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Pneumothorax

What is pneumothorax?

Pneumothorax - the presence of air in the pleural cavity between the chest wall and lungs, caused by the wound of the chest wall or lung injury with one of the branches of the bronchus. Usually the disease occurs between the ages 20 - 40 years.

What are the causes of pneumothorax?

- Trauma to the thorax: lung damage bone fragments of ribs;
- Open chest trauma: penetrating injuries;
- Iatrogenic injury (medical complication or diagnostic intervention) lung injury when trying catheterization of subclavian vein, acupuncture, intercostal nerve blockade, pleural puncture;
- Spontaneous pneumothorax;
- Nonspecific pneumothorax: the gap bullae (bullous emphysema, alopecia), cysts, breakthrough lung abscess into the pleural cavity (pneumoempyema), spontaneous rupture of the esophagus;
- Tuberculosis pneumothorax: the gap cavity breakthroughs caseous foci;
- Artificial pneumothorax is applied with curative intent with tuberculosis of lungs, with a diagnostic for a thoracoscopy, the differential diagnosis of chest wall structures.

What types of pneumothorax release?

In connection with the environment are distinguished:

Closed pneumothorax in the pleural cavity reaches a certain amount of gas that is not growing. Communication with the external environment is not, therefore, its admission is terminated. It is considered the easiest type of pneumothorax because the air has the potential to dissolve itself gradually from the pleural cavity, with a slight short shrift.

Open pneumothorax is the presence of holes in the chest wall, freely communicating with the external environment, so in the pleural cavity created by a pressure equal to atmospheric pressure. In this light decreases, since the essential condition for the unfolding of the lung is a negative pressure in the pleural cavity. Collapsed lung is excluded from the breath, there is no gas exchange, blood is enriched with oxygen.

Valve ("tight"), pneumothorax, progressive accumulation of air in the pleural cavity. Arises in the case of formation of the valve structure, breathable one-sided direction of light from the environment or into the pleural cavity and preventing the release of his back. Air enters at the time of inhalation and exhalation at the time, not finding a way out, remains in the pleural cavity. For valvular pneumothorax is characterized by a triad: a positive intrapleural pressure, leading to the shutdown of the lung breath, irritation of nerve endings of the accession of the pleura, resulting in pleuropulmonary shock, a persistent shift of the mediastinum, which impairs their function, particularly squeezing the large vessels, acute respiratory failure.

Depending on the volume of air in the pleural cavity and the degree of atelectasis differentiate complete and partial pneumothorax.

Bilateral pneumothorax with complete failure to provide assistance leads to rapid death due to a critical impairment of respiratory function.

Symptoms of pneumothorax

The clinical picture depends on the mechanism of the disease, the degree of atelectasis, and what caused it.

The disease begins acutely after physical exertion, or coughing for no apparent reason with a sharp piercing pain in the chest, radiating to the neck, upper extremity, sometimes in the upper half of the abdomen, increasing in breathing, coughing or movement of the chest, difficulty breathing, dry cough. The patient is breathing fast and superficially, there is severe shortness of breath, feeling "a lack of air". Pallor or cyanosis appears (cyanosis) of skin, particularly the face.

With an open pneumothorax the patient lies on the side of injury, tightly clutching the wound. On examination, the wound can hear the noise of air suction. From the wound can be allocated frothy blood. Asymmetrical movement of the chest.

Complications

Occur frequently (up to 50% of cases). These include: intrapleural bleeding due to laceration of pulmonary tissue seroplastic pnevmoplevrit with the formation of "rigid" light (the formation of moorings - strands of connective tissue, excluding the smoothing out of the lung), empyema (purulent pleurisy, pyothorax). When valve ("tense") pneumothorax may develop subcutaneous emphysema (accumulation of small amounts of air under the skin in the subcutaneous fat).

In 15 - 50% of patients have recurrence of pneumothorax.

What can you do?

If you suspect a pneumothorax should immediately call an ambulance or go to the doctor, because it is an emergency, especially if there is a valvular pneumothorax, which, when failure to provide necessary assistance, can lead to death.

If there is an open pneumothorax, it is necessary to convert the closed by imposing not breathable tight bandage ("occlusive bandage") on the open wound of the chest. For example, it can be done with oilskin material or intact sealed polyethylene film is fine and thick cotton-gauze bandage.

What can a doctor?

Your doctor will do a thorough examination of the chest for possible injuries, and then assign all the necessary research, including, first of all, X-ray of the chest.

Treatment of pneumothorax include:

- Immediate hospitalization in the surgical department;
- The elimination of pneumothorax by suction of air from the pleural cavity and restoring the negative pressure.

Closed pneumothorax occurs benign and gradually dissolves. But sometimes it is necessary to remove the pleural puncture the air.

Open pneumothorax requires an initial transfer to a closed pneumothorax (ie, elimination communication with the external environment through the hermetic closure of the wound).

Valve Pneumothorax requires surgical intervention.