What are the signs of a collapsed lung. How is pneumothorax diagnosed and treated. Can a collapsed lung heal on its own. What is the recovery time for a pneumothorax. How to prevent recurrence of a collapsed lung.

Understanding Pneumothorax: What is a Collapsed Lung?

A collapsed lung, medically known as pneumothorax, is a serious condition where air accumulates in the space between the lung and chest wall. This buildup of air exerts pressure on the lung, causing it to collapse partially or fully. As a result, the affected lung cannot expand properly during inhalation, leading to breathing difficulties and other symptoms.

Pneumothorax can occur for various reasons, ranging from traumatic injuries to underlying lung conditions. It’s crucial to recognize the symptoms and seek immediate medical attention, as a collapsed lung can be life-threatening if left untreated.

Types of Pneumothorax

• Spontaneous pneumothorax: Occurs without any apparent cause or injury
• Traumatic pneumothorax: Results from chest injuries or medical procedures
• Tension pneumothorax: A severe form where air continuously enters the pleural space, causing significant lung compression

Recognizing the Symptoms: What Does a Collapsed Lung Feel Like?

Identifying the symptoms of a collapsed lung is crucial for early detection and treatment. The severity of symptoms can vary depending on the extent of lung collapse and individual factors.

Common symptoms of pneumothorax include:

• Sudden, sharp chest pain that worsens with deep breathing or coughing
• Shortness of breath or difficulty breathing
• Rapid heartbeat
• Dry, hacking cough
• Bluish skin color due to lack of oxygen (cyanosis)
• Fatigue or weakness

Is chest pain always present in pneumothorax? While chest pain is a common symptom, some individuals may experience only mild discomfort or no pain at all, especially in cases of small pneumothorax. It’s essential to be aware of other symptoms and seek medical attention if you suspect a collapsed lung.

Causes and Risk Factors: Who is at Risk for a Collapsed Lung?

Understanding the causes and risk factors associated with pneumothorax can help identify individuals who may be more susceptible to this condition.

Common Causes of Pneumothorax

• Chest injuries from accidents or sports
• Underlying lung diseases (e.g., emphysema, cystic fibrosis)
• Medical procedures involving the chest cavity
• Ruptured air blisters (blebs) on the lung surface
• Mechanical ventilation

Risk Factors

Certain factors can increase an individual’s likelihood of experiencing a collapsed lung:

• Smoking: Increases the risk of spontaneous pneumothorax
• Tall, thin body type: More common in young men with this build
• Family history: Genetic factors may play a role
• Previous pneumothorax: Increases the risk of recurrence
• Certain medical conditions: Such as Marfan syndrome or lung diseases

Can lifestyle changes reduce the risk of pneumothorax? While some risk factors are beyond control, certain lifestyle modifications can help reduce the risk of a collapsed lung. Quitting smoking, avoiding activities that strain the chest, and managing underlying lung conditions are essential preventive measures.

Diagnosis and Treatment: How is a Collapsed Lung Detected and Managed?

Prompt diagnosis and appropriate treatment are crucial for managing pneumothorax effectively. Healthcare providers use various diagnostic tools and treatment approaches depending on the severity and cause of the collapsed lung.

Diagnostic Methods

• Physical examination: Listening to breath sounds and assessing vital signs
• Chest X-ray: The primary imaging tool for detecting pneumothorax
• CT scan: Provides detailed images of the chest cavity
• Ultrasound: Used for rapid assessment in emergency situations

Treatment Options

The choice of treatment depends on the size of the pneumothorax and the patient’s overall health:

• Observation: For small, uncomplicated pneumothorax
• Needle aspiration: Removing air with a needle and syringe
• Chest tube insertion: Draining air and allowing the lung to re-expand
• Pleurodesis: Chemical or surgical procedure to prevent recurrence
• Surgery: For persistent or recurrent pneumothorax

How long does it take for a collapsed lung to heal? The recovery time varies depending on the severity and treatment method. Small pneumothorax may heal within a few days with rest, while more severe cases requiring chest tube insertion may take several weeks for complete recovery.

Recovery and Aftercare: What to Expect After Treatment

Proper aftercare and follow-up are essential for ensuring complete recovery and preventing complications or recurrence of pneumothorax.

Recovery Timeline

• Initial recovery: 1-2 weeks for mild cases, 4-6 weeks for more severe cases
• Full recovery: 6-8 weeks for most patients
• Return to normal activities: Gradual resumption under medical guidance

Aftercare Instructions

Following these guidelines can help promote healing and prevent complications:

• Get plenty of rest and sleep
• Avoid strenuous activities and heavy lifting
• Take prescribed medications as directed
• Keep follow-up appointments with your healthcare provider
• Avoid air travel and scuba diving until cleared by your doctor
• Quit smoking and avoid secondhand smoke

When can patients resume normal activities after pneumothorax? The timeline for returning to normal activities varies depending on the individual and the severity of the collapsed lung. Most patients can gradually resume light activities within a few weeks, but it’s crucial to follow your doctor’s recommendations and avoid activities that strain the chest until fully healed.

Preventing Recurrence: Strategies to Reduce the Risk of Future Collapsed Lungs

While not all cases of pneumothorax can be prevented, there are steps individuals can take to reduce the risk of recurrence or initial occurrence, especially for those with known risk factors.

Lifestyle Modifications

• Quit smoking and avoid exposure to secondhand smoke
• Maintain a healthy weight and exercise regularly
• Practice deep breathing exercises to improve lung function
• Avoid activities that put excessive strain on the chest
• Manage underlying lung conditions effectively

Medical Interventions

For individuals at high risk of recurrence, healthcare providers may recommend:

• Pleurodesis: A procedure to create scar tissue between the lung and chest wall
• Bullectomy: Surgical removal of air-filled sacs (bullae) on the lung surface
• Regular follow-up appointments to monitor lung health

Can pneumothorax be prevented entirely? While it’s not always possible to prevent pneumothorax, especially in cases of spontaneous occurrence, adopting a healthy lifestyle and managing risk factors can significantly reduce the likelihood of experiencing a collapsed lung.

Complications and Long-Term Effects: Understanding the Potential Risks

While most cases of pneumothorax resolve with proper treatment, it’s important to be aware of potential complications and long-term effects that may arise in some cases.

Potential Complications

• Tension pneumothorax: A life-threatening condition requiring immediate intervention
• Respiratory failure: In severe cases or individuals with underlying lung disease
• Infection: Particularly in cases involving chest tube insertion
• Chronic pain: Some patients may experience persistent chest discomfort
• Recurrence: Increased risk of future pneumothorax episodes

Long-Term Effects

Most individuals recover fully from pneumothorax without significant long-term effects. However, some may experience:

• Reduced lung function: Especially in cases of recurrent pneumothorax
• Anxiety or fear of recurrence: Psychological impact on quality of life
• Limitations in certain activities: Such as scuba diving or high-altitude climbing
• Need for ongoing medical monitoring: Regular check-ups to assess lung health

Do all patients with pneumothorax experience long-term effects? The majority of patients recover fully without significant long-term consequences. However, individuals with underlying lung conditions or those who experience recurrent episodes may be more likely to face long-term effects. Regular follow-up with healthcare providers and adherence to preventive measures can help minimize these risks.

Living with Pneumothorax: Coping Strategies and Support

Experiencing a collapsed lung can be a challenging and potentially frightening experience. Developing coping strategies and seeking support can be crucial for both physical and emotional recovery.

Emotional Coping Strategies

• Educate yourself about the condition to reduce anxiety
• Practice relaxation techniques such as deep breathing and meditation
• Join support groups or online communities for individuals with similar experiences
• Consider counseling or therapy if experiencing persistent anxiety or depression
• Maintain open communication with family and friends about your concerns

Physical Coping Strategies

• Follow your healthcare provider’s recovery plan diligently
• Gradually increase physical activity as recommended by your doctor
• Maintain a healthy lifestyle to support overall lung health
• Be aware of warning signs and have an action plan for emergencies
• Attend all follow-up appointments and ask questions about your recovery

How can family members support someone recovering from pneumothorax? Family members can play a crucial role in the recovery process by providing emotional support, assisting with daily tasks, encouraging adherence to treatment plans, and helping create a smoke-free environment. Understanding the condition and being patient during the recovery process is essential for supporting a loved one with pneumothorax.

In conclusion, understanding the symptoms, causes, and treatment options for pneumothorax is crucial for early detection and effective management. By recognizing risk factors, following proper aftercare instructions, and adopting preventive measures, individuals can reduce the likelihood of experiencing a collapsed lung or its recurrence. With appropriate medical care and support, most people with pneumothorax can expect a full recovery and return to their normal activities. If you experience symptoms suggestive of a collapsed lung, seek immediate medical attention to ensure prompt diagnosis and treatment.

Collapsed Lung: Care Instructions | Kaiser Permanente

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Overview

A collapsed lung (pneumothorax) is a buildup of air in the space between the lung and the chest wall. The pressure of the air against the lung makes the lung collapse. Your lung cannot fully expand when you inhale. This causes shortness of breath and chest pain.

A collapsed lung is usually caused by an injury to the chest. It may also occur suddenly because of a lung illness, such as emphysema or lung fibrosis. A lung may collapse after lung surgery or another medical procedure. Sometimes it happens for no known reason.

Treatment can depend on the cause and severity of the collapsed lung. Treatment can also depend on whether the problem has returned. Some people stay in the hospital for treatment. In some cases, oxygen may be given (through a mask). It may heal with rest, but your doctor will need to check you. It can take several days for the lung to expand again. Your doctor may have drained the excess air from your chest with a needle or tube. Sometimes surgery is done to help keep the lung inflated.

The doctor will want to keep track of your progress. So you will need a follow-up exam to check your lungs. You may need further treatment if you are not getting better.

A collapsed lung may happen again. Watch for symptoms. If you have shortness of breath or chest pain, get medical treatment right away.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It’s also a good idea to know your test results and keep a list of the medicines you take.

How can you care for yourself at home?

• Get plenty of rest and sleep. You may feel weak and tired for a while, but your energy level will improve with time.
• Be safe with medicines. Read and follow all instructions on the label.
  • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
  • If the doctor gave you a prescription medicine for pain, take it as prescribed.
  • Store your prescription pain medicines where no one else can get to them. When you are done using them, dispose of them quickly and safely. Your local pharmacy or hospital may have a drop-off site.
• If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.
• If you have a bandage over your chest tube, or the place where the chest tube was inserted, keep it clean and dry. Follow your doctor’s instructions on bandage care.
• If you go home with a tube in place, follow the doctor’s directions. Do not adjust the tube in any way. This could break the seal or cause other problems. Keep the tube dry.
• Avoid exercise until your doctor says it’s okay.
• Do not fly in an airplane or scuba dive until your doctor tells you it is okay.
• Do not smoke or allow others to smoke around you. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

• You have severe trouble breathing.
• You have severe chest pain.
• You passed out (lost consciousness).

Call your doctor now or seek immediate medical care if:

• You have new or worse trouble breathing.
• You have new pain or your pain gets worse.
• You cough up blood.
• Your chest tube comes out or is bent or blocked.
• You are bleeding through the bandage where the tube was put in.
• You have symptoms of infection where the tube was put in, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Watch closely for changes in your health, and be sure to contact your doctor if:

• The skin around the place where the chest tube was put in is red or irritated.
• You do not get better as expected.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter Q132 in the search box to learn more about “Collapsed Lung: Care Instructions”.

Pneumothorax (Collapsed Lung): Symptoms, Causes, and More

A collapsed lung is the medical term for when air escapes outside of the lungs into the chest. The pressure causes the lung to be unable to expand. This is also called pneumothorax.

Pneumothorax is the medical term for a collapsed lung. It occurs when air enters the space around your lungs (the pleural space). This can happen when an open injury in your lung tissue causes air to leak into the pleural space. The resulting increased pressure on the outside of your lung causes it to collapse.

Pneumothorax can be traumatic or nontraumatic.

Traumatic pneumothorax results from an injury, like a blow to the chest. Nontraumatic pneumothorax can happen if you have lung disease, like chronic obstructive pulmonary disease (COPD), but it can also happen for no apparent reason in people without lung disease.

The long-term impact of pneumothorax can vary. If only a small amount of air is trapped in the pleural space, there may be no further complications. If the volume of air is larger or it affects the heart, it can be life-threatening.

If pneumothorax results from trauma, the symptoms often appear at the time of the injury or shortly after. Symptoms of spontaneous pneumothorax might appear when a person is at rest. A sudden attack of chest pain is often the first symptom.

Symptoms may include:

• a sudden, sharp, stabbing pain in the chest
• rapid breathing or shortness of breath (dyspnea)
• turning blue, known as cyanosis
• a rapid heart rate
• low blood pressure
• lung expansion on one side
• a hollow sound if you tap on the chest
• an enlarged jugular vein
• anxiety
• fatigue

There are different ways of categorizing pneumothorax, according to their causes or their impact.

One way of differentiating them is as follows:

• traumatic pneumothorax
• nontraumatic pneumothorax
  • primary spontaneous
  • secondary spontaneous

Other subtypes with either traumatic or nontraumatic causes are:

• simple, when it does not affect the position of other structures
• tension, which affects the position of other structures, like the heart
• open, when air moves in and out of an open wound in the chest

Traumatic pneumothorax

Traumatic pneumothorax occurs after some type of trauma or injury has happened to the chest or lung wall. It can be a minor or significant injury. The trauma can damage chest structures and cause air to leak into the pleural space.

Here are some types of injuries that can cause traumatic pneumothorax:

• trauma to the chest from a motor vehicle accident
• broken ribs
• a blow to the chest during a contact sport, like football tackle
• a stab or bullet wound to the chest
• accidental damage during a medical procedure like a central line placement, ventilator use, lung biopsies, or CPR
• diving, flying, or being at high altitude due to air pressure changes

Quick treatment of pneumothorax due to chest trauma is critical as it can lead to fatal complications like cardiac arrest, respiratory failure, shock, and death.

Nontraumatic pneumothorax

This type of pneumothorax is called spontaneous, as it does not result from trauma.

When primary spontaneous pneumothorax happens, there’s no clear reason why it occurs. It’s more likely to happen:

• in people who smoke
• during pregnancy
• in people with Marfan syndrome
• in those with a family history of pneumothorax
• in an otherwise healthy person with a tall, thin body

Secondary spontaneous pneumothorax can happen if a person has:

• a form of COPD, including emphysema and chronic bronchitis
• acute or chronic infection, like tuberculosis or pneumonia
• lung cancer
• cystic fibrosis
• asthma
• severe acute respiratory distress syndrome (ARDS)
• idiopathic pulmonary fibrosis
• collagen vascular disease

Inhaling drugs like cocaine or marijuana can also trigger it.

Tension pneumothorax

Tension pneumothorax is not a classification of pneumothorax but a term that reflects the severity of pneumothorax. You may experience it if you have:

• a blow to the chest
• a penetrating injury
• changes in pressure when diving, flying, or mountaineering
• a spontaneous pneumothorax progressing to a tension type
• some medical procedures

The risk factors are different for a traumatic and spontaneous pneumothorax.

Risk factors for a traumatic pneumothorax include:

• contact sports, like football or hockey
• employment where there’s a risk of falls or other types of injury
• having a medical procedure that involves the chest or lung area
• ongoing assisted respiratory care

The people at highest risk of a nontraumatic pneumothorax include those who:

• have a history of smoking
• have an existing lung condition, like asthma or COPD
• have a family history of pneumothorax, which may indicate genetic factors
• have tall, slim bodies, as this can affect pressure at the top of the lung
• have inflammation in the small airways

Pneumothorax can lead to a number of complications, some of which can be life-threatening.

They include:

• respiratory failure or inability to breathe
• pulmonary edema following treatment for pneumothorax
• pneumohemothorax, when blood enters the chest cavity
• pneumopericardium, when air enters the cavity around the heart
• pneumoperitoneum, when are enters the space around the abdomen
• bronchopulmonary fistula, when a passageway opens between the lungs and the space around them
• heart attack

Tension pneumothorax can quickly progress to:

• an inability to breathe
• cardiovascular collapse
• death

It’s essential to seek emergency medical help as soon as symptoms arise.

Treatment aims to relieve pressure on the lung and allow it to re-expand.

The options will depend on:

• how severe the condition is
• whether the chest cavity is continuing to expand
• the cause
• whether it’s happened before or has been going on for some time

If you have tension pneumothorax or pneumothorax due to an injury, this is a life-threatening emergency. You’ll need immediate medical care and possibly surgery.

Here are some of the treatment strategies:

Observation

If pneumothorax results from a small injury, it may heal without treatment within a few days. Check with a doctor before flying or diving after pneumothorax.

If you’re having trouble breathing, you may need oxygen. Using oxygen can also help speed up the rate at which the lungs reabsorb air from the cavity.

Draining excess air

If the damage is significant or symptoms are severe, a surgeon may need to remove the air or carry out surgery.

Needle aspiration and chest tube insertion are two procedures designed to remove excess air from the pleural space in the chest. These can be done at the bedside without requiring general anesthesia.

In needle aspiration, the doctor inserts a needle into the cavity and extracts the air using a syringe.

For a chest tube insertion, the doctor will insert a hollowed tube between your ribs. This allows air to drain and the lung to reinflate. The tube may remain in place for 2 to 5 days or longer.

Surgery

The doctor may need to carry out a more invasive procedure to see what’s happening in your lungs, like a thoracotomy or thoracoscopy.

During a thoracotomy, your surgeon will create an incision in the pleural space to help them see the problem. During a thoracoscopy, also known as video-assisted thoracoscopic surgery (VATS), the doctor inserts a tiny camera through the chest wall to examine the lung.

If you’ve had repeated episodes of pneumothorax, you may need a small operation to repair any weak areas in the lung where the air is getting through. The doctor may also carry out pleurodesis, in which they stick the lung to the inside of the chest wall.

Other surgical options include:

• sewing blisters closed
• closing air leaks
• or removing the collapsed portion of your lung, which is called a lobectomy

These interventions can reduce the risk of pneumothorax happening again.

In many cases, a person with pneumothorax will need emergency medical treatment, and emergency doctors will carry out the evaluation and diagnosis.

A doctor will look for signs of air in the space around the lungs.

They’ll ask about:

• symptoms
• personal and family medical history
• recent activities
• any previous cases of pneumothorax

They may also carry out imaging tests, like:

• an X-ray
• a CT scan
• a thoracic ultrasound

Your long-term outlook depends on the size of the pneumothorax, the cause, and any treatment you receive.

Most cases of primary spontaneous pneumothorax resolve with observation or minimal treatment. It’s rarely life-threatening. But there’s a 30 percent chance that this type will recur within 5 years, and the risk of recurrence increases each time it happens.

It may take longer to recover if:

• you have a large pneumothorax
• you have a secondary spontaneous pneumothorax
• you have an underlying lung condition
• pneumothorax results from an injury
• it’s not your first experience of pneumothorax

In around 10% of cases, secondary spontaneous pneumothorax is fatal. The risk is higher if you have HIV or COPD. The risk of this type recurring within 5 years is around 43 percent, and the risk increases each time it happens.

Knowing your risk of developing pneumothorax and seeking help as soon as symptoms occur can help prevent severe complications.

Pneumothorax is a condition where air collects between the lungs and the chest cavity. In some cases, it’ll go away without treatment. In others, it can be life-threatening. This will depend on the size and cause of the problem.

There are different types of pneumothorax. Traumatic pneumothorax can happen if someone has an injury to the chest wall or lungs. Nontraumatic pneumothorax can affect people with COPD and other lung diseases, but it can also affect people without lung disease.

Treatment aims to remove the air and re-expand the lungs. In some cases, a surgeon may need to repair the lungs. Pneumothorax can be a life-threatening emergency. Anyone who experiences symptoms, like a sharp, stabbing pain in the chest, should seek immediate medical help.

Features of the formation of atelectasis

00:00

Igor Evgenyevich Tyurin , professor, doctor of medical sciences:

– Features of the formation of atelectasis.

(Slide show) .

Of course, the mechanism of bronchus obstruction – its further fate depends on it. Why. Because fast, instantaneous (within a few minutes or even seconds, or hours, maybe) complete obstruction of the lumen of the bronchus leads to the formation of atelectasis in the truest sense of the word. Air is resorbed from the alveoli, resulting in areas of airless lung tissue.

The peculiarity lies in the fact that in this case (when a foreign body enters the lumen of the bronchus, and this body, like a cork, completely and immediately clogs the lumen of the bronchus), in this case, distal to the place of narrowing of the obturation in the lung tissue, obstructive pneumonitis does not have time to develop – secondary inflammatory process. As a consequence, such atelectasis can exist for many months, sometimes even years – such observations are described in the literature.

After the cause that caused such instantaneous atelectasis is eliminated (say, a foreign body is removed from the lumen of the bronchus), the lung tissue, paradoxically, straightens out. Restores its airiness and continues to function in the same way as the remaining healthy lung tissue. By the way, this is one of the possible examples of the experimental formation of atelectasis of the lung tissue.

When gradual atelectasis occurs, when this process is extended over time. Especially when it is a partial obstruction of the bronchus, and there is communication between the proximal and distal parts of the respiratory tract. In this case, as a rule, obstructive pneumonitis develops.

It has a number of very important distinctive features – we will talk about them a little later. But the most important thing is that there are secondary inflammatory processes with corresponding clinical manifestations.

The second very important circumstance: the degree of obturation of the bronchial lumen. Of course, complete obturation of the bronchial lumen should theoretically lead to the same complete atelectasis. However, we very often observe that such a direct relationship does not exist.

We can observe complete bronchus obstruction and airy lung tissue without any signs of atelectasis. This is not some surprising physiological phenomenon, given that the air supply to individual sections of the lung tissue has a very large number of colotherals.

Once again, this does not have any direct relationship. Just as, in fact, there is no strict sequence in the development of atelectasis, as was often described earlier in textbooks. At first it is partial atelectasis or, as it is sometimes called, hypoventilation. Then this so-called obstructive swelling, then complete atelectasis.

Very often we observe a mixture of different stages, degrees of bronchial obstruction. Therefore, we are more interested in the state of the lung tissue right now.

03:05

(Slide show) .

What is the peculiarity of obstructive pneumonitis. Occurs with a partial violation of bronchial patency. It is characterized by a combination of atelectasis, chronic inflammation, pneumosclerosis.

These three processes keep the lung tissue reduced in volume in a collapsed state and prevent it from expanding. But, most importantly, after the restoration of bronchial patency, as a rule, there is no restoration of the airiness of the lung tissue due to the development of a chronic inflammatory process, distelectasis, emphysema, and pneumosclerosis there. And the degree of airiness can really change, but only slightly.

This is the most important reason, which often complicates the diagnosis of such conditions, when a patient with obstructive atelectasis in the presence of central cancer is subjected to antibiotic therapy. The condition improves somewhat, the airiness of the lung tissue is somewhat restored, but not completely – and then this process continues to exist and does not lead to a positive result.

(Slide show) .

Here is one of these possible variants of obstructive pneumonitis. Infiltrative changes that are localized, in this case, in the upper lobe of the right lung – they are formally completely indistinguishable from upper lobe pneumonia. But the problem is that obstructive pneumonitis itself, despite the ongoing treatment, rarely undergoes a complete regression.

When we observe this patient in dynamics, we see that the changes in the lung tissue remain, but the cause that causes such a secondary inflammatory process has become very clearly visible. In this patient, of course, this is a large pathological formation, which is located at the root of the right lung, in the projection of the upper lobe bronchus. Narrows this bronchus and causes such a continuously recurrent process in the lung tissue.

04:51

(Slide show) .

If we are talking about obstructive pneumonitis, of course, computed tomography and tomography in general are of fundamental importance here. In the case of a decrease in the volume of a part of the lung, as in this patient – and here it is quite obvious a decrease in the volume of the upper lobe of the right lung, uneven compaction of the upper lobe. But with a tomographic study, we see preserved lobar segmental bronchi. This makes it possible to distinguish such a decrease in the volume of the upper lobe during an inflammatory process (in this case, it is prolonged pneumonia) from obstructive pneumonitis resulting from compression or narrowing of the large bronchi.

(Slide show) .

Diagnostic tactics in such cases. We see a protracted course of pneumonia or, moreover, a recurrent course of pneumonia. An x-ray examination determines a pronounced decrease in the volume of a lobe or segment and this does not tend to recover, especially in combination with an expansion of the lung root.

Of course, in this case, bronchological examination and computed tomography are absolutely essential to assess the condition of the lobar and segmental bronchi.

(Slide show) .

And also what I have already said about the violation of bronchial patency and the degree of collapse of the lung tissue. In this case, you see almost complete obturation of the third segmental bronchus. The second segmental bronchus is in place, it is clearly visible – heading backwards. And in front of the stump is a square shape due to the endobronchial formation of the third segmental bronchus, which completely covers the lumen of this bronchus.

However, the lung tissue retains its airiness, and neither radiographs nor CT scans show any signs of atelectasis here. This situation does not arise very often, of course, but there is nothing extraordinary in it. This is a common physiological mechanism for compensatory ventilation of individual sections of the lung.

If we talk about the causes of atelectasis and our ability to distinguish between these causes in some way using the methods of radiation diagnostics, they are here in front of you on the slide.

06:55

(Slide show) .

Of course, the most common are neoplasms. Malignant, much less often benign, tumors. In addition, cicatricial structure, post-tuberculosis, post-traumatic foreign bodies. Including bronchiolitis that occurs in patients who have had pulmonary tuberculosis.

This is compression of the bronchus from the outside. Usually this is either mediastinal lymph nodes, or (when it comes to the lower lobe of the left lung) compacted dilated aorta. Then there is atelectasis of the lower lobe of the left lung – but this is a rarer cause.

Of course, the most common are neoplasms. I will not return to the usual neoplasms that we often encounter in our practice. Almost all the examples of atelectasis that I have just shown, one way or another, were associated with primary tumors of the central bronchi (central cancer) and the formation of the corresponding atelectasis. What I want to show now is our capabilities and our limitations in terms of diagnostics.

(Slide show) .

Can we somehow determine the morphological structure of the pathological formation that closes the lumen of the bronchus and leads to the development of atelectasis. Unfortunately, in most cases, no. Therefore, the common conclusion of radiologists, when they see atelectasis and stenosis of the bronchus, that it is lung cancer, is formally untrue.

Cancer is, after all, an epithelial tumor originating from the surface of the bronchial tree. It’s still a morphological diagnosis. However, bronchoconstriction itself can develop as a result of many other causes.

In a number of cases, we can very well find this reason, see it. One of the rare observations, but, as usual, showing the possibilities of radiation diagnostics. The classic picture of atelectasis of the middle lobe of the right lung. Non-localized shadowing in the right cardiodiaphragmatic angle and a typical triangular shadow in the projection of the middle lobe in the image in the lateral projection.

08:55

(Slide show) .

What do we see with computed tomography. A fat-containing pathological formation that completely blocks the lumen of the middle lobe bronchus. In this case, of course, the radiologist can practically establish a morphological diagnosis by simply analyzing computed tomography images.

(Slide show) .

Naturally, in such cases it is possible to obtain a more beautiful image using, for example, virtual bronchoscopy, as in this case. Make sure that this is really a stenosis of a large bronchus, this is a pathological formation. But the main thing is that in this situation we can see the very reason and actually determine the morphological character.

(Slide show) .

Another possible situation where we understand well what is at stake is carcinoids. These are neuroendocrine tumors, some of which have an exceptionally high blood supply. They behave like hypervascular structures in tomographic examination, with the introduction of contrast agents, and in angiographic studies.

In this situation, the digital radiograph shows the classic picture of atelectasis of the lower lobe of the left lung. In this case, the contour of the dormant left lobe is located inside the contour of the heart. Naturally, the normal image of the dome of the diaphragm, the costophrenic sinus, disappears. And in a tomographic study – a rounded shape with clear contours, a hypervascular formation in the root of the left lung and a typical atelectasis of the lower lobe of the left lung with dilated bronchi.

(Slide show) .

I repeat once again: carcinoid. In this situation, of course, the radiologist can quite accurately suggest, at least, the morphological nature of the changes in the chest cavity.

10:33

(Slide show) .

On the other hand, there are situations when we are completely deprived of such an opportunity. I have already said that most often, of course, this malignant tumor is a cancerous tumor.

(Slide show) .

Metastases in the large bronchi are less common. But if they occur, then the x-ray picture in patients who have had breast cancer, colon cancer, kidney cancer, melanoma, is practically indistinguishable from the x-ray picture of primary lung cancer.

(Slide show) .

In this case, we observe a picture of the formation of complete atelectasis of the upper lobe of the left lung over several months (here it is well shown by arrows).

(Slide show) .

On tomographic examination, a huge pathological formation, almost completely obstructing the lumen of the left main bronchus. At the same time, this is rectal cancer, metastasis to the left upper lobe bronchus. This is morphologically proven. Not every atelectasis with not every malignant formation is a cancerous tumor.

A few words about benign structures and the formation of obstructive atelectasis with such changes.

(Slide show) .

Cicatricial structures, foreign bodies of the bronchi, compression from the outside – these are quite common situations. In this case, of course, the formal picture of atelectasis should be accompanied by additional tomographic studies.

11:55

(Slide show) .

Why. Of course, one of the very common causes in this situation is tuberculosis. Or it is obturation with bronchodilitis. Or it is compression of the bronchi by enlarged lymph nodes. Or these are the consequences of tuberculosis, as in this case.

The narrowed lumen of the middle lobe bronchus is surrounded by partially calcified lymph nodes after tuberculosis. This is a classic middle lobe syndrome as a result of previous primary pulmonary tuberculosis. It is very important that in this case the radiologist has the opportunity to determine the correct topic of these changes and their cause.

(Slide show) .

And on the other hand, this is the loss of caseous-necrotic calcified masses from the lymph node. Broncholiths that enter the large bronchi obturate them. The result is atelectasis of the reed segments. We clearly see this radiopaque foreign body (in this case, broncholitis) directly in the lumen of the lingual segmental bronchus. This, of course, distinguishes such obstructive atelectasis from malignant tumors.

(Slide show) .

As well as with more advanced technical support, when we have multislice computed tomography at our disposal, the broncholitis is perfectly visible here, which is located in the bronchus of the anterior segment (in the third segmental bronchus). It obturates the lumen of this bronchus, but again (note) does not cause the formation of atelectasis, but only a decrease in volume.

(Slide show) .

Of course, the classics of the genre are bronchial foreign bodies. Especially in children, as in this case. This is a chicken bone that obturates the lumen of the lower lobe bronchus. In this case, of course, the radiopaque foreign body (bone) is clearly visible in X-ray tomography. It is well understood what it is.

Difficulties arise in situations where these are not contrasting foreign bodies. Then it is very difficult to distinguish them from neoplasms and other causes that cause compression of the bronchi.

Compression of the bronchi by enlarged lymph nodes, which is observed in malignant tumors, with metastatic lesions of the lymph nodes.

(Slide show) .

In this case, an example of a classic upper lobe atelectasis in a child suffering from tuberculosis of the intrathoracic lymph nodes. In the picture in the lower right corner, you can clearly see the enlarged lymph nodes in the root of the right lung.

14:08

(Slide show) .

Finally, fibroatelectases. A peculiar pathological condition that occurs as a result of the transferred inflammatory process. X-ray signs of atelectasis in this case are combined with the preservation of the lumen of a large bronchus. In fact, this is a pathological condition that combines signs of both fibrotic changes in the lung tissue and signs of atelectasis.

(Slide show) .

It is fundamentally important to determine and prove that the decrease in the volume of a part of the lung is not associated with a neoplasm, but is based on an inflammatory process.

(Slide show) .

Here, of course, a tomographic study, along with a bronchological one, allows you to very accurately assess the condition of the lobar and segmental bronchi and, on this basis, exclude the presence of a pathological formation.

(Slide show) .

Another very important element of bronchial obstruction or atelectasis, types of atelectasis, is the so-called round atelectasis. I will not show discoid atelectasis today – I think everyone knows this well and understands how it looks. But I will show a peculiar kind of lung tissue pathologies, a kind of reflex atelectasis. They arise, I repeat once again, due to various irritating factors.

Typical CT (sometimes even x-ray) picture. It is associated with the formation of a site of compaction in the lung tissue and a very characteristic change in the vascular bronchial pattern in the lung tissue, like a comet’s tail directed from the root of the lung. You see it on CT scans.

(Slide show) .

It looks like this on a plain radiograph – as segmental or subsegmental atelectasis. And with a tomographic study, as I said, this is a fairly characteristic picture.

15:49

(Slide show) .

In conclusion, a few words about retention cysts. Occurs with obstruction of the bronchi of medium caliber. As a rule, these are still the bronchi distal to the subsegmental ones.

Usually this is the result of bronchial tuberculosis, we say, and first of all we look for post-tuberculosis changes in such patients. Although retention cysts or bronchial dilation as a result of the accumulation there of an excessive amount of bronchial secretions can be observed in many other pathological conditions. Where there is a violation of the discharge of bronchial secretions through the bronchi.

It can also be bronchial atresia as a congenital pathology. These are bronchiectasis with the formation of retention cysts. For example, with bronchial asthma, with allergic bronchopulmonary aspergillosis and a number of other pathological processes. Including, as you have just seen, with obstructive atelectasis, such dilated bronchi are formally formed in the form of retention cysts inside the atelectotic lung tissue.

They usually have a typical V- or Y-shape, with the tip towards the root of the lung and the base towards the visceral pleura. Sometimes they contain calcifications (calcified contents, calcified bronchial wall) – then this is a very important criterion in terms of a tuberculosis history in such a patient. And they can also have a liquid density on computed tomography – then this, of course, facilitates the diagnosis.

(Slide show) .

Classical picture: an irregularly shaped pathological formation that has a V-shape with two branches, the tip facing the draining bronchus. A tomographic examination clearly shows calcium inclusions in one of the walls of this pathological formation.

(Slide show) .

Another example, when the content of the retention cyst itself is subjected to calcification. On the radiograph in the lateral projection, a V-shaped large structure is perfectly visible in the anterior part of the right lung, consisting of two horns, with a tip facing the root of the lung. This is clearly seen in the tomographic examination.

(Slide show) .

There is a huge calcified paratrachial lymph node at the root of the lung, complete obstruction of the subsegmental bronchus of the third segment. As well as partially calcified caseous contents of this retention cyst, which is located in the third bronchopulmonary segment.

(Slide show) .

But still, more often we see not such large retention cysts, but smaller formations. This is important, because in this situation, of course, we are talking about differential diagnosis with peripheral formations in the lungs. Such as peripheral cancer or tuberculoma.

Here, of course, the form of such retention cysts and their connection with the bronchus are of key importance. I repeat once again: such a V-shaped or Y-shaped form, at the mouth of which the corresponding bronchus is located, is a very typical picture characteristic of these pathological conditions. This can be seen very clearly in tomography.

This concludes my discussion of atelectasis and retention cysts.

(Slide show) .

18:53

14. Pneumothorax. Clinic. Diagnosis, treatment tactics.

Pneumothorax
– accumulation of air in the pleural space
cavity, which usually leads to
compression of the lung, decreased respiratory
(ventilated) surface. depending
from prevalence are distinguished
the following types of pneumothorax: total,
when air fills the entire pleural space
cavity; partial, or cloak-like,
when the lung does not collapse completely, but
the air surrounds him on all sides, and
circumscribed pneumothorax.

By
the nature of the damage and communication with
external environment allocate a closed and
open pneumothorax and valvular
and spontaneous pneumothorax.

open
pneumothorax occurs
with penetrating wounds of the chest.
In this type of pneumothorax, pleural
the cavity communicates freely with the atmosphere
air through an open chest wound
cells (open to the outside) or a defect in
bronchus or trachea (open inwards).
Pressure in the pleural cavity
side of the lesion becomes positive.
Due to its elastic properties, the lung
subsides. There is a so-called
paradoxical breathing. When inhaling air
enters a healthy lung not only
from the atmosphere, but also from a collapsed lung
on the side of the damage. When exhaling part
air from a healthy lung enters
into a collapsed lung, somewhat inflating
his. Thus, with open
pneumothorax collapsed lung makes
weak breathing movements
straightening out when exhaling and subsiding when
inhale, i.e. performs when breathing
movements that are opposite to a healthy lung.
As a result, the depth of breathing sharply
decreases, ventilation is disturbed
lungs, respiratory and
heart failure, respiratory
hypoxia, shock. Often there is
“flotation” of the mediastinum, i.e. displacement
it either to the sick side, then to the healthy side
with each inhalation and exhalation. At
delayed provision of medical
assistance may result in death from shock,
cardiac disorders.

Sick
complains of shortness of breath, pain in the area
wounds. Examination reveals a wound
from a knife or gunshot wound,
from which, when breathing with noise, they stand out
air and blood spatter. When percussion on
the affected side are determined high
tympanic sound on auscultation
weakening or disappearance of the respiratory
noise. On x-ray examination
reveal the shadow of the collapsed lung
with a clear outer border, no
lung pattern on the periphery.

Treatment.
First aid when open to the outside
pneumothorax (chest wall injury)
reduced to the imposition of occlusal
dressing to seal the wound.
At the same time, events
maintaining cardiovascular function
and respiratory system, anesthesia,
restoration of blood loss by the introduction
various means.

B
hospital perform surgical
treatment and suturing of the wound of the chest wall
followed by continuous aspiration
air and accumulating in the pleural
exudate cavities through drainage. At
concomitant lung injury
the volume of the operation is determined by the nature
this damage. The operation is carried out
with maximum health
organ tissue.

At
open pneumothorax, communicating
with the external environment through the bronchi, damaged
destructive process in the lung (breakthrough
abscess, tuberculous cavity,
cavity form of cancer), treatment is directed
to eliminate the main process,
drainage of the pleural cavity
continuous aspiration of exudate and
air. With a large defect in the bronchus
and an unsuccessful attempt to straighten the lung
resort to temporary obstruction of the bronchus
a special cork made of foam rubber or
other material, after which the receipt
air into the pleural cavity stops,
favorable conditions are created for
expansion of a collapsed lung.
Visceral pleura expanded
lung during bronchial obstruction can
fuse with the parietal, which will lead
to eliminate pneumothorax. For a cure
underlying lung disease
adopted both conservative and
operational methods.

Most
severe and difficult form of pneumothorax
for diagnosis and treatment is
valve
pneumothorax. Valved
pneumothorax is a type
open. It differs in that the air
enters the pleural cavity through
a narrow opening in lung tissue (or
chest wounds) with each breath,
and when you exhale it does not come out completely
due to blockage of the opening in the pleura
surrounding tissues, forming a similarity
valve. As a result, the inhaled air
enters the pleural cavity with each breath
cavity and only partially exits when
exhale. Gradually increasing
pressure in the pleural cavity compresses
lung and large vessels.

B
some cases of valvular pneumothorax
air is pumped through the “valve”
only in one direction, to the pleural
cavity. Pressure (voltage) in
pleural cavity is growing rapidly.
This type of valvular pneumothorax
called tense (Fig. 6.15). When
pressure in the pleural cavity becomes
very high, the lung collapses completely,
the mediastinum moves to the opposite
side, while squeezing healthy
lung. Sometimes there is flotation
mediastinum (i.e. moving it when
breathing in one direction or the other).
In this regard, large
blood vessels, blood circulation is sharply disturbed
and breathing, shock may develop.

Basic
symptoms of valvular pneumothorax
fear, anxiety, cyanosis of the face and neck,
swelling of the veins of the neck, puffiness of the face,
sometimes subcutaneous emphysema, enlargement
intercostal spaces; decline
blood pressure, tachycardia,
arrhythmia. On percussion on the affected
side determine high tympanic
sound, on auscultation – weakening
or disappearance of breath sounds
lack of voice trembling. At
x-ray examination
reveal a total collapse of the lung,
mediastinal shift, low standing
diaphragm, expansion of the intercostal
intervals.

Treatment.
First aid is urgent
unloading (reducing pressure)
puncture of the pleural cavity
needle. Needles are put on the pavilion
plastic tube, and at its end
put on and fix split on
the tip of a “finger” from a glove or
fingertip that will play the role
valve, i.e. to release air from
pleural cavity and prevent
its flow in the opposite direction.
This reduces the voltage in
pleural cavity, create conditions
for spreading (at least partial)
lung on the affected side, enlargement
ventilated surface.

Subsequent
therapeutic measures are carried out in
hospital according to the nature
damage and causes
valvular pneumothorax.

Spontaneous
pneumothorax is
kind of closed. Spontaneous
pneumothorax is usually closed.
However, if valvular
mechanism for a ruptured cyst or
bulle it becomes valvular, tense.

Gap
cysts or bullae may occur
due to increased intrapulmonary
pressure under physical stress, in
time of coughing. Spontaneous
pneumothorax can develop in any
age.

At
rupture of a cyst or bulla into a limited
adhesions part of the pleural cavity
Patients do not report any abnormalities
if the amount of air supplied
into the pleural cavity, does not exceed
5-15% of its volume. Upon admission to
pleural cavity more significant
amount of air develops a typical
pattern of closed or valvular
pneumothorax as according to the physical
research, as well as X-ray
picture.

Treatment.
With a small asymptomatic pneumothorax
no special treatment is required.
Air is usually sucked in during
a few days, and the lung cracks down
on one’s own. If you need to speed up
air evacuation, produce 1-2
pleural punctures.

At
their inefficiency pleural cavity
should be drained and a permanent
aspiration of air to straighten
lung. In a number of cases it is necessary
resort to surgical treatment. way
marginal resection of lung bulla and cyst
can be removed with
videotor-coscopic technology. At
lack of appropriate equipment

15.
Pulmonary bleeding. Causes,
diagnostic and therapeutic tactics .

– expiration
blood from lungs or bronchi
vessels, accompanied by secretion
blood from the respiratory tract. Reasons. LC
may be with non-specific
inflammatory processes in the lungs or
bronchi, tuberculosis and lung cancer,
aneurysms, in the pulmonary system
circulation, pulmonary endometriosis,
in the presence of foreign bodies in the lungs and
bronchi, pulmonary embolism,
fungal and parasitic diseases
lungs, wounds and injuries of the chest
cells, mitral valve defects
♥. A small amount of blood in the sputum
is usually determined in the first days after
operations on the lungs, incl. after biopsy
lung tissue. Often LC comes from
bronchial arteries, which are excessively
developed and aneurysmally changed in
areas of chronic inflammation
process. In case of acute
destructive lesions of the lung tissue,
with wounds and injuries of the chest
source of bleeding is usually pulmonary
arteries and veins. The emergence of LC
contribute to hypertension in the small circle
circulatory disorders, clotting disorders
blood. Respiratory blood is usually
excreted with cough. Its quantity can
be different – from streaks of blood in the sputum
(hemoptysis) to profuse bleeding
continuous stream. In some cases
hemoptysis – a harbinger of abundant
bleeding from the lungs. Distinguished from
respiratory tract blood is liquid, without
clots, frothy, has an alkaline
reaction. In patients with heavy bleeding
in the lower parts of the lungs can be heard
various moist rales. Diagnostics
.
Localization of the source of bleeding
can be determined by x-ray
(according to the nature of lung damage), more than
exactly – with tracheobronchoscopy. If
cannot be identified, resort to
catheterization of bronchial arteries and
bronchial arteriography. Differential diagnosis .
For stomach bleeding, blood
excreted with vomit,
mind – coffee grounds, has an acidic reaction,
which is preserved during aspiration. At
fresh bleeding from varicose veins
esophageal veins blood in vomit
may look little changed, but
usually it has a dark color and does not happen
foamy. Diagnosis with bleeding
from arrosed mucosal vessels
membranes of the mouth, nose and pharynx
such bleeding is detected during examination
oral cavity, pharyngo- and rhinoscopy.
Treatment. All
LC patients should be hospitalized
to the pulmonology department or
department of thoracic surgery. Treatment
should be a warning
obstruction of the bronchi with blood clots, and
in case of respiratory failure – for recovery
airway patency. sick
give a sitting or semi-sitting position
with an inclination towards the lung, from which
bleeding is expected; -decreases
danger of aspiration of blood in the opposite
lung. Persistent cough should not
completely suppress so as not to hinder
coughing up blood that has flowed into the bronchi
and not create conditions for the emergence
aspiration pneumonia. If bronchial
patency is not restored when
coughing, blood is sucked out through a catheter
or, more efficiently, through
bronchoscope. Concomitant obturation
bronchial bronchospasm stop
m-anticholinergics (atropine sulfate according to
0.5-1 ml of 0.1% solution subcutaneously) and β-agonists
(alupent, salbutamol, berotekingalation).
Asphyxia – emergency intubation
trachea, blood suction and ventilation.
At the same time, hemostatic therapy.
In LC without hemodynamic disturbance V/V
protease inhibitors (kontrykal according to
10,000-20,000 IU or Gordox 100,000 IU) and
fibrinolysis (aminocaproic acid – to
100 ml 5% solution). To prevent thrombosis
and embolism treatment with these drugs
carried out under the control of thromboelastogram
and coagulograms. If it is impossible
determine the indicators of clotting
blood systems – hemophobin (2-3 teaspoons
spoons), etamsylate (2-4 ml of 12.5% ​​solution B / B
or V\M), fibrinogen (2 g each in NaClB\B).
bleeding from the bronchial system
arteries – lower blood pressure (if it is N or
↑), maintaining systolic blood pressure at
80-90 mmHg Art. For this, pentamine is administered.
3 ml of 5% sol.W\M, benzohexonium 0.5-1 ml
2.5% solution subcutaneously or intramuscularly; V\V drip
under constant BP monitoring
arfonad. LC causing posthemorrhagic
anemia – an indication for replacement
transfusions of Ermass.
To eliminate hypovolemia after a large
blood loss-injection of native plasma,
polyglucin, rheopolyglucin or
gelatinol. In the absence of hemostatic
effect of drug treatments
bronchoscopy, during which
occlusion of the bronchus of the bleeding segment.
In case of inefficiency – bronchial
arteriography followed by endovascular
occlusion of the bronchial arteries. Often
surgery is needed
on the lungs.