Angina

Pneumothorax of the lung: causes, symptoms and treatment. Pneumothorax - what it is, causes, symptoms and treatment of pneumothorax of the lungs Concept of pneumothorax

Pneumothorax is the appearance of air accumulation in the pleural cavity. This is fraught with serious complications, the lungs cannot function normally, and respiratory function is impaired.
Blood circulation in the lung area is also impaired.

Find the answer

Are you having any problem? Enter “Symptom” or “Name of the disease” into the form, press Enter and you will find out all the treatment for this problem or disease.

What is pneumothorax

Air may get into pleural cavity directly, for example, in case of injury, or from other organs, if they are damaged by disease or as a result of surgical intervention.

The severe consequences of pneumothorax (air in the lungs) are caused by disruption of the usual, healthy ventilation of the lungs. The pressure in the pleura increases, the lung tissue collapses, which is fraught with lung collapse.

There are traumatic pneumothorax and spontaneous:

Traumatic can be open or closed. Open occurs, for example, when gunshot wound, or with a knife. Air rushes into the lung, tearing the lung tissue. Closed pneumothorax is formed in injuries when skin not impaired, but due to a chest injury cells lung becomes damaged and ruptures.
Spontaneous appears suddenly as a result of some action or internal pathologies leading to disruption of the integrity of the pleura and adjacent lung tissues. Spontaneous pneumothorax is divided into: primary, secondary and recurrent. Lead to primary pneumothorax congenital pathologies associated with pleural weakness and pulmonary bullosis. In these cases, even strong laughter, coughing, or just a deep breath can cause pleural rupture. Diving and air flights can cause pneumothorax. Secondary pneumothorax is formed in cases of severe infectious lesions of the lungs, which lead to changes in the structure of lung tissue. With repeated pneumothorax, they speak of a relapse of the disease.

Pneumothorax is also divided depending on the degree of collapse of the lung into:

limited or partial;
complete or total.

According to distribution they are distinguished:

unilateral;
bilateral.

By complexity:

complicated;
uncomplicated.

In connection with external environment:

closed;
open;
valve.

Reasons for air penetration into the pleural cavity

The causes leading to pneumothorax are iatrogenic, spontaneous and traumatic.

Some medical procedures are considered iatrogenic:

installation of a catheter under the collarbone;
pleural biopsy;
artificial ventilation;
puncture of the pleural cavity;
lung operations.

Traumatic causes:

closed injuries chest caused by a fall from a height, or received during a fight, when a broken rib tears the lung tissue;
open injuries caused by wounds in chest cavity(knife, gunshot) that damage the lung.

Spontaneous reasons:

hereditary diseases characterized by weakness of the pleura;
sudden changes in pressure (diving to depth, or vice versa, rising up);
lung diseases caused by certain bacteria and viruses;
neoplasms;
asthma and some other respiratory diseases;
connective tissue pathologies.

Tension pneumothorax occurs in patients connected to artificial ventilation lungs. As a rule, when they exhale, they form positive pressure. This threatens to collapse the organ.

Characteristic symptoms

Pneumothorax begins abruptly. Symptoms of pneumothorax: appears unexpectedly unbearable pain in the chest, there is a lack of air, and a dry cough begins to overcome. The patient cannot lie down; in this position it is even more difficult to breathe, and the pain becomes unbearable.

At partial form closed type painful sensations gradually subside, but shortness of breath and tachycardia are present.

Traumatic pneumothorax is characterized by rapid deterioration. Due to lack of air, the patient breathes rapidly, the skin becomes bluish, the pressure drops, and tachycardia begins. Air with bloody inclusions noisily comes out of the wound.

Air begins to fill the subcutaneous spaces of the chest, neck, affects the face, characteristic edematous phenomena and swelling appear. They are most clearly expressed in the intercostal spaces.

The valve type is the most dangerous. It manifests itself in the form of difficulty breathing, blueness of the face, and general weakness. In addition, the patient develops a feeling of fear and blood pressure rises.

Shortness of breath develops unexpectedly or, conversely, increases gradually. It all depends on the speed of development of the pathology and the volumes captured. With significant lesions, the trachea shifts, the voice changes timbre, and vocal tremors disappear.

On the affected side, breathing is weakened, sometimes the effect of a dumb lung occurs.

X-ray examinations for diagnosis

Pneumothorax on the resulting x-ray is revealed by light zones where there is no pulmonary pattern. Such zones indicate the accumulation of air there.

With prolonged pathology, collapse of the lung occurs. It can be either partial or complete.

Sometimes, to determine the pathology, one x-ray is not enough, and an additional computed tomography is prescribed.

It helps to identify:

small areas of pneumothorax;
emphysematous bullae, which actually lead to pathology;
reasons for relapse.

X-rays and tomography help determine the extent of lung collapse.

To detect the apical, focal accumulation of air, fluoroscopy is performed. During the procedure, the patient can be rotated and displacement of air pockets can be identified. It is important to do this on time.

Because the remaining signs have not yet been diagnosed - the mediastinum is in place, the dome of the diaphragm is slightly deformed. If you miss the moment, the lung will completely collapse, causing acute respiratory failure. This situation can be fatal.

An X-ray taken in a timely manner helps save the patient’s life.

The radiologist will adequately assess the situation, form a reliable conclusion, on the basis of which the specialist will prescribe the correct treatment.

Additionally, electrocardiography may be prescribed. This is relevant for the valvular form of the disease, and allows us to identify pathological changes in the work of the heart.

IN in some cases Consultation with a pulmonary surgeon is required.

Video

Bullous emphysema complicated by pneumothorax

Bullous emphysema often leads to right-sided pneumothorax. IN mild form the pathology may go away on its own.

This is possible in those patients who previously had healthy lungs and did not smoke.

Complicated pneumothorax develops more often in smokers. Bullous emphysema is often the cause of recurrent pneumothorax.

Pressure gradually increases in the bullae, for example, during intense physical activity, or severe coughing, or other movements or actions leading to increased lung function. As a result, a breakthrough can form, air is forced into the pleural area, and collapse occurs.

Bullous pneumothorax most often affects one lung, but in severe cases the disease affects both. Pneumothorax against the background of bullous emphysema sometimes leads to pleural bleeding.

The disease in a mild form is often asymptomatic, or has minor manifestations that the patient does not pay attention to. Meanwhile, the pathology continues to develop and relapse occurs over time.

Repeated pneumothorax is much more serious than the primary one. Therefore, if you have already had similar symptoms with further complications, even with the most minor manifestations of pathology, it is necessary to be examined by a specialist.

The mechanism for the development of pneumothorax in pulmonary bullosis is caused by an increase in pressure in the affected bullae when some movement is made that causes straining or straining of the lungs. Even a banal cough at this moment can contribute to rupture of the thin pleural wall.

At this moment, pain, difficulty breathing, and other symptoms indicating pneumothorax occur.

The appearance of these signs is a reason to consult a doctor. Therefore, if bullous disease respiratory organs has already been diagnosed, then we must try to avoid those situations that could cause rupture of the bullae.

To prevent emphysema, it is necessary to urgently stop smoking and avoid places where there is a possibility of spraying harmful substances, if possible, avoid viral infections.

Features of the chronic form

Accumulated air pockets in the pleural cavity resolve, as a rule, within one to two months, and then recovery is recorded.

If complete resorption of air has not occurred even after three months, it can be stated chronic form pneumothorax. Sometimes air re-enters and the disease relapses.

The transition of pneumothorax into a chronic form is also facilitated by the formed adhesions and deposits at the sites of pleural damage, which disrupts the mechanism of lung expansion. In this state, the patient may not experience any discomfort, his condition is satisfactory.

But, chronic disease often provokes various complications:

pleural infection;
the appearance of pneumothorax on the other lung;
collapsed lung;
relapses of the disease.

Complications often threaten the patient’s life.

Effective treatment of the disease

Pneumothorax is life-threatening. This is especially true for the valve and open shapes. These options require immediate hospitalization. But, even before the medical team arrives, it is necessary to provide the patient with first aid.

Actions should be aimed at preventing further filling of the pleural cavity with air.

At open form It is necessary to apply a compression bandage to prevent air from entering the injured area. To do this, cover the injury site with any material.

For better sealing, wrap the top with more plastic (bag, oilcloth). The patient must be seated to facilitate breathing, brought out of a state of fainting, and given an anesthetic.

In the hospital, a puncture is performed to remove accumulated air from the pleural cavity and to avoid the build-up of negative pressure in the pleural area.

Further treatment of pneumothorax will depend on its type. With a limited, closed form, conservative therapy is carried out.

It consists of providing the patient with rest and blocking severe pain syndromes with painkillers. They do it according to indications pleural puncture.

In the case of a total variant of the disease, for normal expansion of the lung, drainage is placed in the pleural area and air is aspirated using a special apparatus.

To relieve cough syndrome, codeine or dionine is prescribed. All patients undergo oxygen therapy, which accelerates the resolution of pneumothorax several times. Pain relief is carried out with analgesics, sometimes even narcotics.

Surgery is required if most of the lung is damaged due to trauma. The defect is sutured lung tissue, soft tissues of the injured part of the chest, a drainage tube is installed.

Measures are being taken to stop the bleeding. Surgical treatment will be required even if there is no effect of conservative measures. If the drainage has been in place for a week, and the lung has not expanded, then you can’t do without a surgeon.

To reduce the risk of recurrence of the disease, chemical pleurodesis is prescribed. Chemical pleurodesis is the filling of the pleural cavity with special chemicals that promote closure of the spaces between the pleural plates.

Possible consequences and complications

Complications of pneumothorax are a common occurrence and occur in half of patients:

Pleurisy is a common consequence of pneumothorax. It is often accompanied by the formation of adhesions, which interferes with the normal expansion of the lung.
The mediastinum fills with air, which leads to spasm of the heart vessels.
Air enters subcutaneous tissue, the so-called subcutaneous emphysema.
Bleeding in the pleural area.
At long term disease, the affected lung begins to grow connective tissue. It shrinks, loses elasticity, and is unable to straighten even after the removal of air masses from the pleural area. This leads to respiratory failure.
Pulmonary edema.
With a large area of damage to lung tissue, death is possible.

Prevention of relapse

After completion of treatment, the patient is prohibited from any physical activity, airplane flights, deep diving.

Some special techniques By preventive measures There is no cure for pneumothorax, but doctors still recommend certain rules, the implementation of which will reduce the risk of recurrence of the disease:

quit smoking forever;
perform breathing exercises;
be periodically examined to detect lung diseases early stages;
find time for walks in the fresh air.

Pneumothorax in the early stages is well treated, but this, unfortunately, does not guarantee that the disease will not return. According to statistics, the primary spontaneous version of pneumothorax occurs again in 30%, and this happens within the first 6 months. Secondary repeated pneumothorax returns even more often - in 47% of patients.

Due to a lack of gas exchange in the respiratory organs, various concomitant diseases, the work of the heart is disrupted, the blood is less enriched with oxygen, which means that other organs do not receive enough of it, and hypoxia occurs. Therefore, it is so important to consult a doctor on time and receive timely treatment.

Pneumothorax called the accumulation of gas, usually air, in the pleural cavity. The latter, in fact, is a bag that contains the lungs - the respiratory organs of humans and many other animal species. Under normal conditions, the pressure in the pleural cavity is negative, thereby maintaining the lungs in an expanded state. The entry of gas into it and the accumulation of liquid causes collapse of the respiratory system.

There are three types of pneumothorax:

Closed. With this type, air enters the pleural cavity once and can subsequently be absorbed. The prognosis is favorable.
Open. Communication with the external environment is maintained, the pressure in the pleural cavity is equalized to atmospheric levels. The prognosis is doubtful.
Valve. IN in this case air penetrates into the pleural cavity and is retained there; in addition, it is constantly pumped into it, since the tissues at the site of injury create a conditional valve that does not release gas back, allowing it to pass into the cavity. The prognosis is unfavorable because the lung large vessels and the heart are strongly compressed by the continuously flowing air, and the pleural sac is greatly stretched.

Reasons

The main factor causing this pathology is damage to the pleura. Depending on whether it occurred externally or internally, there are two forms of pneumothorax: external and internal.

The first is associated with the penetration of external air into the pleural cavity and occurs when the chest wall is traumatized as a result of penetrating wounds, for example, in car accidents, knife and gunshot injuries, and landslides in the mountains. It can also occur during various medical procedures (introduction subclavian catheter, nerve block, puncture of the pleural cavity). Artificial pneumothorax is applied in the treatment of certain pulmonary diseases, as well as for diagnostic purposes.

Internal damage occurs when lung tissue ruptures and air from the bronchi enters the pleural cavity. The causes of pneumothorax in this case are lung diseases such as closed chest injuries with rib fractures. There may also be spontaneous pneumothorax due to congenital weakness of the pleural tissue, in which case it can rupture with a sharp cough, increased breathing, or physical exertion.

Symptoms

Manifestations of the disease will depend on its type: external or internal.

The signs of the first are quite characteristic: against the background of an existing chest injury, deterioration in the activity of the cardiac and respiratory systems associated with blood loss, the following is observed:

air being sucked into the wound;
discharge of pink foamy blood from it;
asymmetry breathing movements(the damaged side lags far behind).

When air enters the pleural cavity from the inside, the symptoms of pneumothorax occur suddenly:

severe chest pain that worsens with movement or coughing;
breathing is shallow, there is an increase in its frequency;
skin is pale or bluish tint, there is a cooling sensation, increased sweating;
Sometimes there is a cough without sputum production.

Manifestations of the disease directly depend on the massiveness of the lesion; with severe pathology, the signs of pneumothorax are bright, deterioration quickly progresses general condition patient due to dysfunction of the lungs and heart. With minor damage, symptoms can be smoothed out and even disappear completely after some time.

Even if the disease occurred in a closed form and was mild, so that the problem resolved itself, that is, the air was absorbed from the cavity, it can become more complicated:

inflammation of the pleura;
accumulation of air under the skin and in the mediastinum (the area between the lungs where the heart, large vessels, and esophagus are located);
the formation of adhesions and restriction of lung movements as a result.

This pathological condition, when severe, can lead to:

collapse (sharp irreversible decline) of the lung;
bleeding into the cavity and formation of hemothorax.

Diagnostics

During a clinical examination, in addition to the patient’s complaints, the doctor receives the following data: an unnatural semi-sitting position of the person, the intercostal spaces are enlarged, the veins of the neck are swollen. There may be subcutaneous emphysema - when palpating the slightly swollen skin of the face, neck, chest, a crunching sound is heard. When listening to the lungs, the doctor does not hear normal breathing sounds, an increase in the frequency of heart contractions is detected, and a shift in its boundaries to the unaffected side. Blood pressure downgraded.

Diagnosis of pneumothorax by instrumental methods includes:

fluoroscopy (real-time examination);
and detection of air in it (the pressure will be near zero);
and , which are shown after urgent help to clarify the cause of the pathological condition.

Treatment

This disease is considered an emergency, so the patient must be transported to the hospital as quickly as possible, either independently or by ambulance. At the same time emergency assistance appears on the spot or by emergency doctors. If the disease develops as a result of external damage, it is necessary to seal the chest wound as tightly as possible to prevent further accumulation of air in the pleural sac. To do this, apply a bandage using film, oilcloth or a thick layer of cotton wool.

Treatment of pneumothorax in hospital is always surgical, conservative methods in this case they are ineffective.

Urgent help:

The doctor removes air from the pleural cavity by puncturing it with a special needle and suctioning out the contents; the manipulation is performed under local anesthesia.
If the lesion is extensive, drainage is installed, because the one-time extraction of a large volume of air will lead to a sharp expansion of the respiratory organ, and this is fraught with a shock reaction of the body. Drainage can be active when aspiration devices are used, and passive using special techniques.
Open pneumothorax should be converted to closed. This is done by surgeons - they suture the chest wound. Further tactics are similar to those for closed pneumothorax.
With the valvular form of the disease, it is urgent to “open” the pleural cavity, allowing the air to escape. Next, the defect is sutured.

If the patient develops state of shock, it is necessary to give priority attention to restoring the function of the cardiovascular and respiratory systems: blood transfusions, solutions, use medications that act on the centers for regulating the functions of blood circulation and breathing in the medulla oblongata.

The further strategy is to treat, including surgically, respiratory diseases, if they caused air to enter the pleural cavity. So, in the presence of unruptured emphysematous blisters (bulls), caverns, a segment or lobe of the lung is removed ().

Pneumothorax- quite common acute condition. The name is derived from the Greek words “air” and “chest”, which clearly characterizes the pathology - air penetrates between the chest wall and the lung.

Definition

Pneumothorax– entry of air and gas into the cavity between the layers of the pleura. The accumulated air causes compression of the lungs, lack of oxygen and respiratory failure, and provokes complete or partial collapse of the lung.

This condition occurs spontaneously or as a result of external intervention. Relapses occur in almost half of the cases. Characteristic development complications - intrapleural bleeding, subcutaneous emphysema, pneumopleuritis.

Spreading

Numerous cases of this pathology have been recorded throughout the world. This condition is most common in newborn infants and young men under 30 years of age, especially if they are thin and tall. People who smoke and have chronic lung diseases are also at risk.

Origin

Under normal conditions, the pressure in the pleural cavity is maintained at a level below atmospheric. This allows the lungs to remain fully expanded at all times. The penetrated air raises intrapleural pressure, contributing to compression and subsidence (collapse) of the lung, complete or partial. The heart and large vessels are also compressed and pushed to the opposite side of the chest.

Causes of pneumothorox

Depending on the origin, spontaneous primary and secondary, traumatic, iatrogenic pneumothorax are distinguished.

Primary spontaneous

It forms without any visible reason. His reasons:

Congenital weakness of pleural tissues bursting when coughing, laughing, or increased stress;
genetic defect – insufficient outputα-1-antitrypsin;
sudden pressure drop(when flying on an airplane, diving).

Secondary

Develops more often in older people with lung diseases:

Chronic and hereditary ( , , );
infectious (, );
oncologically X ().

Traumatic

The causes are injuries:

Open - cut, stabbed, gunshot;
closed - received during a fight, falling from a great height.

Iatrogenic

Formed during surgery:

During ventilation;
cardiopulmonary resuscitation And;
puncture of the pleural cavity.

Symptoms (signs) of pneumothorax

Depending on the volume of incoming air, the speed of its penetration and the amount of collapse of the lung, the magnitude of the manifestation of symptoms can vary significantly.

The most characteristic symptoms:

Chest pain– sharp, unexpected, intensifies with inhalation. May spread to the abdomen, shoulder, neck;
dyspnea- sudden difficulty breathing;
rapid heartbeat;
increased sweating– sticky, cold sweat;
pale or bluish skin– due to insufficient blood circulation;
cough– paroxysmal, dry;
panic fear;
possible emphysema under the skin– as a result of air entering the subcutaneous tissue.

Types of pneumothorax

Depending on the communication with the external environment, the following types are distinguished:

Closed– message from environment absent, the amount of trapped air is constant. The mildest type, often resolves spontaneously;
open– there is a relationship with the environment. Lung functions are significantly impaired;
valve- characterized by the formation of a valve that allows air to enter the pleural cavity, but does not let it out. With each inhalation, the volume of air in the cavity increases. Most dangerous look– the lung stops functioning, pleuropulmonary shock develops, blood vessels are compressed, the heart and trachea are displaced.

Diagnostics

The possible rapid development of pneumothorax requires rapid diagnosis to provide timely assistance. Diagnostic methods:

Clinical examination– identifying characteristic symptoms, listening with a stethoscope to identify the affected area;
X-ray examination– on the radiograph, a clearly separated zone of clearing without a pattern of the lung is visible on the periphery. The heart, trachea, large vessels are shifted to the opposite side, and the diaphragm is shifted down;
computed tomography– has greater reliability compared to x-rays. Used to diagnose small lesions, identify the cause, and in differential diagnosis;
blood test– hypoxemia is detected in 75% of cases.

X-ray for pneumothorax

Differential diagnosis

The final diagnosis is made based on the results of an x-ray or tomography, on the basis of which pneumothorax is differentiated from the following diseases:

aortic aneurysm;
myocardial infarction;
diaphragmatic hernia.

Treatment

Therapy includes first aid and subsequent medical care.

First aid for pneumothorax

For any pneumothorax it is necessary emergency hospitalization to the surgery department.

A sudden pneumothorax requires emergency medical care, as it is a threat to human life. Not a minute of delay is acceptable!

An ambulance is called immediately when symptoms appear. While waiting for her, the patient is given first aid:

Security free access air;
reassurance sick;
ensuring a semi-sitting position sick;
with open pneumothorax– a sealed bandage is applied to the hole (from a sterile bag, adhesive tape, rubberized fabric or polyethylene);
with valve- an emergency pleural puncture is performed to eliminate trapped air using a needle and a large syringe.

Qualified medical care

Treatment is carried out in a surgical hospital and depends on the type and course of the pathology:

Small closed limited pneumothorax– most often does not require treatment. It resolves spontaneously after a few days without causing serious disorders;
when closed– aspiration of trapped air is carried out using a puncture system;
when open– first they transfer it to a closed one, suturing the hole. Next, the air is sucked out through the puncture system;
with valve– it is transferred to an open form using a thick needle and then treated surgically;
with recurrent – surgical removal its reasons.

Flowchart of the organization of medical care based on the results of a clinical examination

Prevention

Specific preventive measures does not exist in this case.

Primary

Based on maintaining the health of the whole body:

Complete smoking cessation;
regular long walks;
performing breathing exercises;
timely diagnosis lung diseases and their treatment;
avoiding injury chest.

Secondary

Its goal is to prevent the development of relapses:

Fusion of pleural layers;
removal of the cause of the disease.

Forecast

The prognosis is significantly influenced by the type of pathology and the speed of assistance:

For spontaneous uncomplicated pneumothorax– with timely assistance, the prognosis is favorable;
in the presence of pulmonary pathology– development is possible frequent relapses(almost half of the cases);
with traumatic pneumothorax– the prognosis depends on the injuries received;
with valvular pneumothorax– the sooner the patient is in the hospital, the more favorable the prognosis.

Pneumothorax– a serious, potentially fatal condition. In any case, emergency care and emergency hospitalization are required. If characteristic symptoms of pneumothorax develop, you should immediately call ambulance, further treatment will be carried out by a thoracic surgeon and pulmonologist.

Pneumothorax of the lung (from the Greek “pneuma” - air, “thorax” - chest) is a pathological condition in which air enters the pleural cavity and accumulates there, due to which the lung tissue collapses, the blood vessels are compressed and the dome of the diaphragm lowers. Arising due to pathology acute disorders respiratory and circulatory functions are dangerous to human life.

To understand exactly how the disease develops, you need to understand a little about the anatomy of the chest and the serous sac located in it - the pleura.

Pleura is the serous membrane that covers the lungs. It is thin and smooth, consisting of elastic fibers. Essentially, there are three separate “bags” in the chest cavity - for both lungs and for the heart.

The pleura itself is made up of two layers:

Pleura visceralis (pleura pulmonalis) is a visceral (pulmonary) layer that adheres directly to the lung tissue, separating their lobes from each other.
Pleura parietalis is an outer layer that serves to strengthen the chest.
Both leaves are connected along the lower edge of the root of the respiratory organ, forming a single serous sac. The slit-like space formed in the sac is called cavitas pleuralis (pleural cavity). Normally, it contains a small, 1-2 ml, amount of liquid, which prevents the visceral and outer layers from touching. Thanks to this, it is possible to maintain in the pleural cavity negative pressure, created there thanks to two forces: inspiratory stretching of the chest wall and elastic traction of lung tissue.
If for any reason (chest injury, respiratory pathology, etc.) air enters the pleural cavity from the outside or from the inside, atmospheric pressure is balanced, the lungs collapse completely or partially, that is, their complete or partial collapse occurs.

Why does pneumothorax develop?

The causes of the pathological condition can be divided into two large groups:

Mechanical damage and trauma to the lungs or chest. These causes of pneumothorax are:
- closed injury (respiratory organs are damaged by rib fragments, for example);
- penetrating wound (or open trauma);
- Iatrogenic damage (the development of the disease is possible during diagnostic or medical procedures, such as pleural puncture, installation of a subclavian catheter, etc.);
- procedures as part of the treatment of tuberculosis - pneumothorax is created artificially.
Pathologies of the respiratory system. The occurrence of pneumothorax may have the following internal causes:
- bullous emphysema (rupture of air cysts);
- rupture of a lung abscess;
- esophageal rupture;
- in case of tuberculosis – breakthrough of caseous foci;
- other.

How is pathology classified?

It is necessary to mention that in addition to gas, blood, pus, and other liquids can accumulate in the pleura. Therefore, there is the following classification of damage to the serous sac:

pneumothorax (which, in fact, is what we are talking about);
hemothorax (blood accumulates in the pleural cavity)
chylothorax (accumulation of chylous fluid occurs);
hydrothorax (transudate accumulates);
pyothorax (pus enters the cavity of the serous sac).

The classification of the disease itself is quite complex; it is based on several criteria.

For example, depending on the cause of occurrence, the following types of pneumothorax are distinguished:

Based on the volume of air that has entered the cavity between the layers of the pleura, the following types of pneumothorax are recognized:

partial (partial or limited) – lung collapse incomplete;
total (complete) – a complete collapse of the lung has occurred.

There is a classification based on how the pathology has spread:

unilateral (the lung collapsed on one side);
bilateral (the patient’s condition is critical, there is a threat to his life, since collapsed lungs can completely turn off from the act of breathing).

Depending on whether there is a connection with the environment, they are classified:

Closed pneumothorax. This condition is considered the mildest, its treatment is not always required: a small amount of air can resolve spontaneously.
Open pneumothorax. It usually develops due to the presence of damage to the chest wall. The pressure in the pleural cavity becomes equal to atmospheric pressure, and respiratory function is impaired.
Tension pneumothorax. At the same time pathological condition a valve-like structure is formed that allows air to enter the serous sac on inhalation and prevents its release on exhalation. Due to irritation of the nerve endings on the pleura, pleuropulmonary shock and acute respiratory failure occur.

Clinical picture of pneumothorax

The diagnosis can be confirmed and treatment tactics determined only by taking an x-ray. But the symptoms of the disease are quite vivid; their severity is influenced by the causes of the disease and the degree of collapse of the lung.

It is difficult to confuse an open pneumothorax - a person is forced to lie in a lying position on the injured side, air is noisily sucked in through the wound when inhaling, and foamy blood comes out when exhaling.

Symptoms of the spontaneous development of the disease are pain on the side of the chest where the lung is damaged, paroxysmal cough, shortness of breath, tachycardia, cyanosis.

The patient characterizes the pain as dagger-like, piercing. It radiates to the neck and arm and intensifies with inhalation. Sometimes symptoms such as sweating, drowsiness, anxiety, and fear of death occur.

When examining the chest, a lag in breathing on the damaged side is visible. During auscultation on this side, breathing can be heard weakly, or not at all.

Symptoms of the presence of air in the pleural cavity in newborns and babies up to 12 months are anxiety, difficulty breathing, puffiness of the face, shortness of breath, cyanosis, sharp deterioration condition, refusal to eat.

The closed form of the disease is sometimes asymptomatic.

Diagnostics

If the doctor suspects pneumothorax, it should be treated immediately, the doctor:

asks the patient to describe his symptoms;
asks the patient whether he smokes and for how long, whether he has a history of lung and respiratory diseases, whether he has tuberculosis, or whether he is a carrier of HIV;
appoints laboratory tests(the gas content of arterial blood is examined);
prescribes an ecg and x-ray.

X-ray of the lungs

X-ray is the main way to determine whether there is air in the pleural cavity, how much the lung has collapsed, and, therefore, prescribe the correct treatment and save the patient’s life.

To confirm pneumothorax, an x-ray of the chest is taken in the anteroposterior projection, with the patient in an upright position.

An x-ray may show a thin line of the visceral pleura. Normally it is not visible, but in the presence of air in the cavity it can separate from the chest.

X-rays also show that the mediastinum has shifted to the opposite side.

In every fourth case of pneumothorax, a small amount of fluid enters the pleura. This can also be seen by taking an x-ray.

If the presence of air in the pleura is not confirmed on the image, but the description of the symptoms suggests pneumothorax, an x-ray is taken again, and the patient is placed on his side. The examination shows a deepening of the costophrenic angle.

How to treat pneumothorax

Typically, with a traumatic pneumothorax, the patient requires emergency medical care even before he is taken to a medical facility and has an x-ray.

Before paramedics arrive, you need to:

calm a person down;
limit his movements;
give air access;
at open form disease, try to apply a compressive bandage to seal the injury; a plastic bag or fabric folded several times is suitable for this.

Direct treatment of the patient occurs in a surgical hospital, it depends on the type of disease. Basically, by performing a puncture, air is evacuated from the pleural cavity and negative pressure is restored there.

Treatment also includes pain relief during periods of collapse and expansion of the lungs.

Forecast

Provided adequate emergency care, proper treatment and the absence of serious pathologies from the respiratory system, the outcome of the disease can be quite favorable.

Spontaneous pneumothorax, if the underlying cause is not eliminated, can recur.

Live healthy with Elena Malysheva

Information about the disease from 34:25.

Pneumothorax is excessive accumulation of air between the pleural layers, leading to short-term or long-term distress respiratory function lungs and cardiovascular failure.

All cases of pneumothorax can be classified into one of three main forms: iatrogenic (complication of diagnostic and therapeutic procedures), traumatic (there is a direct connection with trauma to the bone apparatus of the chest cavity) or spontaneous pneumothorax of the lung (sudden violation of the integrity of the visceral pleural layer).

In a situation where the pleural cavity does not have direct communication with the ambient air, the volume of air that entered one or both pleural cavities at the time of injury remains at the same level, so a closed pneumothorax occurs.

Open pneumothorax develops when a defect between the pleural cavity and the environment persists, as a result of which air freely accumulates between the layers of the pleura and is removed from the pleural cavity during respiratory movements.

What is it?

Pneumothorax is the accumulation of air or gases in the pleural cavity. It can occur spontaneously in people without chronic lung disease (“primary”), as well as in people with lung disease (“secondary”) and artificial pneumothorax (injection of air into the pleural cavity, leading to collapse of the affected lung). Many pneumothorax occur after chest trauma or as a complication of treatment.

Symptoms of pneumothorax are determined by the size and speed of air entering the pleural cavity; These include, in most cases, chest pain and difficulty breathing. Diagnosis can sometimes be made by physical examination, but sometimes a chest x-ray or computed tomography (CT) scan is necessary. In some situations, pneumothorax leads to severe shortage oxygen and decreased blood pressure, progressing if left untreated to cardiac arrest; This condition is called tension pneumothorax.

Small spontaneous pneumothorax usually resolves on its own and does not require treatment, especially in cases without underlying pulmonary disease. If there is a large pneumothorax or if severe symptoms air can be pumped out using a syringe or by placing a unilateral Bulau drain inserted to remove air from the pleural cavity. Sometimes surgical measures are necessary, especially if the drainage tube is ineffective or repeated episodes of pneumothorax occur. If there is a risk of recurrent episodes of pneumothorax, various methods treatments, such as pleurodesis (sticking the lungs to chest wall).

Classification

There are different types of pneumothorax, which are divided into classifications based on the causes of their occurrence, location and extent of the lesion. Depending on the extent to which the lung tissue and pleura are damaged, the pulmonologist prescribes a treatment plan and announces a prognosis.

Depending on the scale of damage to the lung tissue, there are:

Total pneumothorax (complete). Characterized by complete compression of the lung due to ejection large quantity gas into the pleural cavity.
Limited pneumothorax (partial). The collapse of the respiratory organ is incomplete.

If the lesion is on the left side, left-sided pneumothorax is diagnosed, on the right lung - right-sided pneumothorax. There is also a bilateral type of disease, which develops due to total compression of two lungs at the same time and is fraught with the rapid death of the victim.

The disease is also divided according to its causes:

Traumatic pneumothorax. This option is possible if the chest is damaged. It develops as a result of a penetrating wound (for example, a knife wound), as well as due to injury to the lung tissue by a fragment of a rib during an open or closed fracture.
Spontaneous. Occurs due to rapid rupture of lung tissue against the background chronic disease or predisposing factors. Thus, the cause of primary (idiopathic) pneumothorax can be congenital deficiency pleural tissue, loud laughter or sharp cough, rapid diving to depth, as well as flying on an airplane. Secondary develops due to severe lung diseases.
Artificial. It is created intentionally under the supervision of a competent specialist for the treatment of certain respiratory diseases.

According to the communication with air from the environment:

Closed. A one-time hit occurs small quantity air into the pleural cavity, after which its volume no longer changes.
Open. Observed visual defect the sternum, through which, with each inhalation, air enters the cavity, and with exhalation, it exits. The process may be accompanied by audible squelching and gurgling.
Valve. Has the most severe consequences. During a tension pneumothorax, with each inspiration, air enters the peripulmonary space, but there is no escape of it out.

Each of the conditions, regardless of severity, requires a thorough examination by a doctor and proper treatment. This will help minimize the risk of relapse, and in some cases save the life of the victim.

Reasons for development

Not in the lung muscle tissue, so it cannot straighten itself to allow breathing. The inhalation mechanism is as follows. In normal conditions, the pressure inside the pleural cavity is negative - less than atmospheric pressure. When the chest wall moves, the chest wall expands due to negative pressure in the pleural cavity lung tissue“picked up” by the traction inside the chest, the lung expands . Next, the chest wall moves in the opposite direction, the lung, under the influence of negative pressure in the pleural cavity, returns to its original position. This is how a person performs the act of breathing.

If air enters the pleural cavity, the pressure inside it increases, the mechanics of lung expansion are disrupted - a full act of breathing is impossible.

Air can enter the pleural cavity in two ways:

in case of damage to the chest wall with a violation of the integrity of the pleural layers;
with damage to the mediastinal organs and lungs.

The three main parts of pneumothorax that cause problems are:

the lung cannot expand;
air is constantly sucked into the pleural cavity;
the affected lung swells.

The inability to expand the lung is associated with the re-entry of air into the pleural cavity, blockage of the bronchus against the background of previously noted diseases, and also if pleural drainage was installed incorrectly, causing it to operate ineffectively.

Air suction into the pleural cavity can pass not only through the formed defect, but also through the hole in the chest wall made for installing drainage.

Pulmonary edema can occur as a result of stretching of the lung tissue after medical actions aimed at quickly restoring negative pressure in the pleural cavity.

Symptoms and first signs

The severity of pneumothorax symptoms depends on the cause of the disease and the degree of compression of the lung.

A patient with an open pneumothorax takes a forced position, lying on the injured side and tightly pressing the wound. Air is sucked into the wound with noise, foamy blood mixed with air is released from the wound, the excursion of the chest is asymmetrical (the affected side lags behind when breathing).

Development spontaneous pneumothorax usually acute: after a coughing fit, physical effort, or without any visible reasons. With the typical onset of pneumothorax, a piercing stabbing pain appears on the side of the affected lung, radiating to the arm, neck, and behind the sternum. The pain intensifies with coughing, breathing, and the slightest movement. Often pain causes the patient to have a panicky fear of death. Pain syndrome with pneumothorax it is accompanied by shortness of breath, the severity of which depends on the volume of collapse of the lung (from rapid breathing to severe respiratory failure). Pallor or cyanosis of the face appears, and sometimes a dry cough.

After a few hours, the intensity of the pain and shortness of breath subsides: the pain bothers you at the moment take a deep breath, shortness of breath occurs with physical effort. The development of subcutaneous or mediastinal emphysema is possible - the release of air into the subcutaneous tissue of the face, neck, chest or mediastinum, accompanied by swelling and a characteristic crunch upon palpation. On auscultation on the side of the pneumothorax, breathing is weakened or not heard.

In approximately a quarter of cases, spontaneous pneumothorax has an atypical onset and develops gradually. Pain and shortness of breath are minor, and as the patient adapts to new breathing conditions, they become almost unnoticeable. Atypical form The course is typical for limited pneumothorax, with a small amount of air in the pleural cavity.

Clearly clinical signs of pneumothorax are determined when the lung collapses by more than 30-40%. 4-6 hours after the development of spontaneous pneumothorax, an inflammatory reaction from the pleura occurs. After a few days, the pleural layers thicken due to fibrin deposits and edema, which subsequently leads to the formation of pleural adhesions, making it difficult to straighten the lung tissue.

Pneumothorax - first aid during an attack

Pneumothorax - extremely severe pathological process respiratory system, which can lead to irreversible processes in the body and fatal outcome. Providing first aid during an attack of illness should be urgent. When a patient develops a sudden relapse or an acute attack of pneumothorax, without medical care there is no way around it, you need to call an ambulance right away.

How can you help the patient? If pneumothorax is caused by a penetrating chest injury, the wound must be closed to prevent air and blood from escaping. For this, rags or bandages with cotton are used. To stop air from escaping through the wound, you can use a film to cover the hole. If possible, items that will be used to cover the wound should be disinfected as much as possible. The film must cover the wound hole hermetically, otherwise there will be no point in such a bandage.

If valvular pneumothorax occurs, it is necessary to provide access to oxygen by pulmonary puncture. But only a person with a medical education or the skills to carry out this manipulation can do this correctly, without harm to health. Puncture allows you to straighten the lung, prevent mediastinal fusion and displacement internal organs.

Complications

Complications of pneumothorax are common and occur in half of patients:

Pleurisy is common consequence pneumothorax of the lung. It is often accompanied by the formation of adhesions, which interferes with the normal expansion of the lung.
The mediastinum fills with air, which leads to spasm of the heart vessels.
Air enters the subcutaneous tissue, the so-called subcutaneous emphysema.
Bleeding in the pleural area.
With a long course of the disease, the affected lung begins to become overgrown with connective tissue. It shrinks, loses elasticity, and is unable to straighten even after the removal of air masses from the pleural area. This leads to respiratory failure.
Pulmonary edema.
With a large area of damage to lung tissue, death is possible.

Diagnostics

Diagnosis of pneumothorax is based on data obtained during examination and examination of the patient. Percussion reveals a box or tympanic sound, spreading to the lower ribs, a displacement or expansion of the boundaries of cardiac dullness. Palpation determines weakening or absence voice tremors. Breathing is weakened or not audible.

X-ray examination reveals a zone of clearing and displacement of the mediastinal organs; there is no pulmonary pattern. A more detailed image can be obtained using computed tomography. Additional diagnostic methods are: pleural puncture with manometry, videothoracoscopy, examination gas composition blood, electrocardiography.

For hemopneumothorax and pyopneumothorax, a diagnostic puncture is performed to determine the cellular composition and the presence of pathogens.

Treatment of pneumothorax

Pneumothorax is a condition requiring emergency care, which will be provided in a hospital. Pneumothorax is treated by surgeons and pulmonologists. Open pneumothorax requires an airtight bandage, valve pneumothorax requires urgent puncture with air removal and further operation to remove the suction valve.

In the future, hospital treatment will depend on the causes of pneumothorax - removal of air, restoration normal pressure inside the pleura, and suturing wounds, removing rib fragments, lung surgery, etc.

In order to prevent the development of pneumothorax again, a procedure of pleurodesis is performed - creating artificial adhesions in the pleura with the lung fully expanded.

Surgical intervention

If there is a penetrating wound into the chest cavity (for example, in a military situation), after which pneumothorax develops and a one-sided air leak occurs, there is a need for pre-medical intervention. For this purpose, decompression needles were developed, which, with proper manipulation, pump out the air entering the pleural cavity, due to which the pressure can stabilize. Special occlusive dressings (films) have also been developed, with an adhesive base, which stick even to wet skin, creating an airtight seal at the wound site and preventing the pressure in the chest from becoming equal to atmospheric pressure.

Pneumothorax in any of its manifestations requires surgical intervention. These include the following types of procedures:

Closed type - using a puncture, air is pumped out from the pleural cavity.
Open type - thoracoscopy or thoracotomy is performed to check the lung tissue and pleura. The defect is sutured, thereby stopping the flow of air into the pleural cavity. Next, repeat the event as in the closed type.
Valvular pneumothorax - puncture is performed using a thick needle. After this, it is treated surgically.
Recurrent pneumothorax - its causes are removed surgically. Often, not a regular pleural puncture is performed, but a drainage tube is installed to pump out air.

Prognosis and prevention

Usually simple manifestations of the disease do not have adverse consequences for the human body. The prognosis is determined by the degree and size of damage to the respiratory system. The faster help is provided, the less likely worsening of the condition.

Up to 40% of people may experience a relapse. Typically, recurrence occurs within six months after the first attack.

Death rate:

HIV-infected - no more than 25%.
In people with congenital cystic fibrosis, the development of unilateral pneumothorax is 5%. Double-sided gives 25%.
In people with chronic obstructive pulmonary disease, the average is 5%.

Special medical measures There is no way to prevent the occurrence of pneumothorax. To reduce the risk of developing severe pathology, it is important to always seek treatment promptly. medical care with the development of diseases of the internal organs of the respiratory system. This especially applies to bronchitis, asthma, and pneumonia.

Patients who have suffered pneumothorax need to be careful about their health. Heavy physical activity is excluded. Once a year it is necessary to undergo a complete medical examination, special attention is paid to chest x-rays and blood and sputum tests for tuberculosis. With frequent relapses, the only treatment for pneumothorax is surgery - thoracoscopy.