What is a spontaneous pneumothorax: clinical features and treatment
Often in medical practice is found such a pathological condition as spontaneous pneumothorax. It occurs as a result of entering into the pleural cavity of air. Human lungs are situated in thoracic cavity. Outside they are covered with pleura. Isolated parietal sheet and visceral pleura. The first is part of the wall of the thoracic cavity and the visceral is located within the cavity. They covered the outside light. The space between the outer and inner leaf and is called the pleural cavity. In a healthy person, this cavity is sealed. It maintains a constant pressure. Pneumothorax when this balance is disturbed as a result of flow of air in one or the other pleural cavity. What is the etiology, clinic and treatment of pneumothorax?
Features of spontaneous pneumothorax
Under pneumothorax means a pathological condition resulting from accumulation of air in the pleural cavity causing displacement of the mediastinum and atelectasis. Received gases increase the pressure in the cavity that causes the lung to collapse. There are 3 forms of this condition: spontaneous pneumothorax, artificial, and post-traumatic. Spontaneous pneumothorax is characterized in that it arises by itself, without any traumatic factor from the outside. This pathology in the majority of cases are diagnosed in adults aged 20 to 40 years. Men suffer from this disease more often than women.
Spontaneous pneumothorax can be primary, secondary and recurrent. In the first case, the cause is not determined. The secondary type may occur on the background of various diseases of the lower respiratory tract, systemic diseases, neoplasms. This condition can be complicated and uncomplicated. In complicated pneumothorax may cause bleeding or the development of pleurisy. There are 3 stages of this condition: total compensation, partial compensation and decompensation.
At stage 1 the body cope with respiratory and hemodynamic disturbances.
This stage is characteristic of small or medium pneumothorax, atelectasis which is 1/3 or 1/2 of the normal volume. If this value exceeds 50%, there is a total spontaneous pneumothorax. When resistant compensation of vital capacity of lungs decreases to 75%. There are no signs of respiratory distress. In the unstable phase compensation condition of the patients worse. Shortness of breath, more severely reduced VC. The most dangerous stage of decompensation. When her shortness of breathappears alone. A decrease in saturable blood oxygen.
What are the reasons for the development of spontaneous pneumothorax? Main etiological factors for primary spontaneous pneumothorax are:
- congenital lack of alpha 1-antitrypsin;
- the weakness of the pleura;
- sudden changes in pressure.
Primary pneumothorax develops on the background of the normal state of the lung tissue. Pressure differences can be observed in the conduct of diving operations, flying in an airplane or helicopter, as well as climbers and individuals involved in caisson work. If a person from the moment of birth the weakness of the pleura, coughing or sneezing can provoke its rupture and development of spontaneous pneumothorax. By the predisposing factors in the development of this disease include Smoking, asthenic type of Constitution. As for secondary spontaneous pneumothorax, its causes are connected with various diseases. The reasons can be:
- bronchial asthma;
- cystic fibrosis;
- Wegener's granulomatosis;
- bullous emphysema;
- abscess of lung;
- TB infection;
- lung cancer;
- systemic disease (lupus, scleroderma, rheumatoid arthritis);
- pulmonary fibrosis;
- Bechterew's disease;
- congenital disease (Marfan syndrome);
- the endometriosis.
Newborns toddlers spontaneous pneumothorax can be due to distress syndrome, damage to the lung and pleura in the course of lung congenital malformations of the lung tissue.
In the presence of human spontaneous pneumothorax the symptoms will depend on the extent of atelectasis. Pneumothorax can proceed in the erased form. Basic signs include:
- piercing or pressing pain in the chest;
- shortness of breath;
- shortness of breath;
- feeling short of breath;
- pallor of the skin;
- the emergence of a sense of fear.
In severe cases, victims can lose consciousness. Primary spontaneous pneumothorax occurs less rapidly. The main symptom - pain. It has the following characteristics:
- acute or compressive;
- localized in the left or right side of the chest;
- has different intensity;
- may radiate to the shoulder, neck, hands and even the lower back;
- gradually decreasing.
Equally important symptom is shortness of breath. In the phase compensation, the shortness of breath occurs during exercise. In severe cases, itworried sick person alone. To ease their condition, these patients often take a forced posture (sitting or lying). The pain decreases when a person lies on the affected side. When a medical examination may reveal crepitus (crunching) at the location of the neck or in the torso area. Every fifth patient man pneumothorax occurs in atypical form, without causing great discomfort. In the case of pleurisy with pneumothorax are possible the appearance of dry cough. Secondary spontaneous pneumothorax occurs most seriously. It can lead to lung collapse, the development of a reactive pleural effusion, hemothorax (accumulation of blood in the pleural cavity), bronchiectasis and pneumonia. A pneumothorax always requires immediate assistance.
Treatment is only the final diagnosis and establishing the type of pneumothorax. Diagnosis includes:
- a survey of the patient to identify major complaints, and the development of the disease;
- external inspection;
- physical examination (listening to the lungs, determination of the chest excursion);
- General and biochemical blood analysis;
- x-ray examination;
- CT or MRI;
- the study of the esophagus;
If necessary, a biopsy can be arranged. During the physical examination found decreased breath sounds, voice tremor, tympanic sound at percussion, weaken breathing noises.
When examination revealed reduced chest excursion from the affected side, extending the time between edges. The most valuable method of diagnosis - x-ray examination. It can be used to detect gas accumulation in the pleural cavity. CT and MRI help to identify the cause of the pneumothorax.
Radiography of the esophagus is carried out to exclude this pathology as diaphragmatic hernia.
An experienced doctor must know not only the symptoms of spontaneous pneumothorax, but the treatment of this dangerous condition.
The main goal of treatment is removal of accumulated gases and the expansion of the lung.
The treatment involves holding one or more punctures. After their meeting is bound to organize a control x-ray. After thoracocentesis is draining. Drainage is placed in the 2nd intercostal space to the side of the affected lung. After a complete straightening of the body, the drainage is removed. To do this it is recommended in a day. If such manipulation gives the desired result, can be carried outsurgical treatment.
To facilitate the straightening of the lung is required to clear the bronchi of mucus. For this purpose, bronchodilators, mucolytics, expectorants. Often managed by therapeutic bronchoscopy. This may be regional resection, removal of bull, lobectomy. Such treatment is rarely applied. In most cases of idiopathic spontaneous pneumothorax ends in recovery.
Prevention of spontaneous pneumothorax includes timely treatment of respiratory and systemic diseases, Smoking cessation. Thus, the appearance of signs of spontaneous pneumothorax is a reason for seeking medical attention and examination.