Pneumothorax of the lung - causes, diagnosis, treatment, surgery and prevention. Pneumothorax: causes, symptoms, treatment and prevention

Pneumothorax is defined as the presence of air or gas in pleural cavity, for example, in the space between the visceral and parietal layers of the pleura, which can impair oxygenation and ventilation in the lungs. Clinical results depend on the degree of lung collapse on the affected side. If the pneumothorax is significant, it may cause mediastinal shift and compromise hemodynamic stability. Air can enter the intrapleural space through injury chest or from the outside it is easy, which is observed in some complex pathologies.

Causes of pneumothorax development

Spontaneous pneumothorax is divided into two types:

Primary, which occurs in the absence of a specified lung disease.
Secondary, developing due to some lung disease.

The causes of primary spontaneous pneumothorax are unknown, but established risk factors include male gender, smoking, and a family history of pneumothorax. The various underlying mechanisms are discussed below.

Secondary spontaneous pneumothorax occurs in a variety of lung diseases. The most common is chronic obstructive pulmonary disease (COPD), which accounts for about 70% of cases.

Known lung diseases that can significantly increase the risk of pneumothorax are:

Respiratory tract diseases - COPD, especially with emphysema and the development of air cavities, status asthmaticus, cystic fibrosis.
Lung infections - Pneumocystis pneumonia, tuberculosis, necrotizing pneumonia.
Interstitial lung diseases - sarcoidosis, idiopathic pulmonary fibrosis, histiocytosis, lymphangioleiomyomatosis.
Connective tissue diseases - rheumatoid arthritis, ankylosing spondylitis, polymyositis and dermatomyositis, systemic scleroderma, Marfan syndrome and Ehlers-Danlos syndrome.
Oncological diseases - lung cancer, sarcomas involving the lungs.
Menstrual pneumothorax associated with menstrual cycle and concomitant endometriosis.

In children additional reasons can become measles, echinococcosis, penetration into the lungs foreign body and other diseases, for example, birth defects development of cystic adenomatoid and congenital lobar emphysema.

11.5% of people with spontaneous pneumothorax have a family member who has previously suffered from the condition. Hereditary predisposing pathologies can be:

Marfan syndrome.
Homocystinuria.
Ehlers-Danlos syndrome.
Deficiency of alpha-1 antitrypsin, which leads to emphysema.
Burt-Hogg-Dubet syndrome.

In general, these conditions cause symptoms other than pneumothorax, which is often just an additional sign.

Traumatic pneumothorax can occur due to blunt trauma or penetrating injury to the chest wall. The most common mechanism is penetration of sharp bone fragments from rib fractures, which damage lung tissue. Traumatic pneumothorax may also occur in patients near explosions, although there may be no obvious chest injury.

Medical procedures, such as inserting a central venous catheter into one of the chest veins or taking biopsy samples from lung tissue, can also lead to pneumothorax. Artificial ventilation lungs with positive pressure, or mechanical non-invasive ventilation can lead to barotrauma associated with pressure changes, which often leads to pneumothorax.

Divers who use special breathing systems when swimming to great depths often damage their lungs and pleura. Divers often suffer from pneumothorax as a result of barotrauma from a sharp rise from depth, or when holding their breath for a long time.

How is the disease classified depending on the leading factor?

Spontaneous pneumothorax is usually studied in detail in search of a treatment approach that ranges from observation to active intervention. Primary spontaneous pneumothorax occurs due to the absence of underlying lung disease and provoking factors, among others. In other words, air enters the intrapleural space without prior trauma and without underlying history clinical form lung diseases.

However, many patients labeled as primary pneumothorax often have subclinical lung disease causing the presence of pleural sacs that can be detected by computed tomography(CT). The classic patient for this form of the disease is usually 18-40 years old, tall, thin, and often a heavy smoker.

Secondary spontaneous pneumothorax occurs in patients with wide range diseases of the lung parenchyma. Patients have an underlying pulmonary pathology that alters the normal structure of the lungs. Air enters the pleural cavity through stretched or damaged alveoli. The clinical presentation of these patients may include more severe symptoms and complications due to comorbidities.

Iatrogenic pneumothorax is essentially traumatic because it occurs due to damage to the pleura and is secondary to a diagnostic or therapeutic procedure. Half a century ago, iatrogenic pneumothorax was predominantly the result of deliberate injection of air into the pleural space to treat tuberculosis.

Traumatic pneumothorax from blunt trauma or penetrating injury occurs as a result of disruption of the parietal or visceral layer of the pleura. The treatment steps for traumatic pneumothorax are similar to those for treating illness resulting from non-traumatic causes. If the injury causes communication of the pleural cavity with the external environment or leads to hemodynamic disturbances, drainage of the pleural cavity is performed to remove air, which allows the lungs to open.

There is a subset of traumatic varieties of pneumothorax classified as atypical - they may not be visible on a radiograph, but they can be distinguished on a CT scan. In short, pathological processes of pneumothorax can be observed and treated if they manifest themselves symptomatically.

Tension pneumothorax

This type of pneumothorax is a life-threatening condition that occurs when air is trapped in the pleural cavity under positive pressure. Air masses displace mediastinal structures and damage cardiac function. Saving a patient's life is only possible in a modern intensive care unit. Because tension pneumothorax occurs infrequently and has potentially devastating results, high index suspicion, knowledge of basic emergency thoracic decompression procedures is important for all healthcare providers. Immediate chest decompression is mandatory if tension pneumothorax is suspected. The situation requires immediate radiographic confirmation.

Pneumomediastinum

Pneumomediastinum represents the presence of gas in the tissues of the mediastinum, appears there spontaneously, after medical procedure or injury. Pneumothorax may occur secondary to pneumomediastinum.

Symptoms of pneumothorax development

Symptoms of pneumothorax vary depending on the type.

Spontaneous and iatrogenic pneumothorax

Until the air bubble ruptures and causes a pneumothorax, no clinical signs or symptoms are present in spontaneous pneumothorax. Young and otherwise unaffected patients may tolerate the major physiological effects of decreased vital capacity and oxygen partial pressure deficiency quite tolerably, with minimal changes in quality of life. However, if underlying lung disease is present, a pneumothorax may cause respiratory distress.

Classic signs of pneumothorax are the development of three chest pains and shortness of breath. Typically, both symptoms are present in 64-85% of patients. Chest pain, described as severe and stabbing, often radiates to the ipsilateral shoulder and worsens with inspiration. With secondary pneumothorax, chest pain will manifest itself with more pronounced clinical symptoms.

Dyspnea is usually characterized by a sudden onset and is more severe in secondary spontaneous pneumothorax due to a decrease in the respiratory reserve of the lungs. Anxiety, cough and nonspecific symptoms such as malaise and fatigue are less common. The most common underlying abnormality in spontaneous pneumothorax is chronic obstructive pulmonary disease (COPD) and cystic fibrosis.

Spontaneous pneumothorax usually develops at rest. By definition, this type of illness is not related to trauma or stress. Symptoms of iatrogenic pneumothorax are similar to spontaneous ones and depend on the age of the patient, the presence of concomitant pulmonary diseases and the degree of pneumothorax.

A history of previous pneumothorax is extremely important as recurrence is common, with an incidence of 15-40%. Up to 15% of relapses may occur on the opposite side. Secondary pneumothorax is often more likely and recurs in cystic fibrosis in 68-90% of cases. No studies have found that the number or size of bubbles found in the lungs can be used to predict relapse.

Tension pneumothorax

Signs and symptoms of tension pneumothorax are usually more dramatic than those of the simple form, and correct clinical interpretation is critical to diagnosis and treatment. Tension pneumothorax is classically characterized by hypotension and hypoxia. On examination, there are no breathing sounds, and there is a deviation of the trachea from the affected side. The chest may be distended, swelling jugular vein and tachycardia are common symptoms.

Symptoms of tension pneumothorax may include:

Chest pain (in 90% of patients).
Shortness of breath (80%).
Anxiety.
Fatigue.
Spicy or dull pain in the epigastrium (rarely).

Menstrual pneumothorax

Women aged 30-40 years who seek help with the characteristic symptoms of right pneumothorax within 48 hours after the onset of menstruation give reason to suspect menstrual pneumothorax.

Pneumomediastinum

Pneumomediastinum must be differentiated from spontaneous pneumothorax. Patients may or may not have symptoms, as this variant is easily tolerated, although the mortality rate in cases of esophageal rupture is very high. This usually occurs when intrathoracic pressure increases significantly, for example, during exacerbation of bronchial asthma, cough, vomiting, childbirth, convulsions. In many patients with pneumomediastinum, esophageal rupture is possible as a result of endoscopy.

Other symptoms may include chest pain, usually radiating to the neck, back, shoulders, and worsening with deep breathing, coughing, or lying on the back. In addition, shortness of breath, neck or jaw pain, dysphagia, dysphonia, and abdominal pain are common. Trauma to the mediastinum, although present in 6% of patients, does not cause serious damage.

Clinical signs of pneumothorax can range from completely asymptomatic to life-threatening respiratory failure. Symptoms may include:

Sweating.
Splinting the chest wall to relieve pain.
Cyanosis (in case of tension pneumothorax).

Affected patients may also have changes in mental status, including decreased alertness and rarely loss of consciousness.

Respiratory symptoms may include the following:

Respiratory failure is considered a universal symptom. Possible respiratory arrest.
Tachypnea or bradypnea as a preterminal phenomenon.
Asymmetrical expansion of the lungs: displacement of the mediastinum and trachea to the opposite side is likely to occur with tension pneumothorax.
Shallow breathing.
Breathing sounds in the lungs are heard only in the unaffected half of the chest.
Hypersonnance on percussion: a rare symptom that may be absent even on late stage diseases.
Decreased tactile sensitivity.
Pathological noises in the lungs - moist rales, shortness of breath.

Cardiovascular indicators may manifest themselves as follows:

Tachycardia is the most common. If the heart rate is faster than 135 beats per minute, this may indicate a tension pneumothorax.
Paradoxical pulse.
Hypotension should be considered as nonspecific symptom, although it is generally considered a key sign of tension pneumothorax.
Swelling of the jugular veins.

Surgical treatment for gas accumulation in the pleural cavity and possible complications

Medicines may be needed to treat the pulmonary disorder that causes pneumothorax. For example, intravenous administration of antibiotics is included in the treatment of pneumothorax, in the presence of a complication in the form of staphylococcal pneumonia. In addition, research suggests that administering prophylactic antibiotics during chest tube insertion may reduce the incidence of complications such as emphysema.

It is clear that the use of analgesics can provide patient comfort until chest tube drainage is ruled out. Some authors advocate the use of intercostal nerve blocks to improve patient comfort and reduce the need for narcotic analgesics.

In patients with recurrent pneumothorax who are not surgical candidates, sclerotherapy with talc or doxycycline may be of benefit.

The decision to observe or treat with immediate intervention is influenced by a risk assessment in the balance between patient care and the likelihood of possible spontaneous resolution or relapse.

Below is the possible behavior of a specialist depending on the condition of a patient with pneumothorax:

Asymptomatic - treatment decisions are guided by an assessment of the long-term risk of relapse.
Symptoms are present, but the course is clinically stable - simple aspiration and delayed hospitalization for spontaneous pneumothorax if the patient is stable. In addition, a small catheter or chest tube to remove air is recommended.
A complex course with characteristic symptoms, including pain - installation of a chest tube and observation during hospitalization.
Flow, life-threatening- pneumothorax causing hemodynamic instability is life-threatening and requires immediate placement of a drainage tube.

If the patient has had repeated episodes of pneumothorax, or if the lung remains unexpanded 5 days after chest tube placement, surgical treatment may be necessary. The surgeon may use treatment options such as thoracoscopy, electrocautery, laser treatment, bleb resection, or open thoracotomy.

Other signs requiring immediate surgical intervention:

Persistent air leak into the pleura for longer than 7 days.
Periodic manifestations of ipsilateral pneumothorax.
Contralateral pneumothorax.
Bilateral pneumothorax.
Patients with acquired immunodeficiency syndrome.

Misdiagnosis is the most common complication. A simple pneumothorax can turn into a tension pneumothorax. In addition, if pneumothorax does not exist, the patient may develop one after decompression with a needle instrument. The needle can damage the lung, although this is rare. And it can cause significant lung damage or hemothorax. If the needle is initially positioned too medial to the sternum, the instrument may cause hemothorax from rupturing the lower set of intercostal vessels or the internal mammary artery.

Damage to the intercostal neurovascular bundle and lung parenchyma may occur after tube drainage of the pleural cavity, especially if trocars are used. In addition, an increased risk of postoperative bleeding is associated with the process of lung transplantation for medical pleurodesis and surgery.

Complications of pneumothorax include the following:

Hypoxemic respiratory failure.
Stopping breathing or cardiac activity.
Hemopneumothorax.
Bronchopulmonary fistulas.
Pulmonary edema.
Empyema.
Pneumomediastinum.
Pneumopericardium.
Pneumoperitoneum.
Pyopneumothorax.

Complications of surgical procedures include:

Acute respiratory distress.
Infection of the pleural cavity.
Skin or systemic infection.

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A person suddenly choking requires immediate attention. Often such symptoms appear with pneumothorax, which can be open, closed, spontaneous, etc. Below we will look at the causes of different forms of the disease, what signs they have, and what first treatment is required.

What it is

Pneumothorax is a phenomenon in which air enters the pleural cavity and accumulates there. As a result, the normal functionality of the pulmonary system is disrupted and the person suffers from symptoms improper breathing and accompanying signs. Pathology has different causes, it is typical for older people 18-45 years old.

During an attack, the patient needs emergency care, since due to severe pneumothorax, breathing can completely stop and the person will die. Below we will take a closer look at what the first symptoms of the disease are and how to provide first aid.

Due to excess accumulation of air in the pleural space, short-term or long-term impairment of pulmonary function occurs, which can lead to the development of cardiovascular failure. The main factor leading to pneumothorax is the presence of defects and damage in the pleura, through which air enters the space between them. Damage occurs for various reasons, due to injuries, other mechanical influences, etc.

As a result, intrapleural pressure increases greatly, which is normally lower than atmospheric pressure. This ends with the collapse of the lung, which is also called collapse.

In addition to rapid and difficult breathing, the main symptom of pneumothorax is a sharp pain syndrome in the chest. A constant lack of oxygen leads to pale and cyanotic skin, which is especially noticeable on the face. A person begins to literally suffocate and, if emergency assistance and subsequent treatment are delayed, he can die.

ICD-10 code

Pneumothorax different types according to the international classification it is included in the class J93. In this case, spontaneous has a code according to ICD-10 - J93.1.

Classification and types

According to the main classification, pneumothorax is divided into two global types, characterizing the presence of communication with the external environment:

Open means the entry of air through external defects on the body, which is typical for various injuries, leading to depressurization of the respiratory organs from the outside.
Closed pneumothorax is not in contact with the external environment, the damage is present from inside the lung. Usually it proceeds more easily, the symptoms and signs are less pronounced, but it occurs suddenly without causes noticeable to others, which does not allow you to quickly understand what the problem is and quickly respond adequately.

The following type of classification divides the disease according to its prevalence; the disease is classified as:

Unilateral when only one lung collapses.
Bilateral – pathological condition affects both lungs. This type is more dangerous, since there is no reserve pulmonary lobe through which the body can be supplied with oxygen.

Classification for reasons pneumothorax is divided into:

Traumatic, which occurs when a penetrating wound to the chest, for example, with a knife or when the ribs are broken and the lungs are damaged by their debris.
Spontaneous, which is always closed, and comes completely unexpectedly. It is difficult to carry out treatment in such a situation, since the exact cause is not clear.
Tension pneumothorax means that the pleural area receives air, but it does not leave it and gradually fills from the inside. I call this state complete collapse.
Secondary, meaning a consequence of any disease of the lungs or adjacent organs.
Artificial, also called iatrogenic. It is specially created by a doctor as part of special treatment, for example, with pleural biopsy.

To characterize pneumothorax, it is important to divide it by how much gas is in the interpleural zone. According to this type of pathology, it is classified into:

Partial (partial, limited), when the lung does not collapse completely;
Total;

Causes

The entire set of factors leading to pneumothorax is divided into three subgroups:

Respiratory diseases;
Injuries, wounds, wounds;
Measures necessary for any treatment;

Spontaneous pneumothorax, which appears without apparent underlying causes, is often caused by various internal problems with the lungs and related organs. Typically, signs of the disease appear:

due to bullous disease;
with airway obstruction, cystic fibrosis, status asthmaticus;
as a consequence of infectious lesions such as pneumonia, tuberculosis;
with pathologies in the connective structures of the lungs occurring due to rheumatoid arthritis, ankylosing spondylitis, polymyositis;
for cancer and metastases in the lungs;
as a consequence of breast endometriosis;

Let's consider what causes pneumothorax in different types.

Symptoms of pneumothorax

Pneumothorax is associated with accumulations of air masses in the pleural zone, which leads to compression of the lungs and their displacement. This situation results in the following pronounced symptoms:

The inhalation process is very complicated, the patient breathes shallowly and frequently;
A dry cough appears;
The heart is accelerated (tachycardia) and beats unevenly;
There is pain inside the chest;
The skin of the face and body turns pale and then turns blue due to lack of oxygen;
From psychological factors signs of fear and depression are noticeable;
Blood pressure falling below normal;
The manifestations and symptoms of emphysema are visible under the skin, i.e. air clusters
The patient takes a comfortable position in a sitting or semi-sitting position;
Increased sweat production;

The severity of the symptoms of pneumothorax depends on the causes of the disease.

In the spontaneous form, severe pain is felt in the chest in the place where the breakthrough occurred. At first painful sensations Many people characterize them as acute; later they become aching and dull.
Valvular pneumothorax leads to the fact that the patient is very excited, and a stabbing pain is felt in the sternum. Other symptoms include a feeling pain symptoms in the shoulder blades, collarbone, abdomen.

With open, tense pleural and other types of pneumothorax, during spontaneous or obvious exacerbation, the patient quickly weakens. At such a moment he needs urgent first aid, otherwise he may suffer severe consequences and complications, even death.

Consequences

Due to the rapid development of pneumothorax symptoms, consequences can be avoided only in half of the cases. In other situations, the following consequences arise:

Pleural emphysema with the development of purulent pleurisy, pyothorax.
Intrapleural bleeding due to damage to pulmonary structures.

With valve-type pneumothorax, subcutaneous emphysema often forms when air accumulates under the epidermis.

In the absence of treatment and chronic pneumothorax, the lung tissue is gradually replaced by connective tissue, which is why the organ wrinkles, loses elasticity and functionality. All this leads to heart failure and death.

Diagnostics

The primary diagnosis of pneumothorax is made during the initial examination, based on what symptoms the patient is suffering from. To do this, the doctor pays attention to:

a pose where you take a sitting or half-sitting position, in which it is easier to breathe;
presence of cold sweat skin, shortness of breath, cyanosis or pallor;
Widened spaces between the ribs with limited movement of the chest on the side of the lesion;
low blood pressure, tachycardia, change in the position of the heart in the direction of the normal lung;

The best diagnostic method for pneumothorax is considered x-ray. It's fast and available method, which has sufficient accuracy. An x-ray is required during inhalation or exhalation, depending on the extent of the lesion.

Photo. What can be seen on an x-ray

If it is necessary to differentiate from other diseases, tomography is performed, which gives a more accurate result. During diagnosis, it is important to distinguish pneumothorax from:

Asphyxia;
Pleurisy;
Emphysema;
Aortic aneurysms;
Diaphragmatic hernia;

First aid

Pneumothorax is associated with a situation of acute lack of air, threatening fatalities, therefore it is important to know how to provide first emergency aid to people with such pathology.

The first step is to call an ambulance at the number 103 , it is necessary to explain that the case is an emergency and requires the urgent arrival of doctors. Before doctors arrive, you must:

Stop bleeding;
Do not allow air to enter the pleural space;

It is impossible to give additional specific instructions, since much depends on individual factors, the depth of the wound, etc.

Arrived medical workers must provide emergency medical care - administer the necessary medications based on the patient’s condition, urgently hospitalize him in the pulmonology department, where first aid will consist of pleural puncture to remove air bubbles from the pleural area.

Treatment of pneumothorax

The patient undergoes the first treatment while still in the ambulance, it consists of:

In oxygen therapy;
Pain relief, since the process of such defective breathing causes noticeable pain;
Suppressing coughs that cause painful symptoms;
Pleural puncture;

Further therapy is determined by the type of pneumothorax:


With a small closed and limited	No special measures are required, the disease disappears on its own, without consequences or complications, within 2-5 days.
Closed extensive	The procedure for aspiration of air masses that have penetrated inside.
Open	The first task is to convert this pneumothorax into a closed type. Next, standard treatment is prescribed.
Recurrent	Surgery is prescribed to eliminate the causes. For patients under 45-50 years of age with a recurrent course, active aspiration is indicated.
Valve	They lead to an open one, using a thickened needle, and then a surgical operation is prescribed.

Treatment periods vary from a couple of weeks to 6-8 months, depending on the causes and severity of the condition.

Rehabilitation

According to statistics, every fifth person who has suffered pneumothorax caused by internal disease is susceptible to relapse due to a violation of the recovery and rehabilitation regime. In such conditions, exacerbation can be bilateral, which carries huge risks of death, therefore, recovery period you need to adhere to a number of rules and principles:

For a month after discharge, do not experience even minor physical exertion, do not fly on airplanes, as during flight there are sharp changes atmospheric pressure;
Avoid other types of activity during which the ambient pressure “jumps” sharply;
To give up smoking;
Be examined for infectious pathologies lungs;

Forecast

Pneumothorax of any type requires immediate hospitalization with emergency first aid and subsequent diagnosis of the condition of the lungs and pleural cavity. The survival prognosis strongly depends on the characteristics and type of pathology. With a bilateral form, survival rate is about 50%.

Pneumothorax is the accumulation of gas in the pleural cavity, resulting in prolapse of lung tissue with displacement of the mediastinum. This in turn leads to compression of large blood vessels mediastinum, circulatory disorders and respiratory dysfunction.

The air in the lungs enters through a cavity that has formed there for a number of different reasons. Often during pneumothorax, the victim’s life is in danger. To seek timely medical help, you should be able to recognize the first signs of this disease.

Reasons for the development of the disease

Pneumothorax of the lung is a respiratory condition that can occur due to many precipitating factors. The disease develops due to two main reasons: mechanical damage to the chest, as well as the presence of certain diseases that destroy lung tissue. In the second case, the patient must know the first signs of lung destruction.

Possible causes of the disease:

chest injuries (open, penetrating and closed, which are accompanied by rib fractures);
damage to the lung during certain medical procedures (puncture of the pleural cavity, installation of a subclavian catheter, etc.);
some diseases of the respiratory system (tuberculosis, abscess, emphysema);
spontaneous rupture of the esophagus (Boerhaave syndrome);
features of the body that imply underdevelopment of the pleural petals.

Sometimes in medical practice the method of applying an artificial pneumothorax is used.

This method allows you to stop pulmonary bleeding and helps cure some forms of tuberculosis. As a rule, the treatment is long-term and the patient knows in advance about the method by which the therapy is carried out.

Classification

Exist different kinds pneumothorax, which are divided into classification based on the causes of their occurrence, location and extent of the lesion. Depending on how much 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 of a chronic disease or predisposing factors. Thus, the cause of primary (idiopathic) pneumothorax can be congenital insufficiency of pleural tissue, strong laughter or a sharp cough, rapid immersion to depth, as well as an airplane flight. 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.

Pneumothorax can be complicated by various pathologies or occur without them. The clinical picture of the disease also depends on the amount of air entering the pleural cavity and its circulation in the wound.

According to the communication with air from the environment:

Closed. A one-time entry of a small amount of air into the pleural cavity occurs, after which its volume no longer changes.
Open. There is a visual defect in 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.

Symptoms

Signs of pneumothorax are quite difficult to miss. The clinical picture is distinct; signs of oxygen starvation may be observed, as well as the consequences of circulatory disorders that occur due to compression of the mediastinum.

Symptoms of pneumothorax:

pain in the affected area of a stabbing nature, which can radiate to the arm, back, neck;
painful sensations increase significantly during movement, coughing, talking, sneezing;
fear of death caused by severe pain and the inability to take a full breath;
the victim takes a forced position;
shortness of breath, less often – dry cough;
swelling of the neck veins;
pallor, and then cyanosis (blue discoloration) of the skin;
disturbance of heart rhythm, signs of arrhythmia;
if the pneumothorax is open, you can visually observe air entering the wound, then foamy blood is released from it.

Depending on the location and extent of the lesion, symptoms may be weakened. After a few hours, the symptoms weaken significantly, pain and shortness of breath appear only during bodily movements. Sometimes emphysema develops, which is the release of accumulated air under the skin.

After a few hours, inflammation of the pleura develops. The clinical picture differs in severity if damage to lung tissue occurs by more than 40%.

The accumulation of air in the pleural cavity is a life-threatening and health-threatening condition, therefore, when the first signs of the disease appear, you should immediately seek medical help. It is especially necessary to monitor your well-being for those patients who suffer from chronic diseases of the pulmonary and digestive systems.

Diagnostics

Pneumothorax of the lungs is determined by the method complex diagnostics, which includes a survey and examination of the victim, as well as radiography and pulmonary puncture, if necessary.

Laboratory blood tests are usually clinical picture don't clarify. The analyzes can trace the dynamics of the concomitant disease that contributed to the rupture of lung tissue. IN arterial blood Hypoxemia (accumulation of foreign gases) may occur.

Survey

To correctly assess the condition of the victim, the pulmonologist needs to conduct a thorough interview.. This will help identify the causes of pneumothorax and prescribe the correct treatment.

During the initial visit, a complete history of life and a specific disease is collected; during a second visit to the doctor, the patient answers questions that relate exclusively to the disease.

What a specialist needs to know to make a diagnosis:

presence of any chronic diseases;
what symptoms of the disease are present;
when and why the pain appeared, its nature, intensity;
whether there has been a recent blow, fall, or other mechanical impact, which could cause compression of the lung.

It is necessary to answer the doctor’s questions as thoroughly and quickly as possible; you should not remain silent about existing diseases. If you are allergic to any medications, you need to tell them about it. medical personnel. After the interview, an examination and additional examinations are carried out.

Inspection

The patient's position can be visually assessed. As a rule, it is forced, on the side in which the lung prolapse occurred. If the wound is open, the specialist notes its size and the presence of foam in the blood. During auscultation, breathing is practically not audible on the affected side.

The pulmonologist also evaluates the nature of shortness of breath, which during pneumothorax is frequent, superficial. Percussion of the affected side produces a boxed sound (dull, hollow). The excursion of the chest on the side where the pneumothorax occurred is slightly behind the healthy one.

Radiography

On x-rays you can see a large light area on the affected side.. The pulmonary pattern is not visible. There is a clear boundary between healthy and damaged lungs. A displacement of the mediastinum is visually noticeable, the dome of the diaphragm is lowered.

Pleural puncture

Conducted under local anesthesia using a hollow needle, which is inserted into the intercostal space from the back. During the procedure, all accumulated air is removed, after which the nature of the contents of the pleural cavity is clarified in the laboratory.

The biomaterial is also sent for bacteriological and cytological examination. In severe cases, if the puncture does not alleviate the condition of the victim, medical indications Thoracoscopy is performed.

Treatment

For a person who does not have sufficient knowledge in the medical field, carry out the necessary therapeutic measures and it will be difficult to provide first aid to the victim. Therefore, it is better to entrust the evacuation of accumulated air to professionals.

There are no treatment methods that provide a 100% guarantee against recurrence of the pathology. Therefore, therapy has 3 goals: eliminate the cause, resolve pneumothorax in a particular case, and prevent the likelihood of relapse.

Oxygen therapy

Medical observation without any serious interventions is indicated in the case of non-extensive pneumothorax, when tissue damage is no more than 15%. In such cases, spontaneous resorption of air from the cavity is possible, which takes about 1-2 weeks.

Oxygen therapy is indicated for all patients suffering from prolapse of lung tissue. The procedure helps the body recover faster and reduces the risk of complications. In patients with a history of COPD or other chronic diseases, it is necessary to monitor the concentration of gases in the blood.

Aspiration of the contents of the pleural cavity

Evacuation of the contents of the cavity is performed using a catheter or hollow needle. The procedure is carried out by a competent specialist, since a non-professional is able to pierce an artery and some vital organs. In one session, it is allowed to remove no more than 4 liters of air. This should be done gradually to prevent mediastinal shift.

If symptoms remain several hours after aspiration and respiratory functions are not restored, installation of a drainage system is indicated.

Indications for the procedure:

multiple relapses of the disease;
age over 50 years;
lack of success with aspiration.

A special drainage tube is installed in the intercostal space, which helps remove excess air.. An air or water lock is attached to the end. In the second case, it is possible to track the smallest gas leak, which is why this technique is more popular. Removal of the drainage occurs one day after the complete cessation of the passage of air masses, if radiography confirms expansion of the lung.

Introduction of special substances into the pleural cavity (chemical pleurodesis)

This procedure is carried out to prevent possible relapses, if their probability is high enough. To do this, special substances are introduced into the pleural cavity that promote its obliteration, that is, the fusion of the pleural layers with each other. Administration is carried out through the drainage system. Chemical pleurodesis helps minimize risks re-development diseases to almost zero levels.

Surgical intervention

The operation is performed when it is impossible to use alternative treatment methods or their ineffectiveness. In this case, thoracotomy or thoracoscopy is performed. Surgery is the most effective method combating pneumothorax and its further relapses.

When it is carried out:

the lung tissue does not straighten out a week after drainage;
spontaneous bilateral pneumothorax;
relapse occurs after chemical pleurodesis;
if the victim received the disease due to a certain profession (pilot, diver, etc.);
complicated pneumothorax.

The decision to carry out the operation is made by the commission, analyzing all previous actions of the medical staff and studying the victim’s tests. Intervention is also carried out if the cause of the disease is open wound. It is sutured, after which the patient is observed and the necessary measures are taken to treat pneumothorax of the lung.

Prevention, possible complications, prognosis

The concept of pneumothorax is familiar to many people suffering from other chronic lung diseases. It is a serious complication that, if not properly treated, can lead to the death of the victim.

The most favorable prognosis is if tissue damage is no more than 15%. The most critical conditions are diagnosed in the case of spontaneous bilateral pneumothorax. The success of treatment depends on the speed of contacting a doctor and subsequent resuscitation measures.

What can be done for prevention:

stop smoking;
treat accompanying illnesses lungs, digestive tract;
visit a pulmonologist once every six months, especially if shortness of breath occurs;
lead healthy image life;
limit the number of air travel;
do not dive into depth.

As a rule, pneumothorax does not occur without any reason. If a person is attentive to his health, undergoes preventive examinations in a timely manner and, at the slightest sign of deterioration, consults a doctor, the risk of serious illnesses is reduced significantly.

Pneumothorax is a disease that results in the accumulation of air in the pleural cavity of the lungs. They are depressurized.

Air penetration into the pleura increases pressure. After which partial or complete collapse of the lung occurs.

The person's condition is very serious and requires urgent assistance. Pneumothorax can be open or closed. Its occurrence is often due to lung disease or injuries (puncture wounds, bullet wounds, etc.).

Causes of the disease

The likelihood of developing spontaneous pneumothorax is observed in middle-aged people. The causes may be:

bullous disease;
infectious diseases (atypical,);
pulmonary endometriosis;
interstitial lung lesions;
malignant formations;
inflammation of connective tissue (and, polymyositis).

Traumatic pneumothorax occurs after trauma to the chest cavity. There are:

Penetrating chest wounds ( stab wounds, firearms, as well as fragmentation).
Chest injuries without penetrating effects from the external environment (provoked by tissue traumatization by sharp edges of broken ribs, lung rupture).

Valvular pneumothorax occurs after a spontaneous or traumatic one. It is one of the most dangerous species.

Iatrogenic pneumothorax may be a consequence medical manipulations. Such as:

pleural puncture;
incorrect placement of the central vein catheter;
taking a sample of the affected lung tissue (biopsy);
Endoscopic transbronchial biopsy;
rupture of the alveoli during mechanical ventilation of the lung (barotrauma).

Artificial pneumothorax is used to treat tuberculosis (mainly for fresh destructive forms). This is a procedure for introducing oxygen into the pleural cavity. The procedure is used to reduce the formation of cavities.

Pneumothorax in newborns is considered abnormal. The occurrence of this disease is associated with genetic pathologies of the lungs and pleura, as well as injuries and inflammatory processes. Reasons may be:

severe crying;
rupture during forced artificial respiration;
genetic pathology;
rupture of a lung abscess;
cyst rupture.

Catamenial or menstrual pneumothorax is a rare form that develops 2-3 days after the onset menstrual bleeding. Occurs for reasons:

intrathoracic endometriosis;
the production of a hormone during ovulation - prostaglandin F2. Its appearance causes a narrowing of the bronchioles.
the absence of a mucus plug in the cervix, which allows air to pass through the openings of the diaphragm into the pleura.

Symptoms

Symptoms of pneumothorax appear due to the accumulation of air in the pleural cavity. Their development depends on the stages of lung shrinkage.

Based on the size of the collapsed lung, they are divided into:

small (up to 25%);
average (50-70%);
total (100%);
tense (displaced mediastinum).

Spontaneous pneumothorax occurs:

primary (idiopathic);
secondary (symptomatic);
recurrent appearance.

The disease is accompanied by a coughing attack. A stabbing pain is felt in part of the diseased lung, which over time turns into an aching pain. This is accompanied by facial cyanosis (bluish skin color due to the accumulation of carbon dioxide in the blood), pallor. The pain may worsen with movement, breathing and coughing. The patient may have. Trying to reduce shortness of breath and pain, the patient most often lies on the sore side or sits down with an inclination towards the sore side.

Traumatic syndrome affects general state sick. There is a decrease blood pressure, severe shortness of breath, the skin becomes bluish, the pulse quickens, and acute pain appears. As you exhale, foamy blood is released from the wound.

During the period of traumatic pneumothorax, air may collect in the subcutaneous tissue of the sternum, the entire neck, face and mediastinum. Palpation in places of swelling gives a crunching sensation under the fingers.

Valvular pneumothorax is an extremely serious condition of the patient. Penetration of the entire air mass into the pleural area occurs, the exit of which is impossible. Symptoms and disorders are extremely pronounced. Shortness of breath, sometimes loss of consciousness, and cyanosis rapidly increase. Sharp and stabbing pain that can radiate to the shoulder blade, shoulder and abdominal cavity.

At in serious condition veins may swell upper limbs and cervical. The affected side increases due to the expansion of the spaces between the ribs. Heart rate increases and blood pressure decreases.

Subcutaneous emphysema progresses, speech is inhibited. When it grows in the wrong place, it often causes heart and pulmonary failure.

The childish appearance occurs when the lungs do not expand properly. In a child under three years of age, this can develop into pneumonia.

Often symptoms are not clinically apparent. In case of complications, signs of pneumothorax in children are:

body cramps;
pallor;
increased heart rate;
temporary cessation of breathing.

The diagnosis is made upon examination. Most often, a chest x-ray or CT (computed tomography) scan is needed.

Diagnostics

The examination is done using the auscultatory method (listening with a stethoscope). Thus, weakening or complete absence of breathing in part of the diseased lung is detected.

Using the tapping method (percussion), the doctor hears a loud and low sound.

During a preventive fluorography photograph, a specialist may suspect a mantle-shaped pneumothorax. In order to make sure of this, he prescribes x-ray diagnostics.

Another examination method is an x-ray. When a disease occurs, the image shows the causes and symptoms of its manifestation. There is a lumen with the absence of a lung pattern, this is caused by the fact that air collects in the pleural cavity. The diaphragm may go down.

The mediastinum goes to the side of the normally functioning lung. Lung atelectasis may form (partial or complete contraction of the lung tissue, which leads to a decrease in the amount of air in the lungs and impairs the ventilation of the alveoli).

Snapshot back side will show a thin line of visceral pleura (no more than 1 mm). The clearing strip is shown by the lateral position.

Thoracoscopy is used for diagnosis. Thanks to it, the pleural cavity of a sick person is examined. A special device - a taracoscope - is inserted through a hole made in the chest wall. It is used to detect gas and increased pressure inside the pleura.

Computed tomography is listed as one of the the best ways surveys in this area. It makes it possible to detect the presence of gas in the pleura. This test may reveal the likely origin of a spontaneous pneumothorax that is not recognized by radiographic examination.

Complications

This disease, if not properly treated, can lead to some complications. The most common are:

with the valvular form, subcutaneous and mediastyl emphysema may develop;
tearing of the lung tissue can provoke bleeding inside the pleura;
the formation of adhesions that interfere with the expansion of the lung. Because of them, serous-fibrinous pleurisy develops;
accumulation of pus in the pleural cavity (pleural empyema);
reventilation pulmonary edema.

A long course of the disease (especially without timely seeking medical help) can cause the replacement of lung tissue with connective tissue. The lungs shrink and lose their elasticity.

Pulmonary heart failure develops, which can lead to death.

Treatment

The mild form, which passes without symptoms of the respiratory system, sometimes does not require immediate hospitalization or even treatment. However, it must be observed by radiographic examination.

In uncomplicated forms of its manifestation, the subpleural bladder or bulla decreases. A defect in the visceral pleura becomes covered with fluid that consists of white blood cells (fibrous effusion).

After which it seals and heals on its own. All air is absorbed within 3 months.

Relapses occur in up to 50% of people.

Drug treatment (medicines)

First medical aid is provided by administering the following drugs:

Analgesics - analgin. For excruciating pain, narcotic substances (morphine, omnopon) are administered;
Antibiotics - tetracycline group (doxycycline, tetracycline and others);
Anti-tetanus serum.

After surgery, blood thinning drugs (heparin, warfarin, etc.) are prescribed.

In case of circulatory problems, caffeine and camphor are administered.

Preventive methods for recurrent types use the method of chemical pleurodesis. Irritants are introduced:

magnesium silicate;
glucose;
silver nitrate solution.

Surgery

With a penetrating wound in chest cavity(for example, in conditions of military operations), after which pneumothorax develops and a unilateral air leak occurs, the need for pre-medical intervention arises.

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 with examination of 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.

Postoperative exercises

After a wound or any other injury that results in pneumothorax, it is necessary to restore your physical shape. For this purpose, physical therapy exercises are used, which begin 3-4 weeks after injury.

It is necessary to start (as with any training) with light, gentle exercises, gradually increasing the load. The most common exercises are breathing exercises (inflating balloons, breathing into a tube). Strelnikova’s breathing exercises are actively recommended by doctors.

Complementary and alternative home treatments

Self-treatment for this disease is impossible - seeking help from a qualified specialist is the only right decision. But you can combine drug treatment with traditional medicine recipes.

Herbal treatment

Recipe from Veronica officinalis. Brew 1 tablespoon of the crushed plant in two glasses of water. Cover with a lid and leave for 2 hours. Filter before use. Drink 1 teaspoon of infusion 4 times a day. After several doses of the infusion, the patient’s appetite noticeably increases.

Cloudberry juice is very useful. Drink it instead of tea several times a day.

To restore strength, use a decoction of knotweed. It lowers blood pressure and increases blood clotting.

For the decoction, take 1 tablespoon of herbal raw materials, pour 250 g of boiled water into it. Then simmer in a water bath for 15 minutes. Then remove from heat and cover with a lid for 2 hours. Before use, filter and drink 1 tablespoon 3 times a day

Prevention

avoid changes in barometric pressure (flying in airplanes that are not equipped with atmospheric pressure stabilizers, avoid deep diving and rock climbing);
stop smoking;
For 3 months, stop playing sports and do not lift weights.

Forecast

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 the condition will worsen.

Specialty: Cardiologist, Therapist, Functional diagnostics doctor.

Pneumothorax (Greek pneuma, “air” + thorax, “chest, chest”) is the accumulation of air in the pleural cavity. This is an acute condition that requires hospitalization of the patient in a surgical hospital.

Types and causes of pneumothorax

Pneumothorax - emergency, which occurs when air enters the pleural cavity.

If communication between the environment and the pleural cavity has ceased, the pneumothorax is called closed. If there is free access of air into and out of the pleural cavity, this is an open pneumothorax. With valvular pneumothorax, air enters the pleural cavity during inspiration, but cannot exit it and accumulates, which leads to displacement of the lung and other organs of the chest.

According to the mechanism of development, pneumothorax is distinguished:

spontaneous,
traumatic,
artificial.

Spontaneous pneumothorax

Spontaneous pneumothorax develops when the inner layer of the pleura is torn and air from the lungs enters its cavity. This condition most often develops in young men with low body weight. It can be caused by a malformation of the lungs, and can also be a complication of various lung diseases: tuberculosis, bullous emphysema, cyst, lung abscess, etc., in which air cavities can form in the lungs. At severe cough, deep breathing, sudden movements, during stress, the wall of such a cavity is damaged, and air escapes between the layers of the pleura. When pus enters the pleural cavity, a serious complication develops - pleural empyema.

Traumatic pneumothorax

This condition occurs with an open wound to the chest or blunt trauma to the chest with damage to the lung. Less commonly, the cause of pneumothorax is complications of medical procedures - pleural puncture, bronchoscopy with removal of a foreign body, etc. Surgical pneumothorax can occur during interventions accompanied by opening the chest.

Artificial pneumothorax

Previously, this method was used to treat pulmonary tuberculosis to collapse the resulting cavities - cavities. In modern conditions, air is introduced into the pleural cavity during its endoscopic examination, during certain types of x-ray examination under the strict supervision of medical personnel.

Symptoms of pneumothorax

Spontaneous pneumothorax develops suddenly and is manifested by acute “dagger” pain in the chest. Sometimes a dry cough appears. A sick person cannot lie down and usually takes a semi-sitting position. With valvular pneumothorax, shortness of breath quickly increases, the face turns blue, weakness increases, and loss of consciousness may develop.

With a small volume of air entering the pleural cavity, the pain quickly subsides, sometimes shortness of breath and rapid heartbeat persist. Pneumothorax may not manifest itself clinically (asymptomatic).

At traumatic pneumothorax The general condition of the patient suffers significantly. Severe shortness of breath (respiratory rate reaches 40 per minute), cyanosis of the skin. Blood pressure decreases, heart rate increases, and blood pressure develops. When breathing, blood with air bubbles is released from a wound on the chest wall. Particularly dangerous is valvular pneumothorax, in which air quickly accumulates in the pleural cavity, causing collapse of the lung, displacement and compression of mediastinal organs (heart, large vessels, bronchi).

In traumatic pneumothorax, air sometimes spreads into the subcutaneous tissue face, neck, chest wall. These parts of the body thicken and take on a swollen appearance. If you touch skin with subcutaneous emphysema, you can feel a characteristic sound reminiscent of crunching snow.

Treatment of pneumothorax

In a surgical hospital, drainage of the pleural cavity into which air has entered is carried out.

A patient with symptoms of pneumothorax should be immediately taken to a surgical hospital. When providing first aid the patient must be placed in a semi-sitting position. If there is a chest wound with blood oozing from it with air bubbles, you must urgently apply a sealing bandage to it using an adhesive plaster or ordinary oilcloth or cellophane. It is important to allow air to enter the pleural cavity!

If there is a sharp drop in blood pressure, severe shortness of breath, or cyanosis of the face, urgent pleural puncture with a thick needle is indicated. It is carried out in the II/III intercostal space along the midclavicular line. The needle is fixed to the skin with an adhesive tape.

During transportation, painkillers can be administered to the patient. During development cardiopulmonary failure carry out resuscitation measures.

In a hospital setting, drainage of the pleural cavity is performed to remove air and prevent infectious complications. The drainage is removed 1–2 days after the lung has completely expanded. If drainage is ineffective or in severe cases, an operation is immediately performed to suture the lung defect and restore the integrity of the pleura.

Features of pneumothorax in children

Immediately after the first few breaths, the newborn may develop spontaneous pneumothorax. It occurs when the lungs expand unevenly, especially against the background of developmental defects. In children under 3 years of age, this condition can be a complication. At an older age, pneumothorax occurs during coughing during an attack of bronchial asthma, inhalation of a foreign body, etc. This condition can be a complication of ventilation during various operations.

Pneumothorax in children may not manifest itself clinically. Sometimes you can notice a short-term cessation of breathing, in more severe cases - rapid heartbeat, cyanosis of the skin, and convulsions.

The principles of treatment of pneumothorax in children are the same as in adults.

Which doctor should I contact?

For chest injuries or any conditions where sharp pain in the chest, severe shortness of breath and the patient’s well-being is rapidly deteriorating, it is necessary to call an ambulance, which will take the victim to a surgical hospital. Once this life-threatening condition has resolved, the patient is examined by a pulmonologist to diagnose the underlying condition that led to the development of the pneumothorax.

Channel One, program “Live Healthy!” with Elena Malysheva, section “About Medicine” on the topic “Pneumothorax” (from 34:05):

Educational video “Puncture of the pleural cavity for tension pneumothorax.”