specialists. In no case do not self-medicate, because there is a lung rupture due to fractures of the chest, ribs or a fall from a great height.
There are several methods to identify this terrible diagnosis:
- With the help of x-rays, which is the fastest, but it is necessary to act quickly.
- MRI - magnetic resonance imaging, which can show specialists what is happening in a particular organ.
- CT scan.
Fluorography
The most common method for diagnosing a lung rupture is fluorography, but with its help it is not always possible to accurately determine the location of the rupture and the degree of its danger, so it is better, of course, to use the last two methods.
Self diagnosis
Briefly, it should be noted signs of lung rupture , according to which you can determine the disease without medical intervention:
- lack of air, severe shortness of breath;
- blood spitting;
- severe hematoma in the chest area.
But itβs best to go to the hospital as soon as possible after such injuries and immediately begin treatment under the supervision of doctors. Although it often happens that an ambulance in such cases simply does not have time to get there, especially if the rupture happens very close to the base of the lung.
Treatment
Damage to the lung is a life-threatening condition that requires an emergency surgery. With a satisfactory condition of the patient, he will be transported to the hospital, however, experts recommend calling doctors who will quickly determine the most optimal treatment algorithm and evaluate the condition of the victim.
Therapy protocol
Treatment of lung rupture is performed according to the following emergency care protocol:
- Measures are being taken that do not allow air to enter the pleural cavity.
- Restoring the integrity of the lung parenchyma.
When preserving an organ, it is necessary to restore its function as quickly as possible. If it is necessary to remove the damaged lung, the functions of the remaining part of the organ are developed. Hemostatic drugs (gelatin, calcium chloride) or blood transfusion often give a positive effect. If the patient worsens - shortness of breath increases, bleeding intensifies and stenosis appears, even despite the treatment started, it may be necessary to perform surgery on the lung parenchyma.
Typically, the patient is prescribed inpatient treatment, where the pleural cavity is drained to remove excess fluid and air from the lungs. With minor damage to the organ and a satisfactory condition of the patient, doctors can simply observe the patient. If the damage to the organ is severe, the patient is shown open access surgery. A consultation of doctors solves the question of whether it is possible to preserve some part of the lung, or is it impossible.
Surgical intervention
When performing surgical intervention, general anesthesia is usually used with the use of ether-oxygen anesthesia, which is administered by the intratracheal method. But in some cases, the operation can be performed under novocaine local anesthesia. It is advisable to anesthetize not only the skin, but also the subcutaneous tissue, mediastinal pleura, cut lines, the root of the lung and the abdominal nerve. Also, when a lung rupture is performed:
- videothoracoscopy with laser and electronic coagulation;
- the injured area is treated with fibrin or medical (cyanocrylate) glue;
- impose a Raeder loop;
- hardware or manual seam.
- thoracotomy - suturing the wound with double-row interrupted sutures.
The first two methods, to which a marginal or typical resection of the affected organ is added, are the most popular. In any case, after the operation is performed, drainage and mandatory sanitation of the pleural cavity are performed.
Effects
The consequences of lung rupture can be divided into two groups. The first, early group includes respiratory failure, pain shock, and displacement of the chest organs. If, after rupture of the lung, the collapsed organ is straightened excessively rapidly, a decrease in blood pressure is acceptable. Over time, it returns to normal.
Late results of lung rupture: infection, the formation of the inflammatory process with open pneumothorax. With open pneumothorax, blood often penetrates into the chest, and hemopneumothorax can develop. Secondary spontaneous closed lung rupture may occur, as there are other dilated alveoli that can crack.