Lungs. Lung diseases. Diagnosis and treatment. Precancerous conditions of the lungs Common lung diseases

Atelectasis is a pathological condition in which the lung tissue loses its airiness and collapses, reducing (sometimes significantly) its respiratory surface. The result of the collapse of part of the lung is a decrease in gas exchange with an increase in the phenomena of oxygen starvation of tissues and organs, depending on the volume of the area that has lost its airiness.

Shutting down the right or left lower lobes reduces lung capacity by 20%. Atelectasis of the middle lobe reduces it by 5%, and one of the segments of any of the apical lobes - by 7.5%, forcing compensatory mechanisms to come into play, which manifest themselves in the form of symptoms characteristic of atelectasis.

At the same time, atelectasis should not be confused with zones of physiological hypoventilation of the lungs when a healthy person is at rest, which does not require active consumption of oxygen from the air.

The mechanism of formation of pulmonary atelectasis and its causes

1. Local narrowing of the lumen of the bronchial tree:

• In cases of compression from the outside by a lung tumor located next to the bronchus;
• With local enlargement of lymph nodes, which accompanies inflammatory and tumor processes;
• During processes occurring in the wall of the bronchus (with increased mucus formation or discharge of pus, bronchial tumor with growth into the lumen of the vessel);
• Hit foreign bodies(aspiration of vomit, choking).

As a rule, this mechanism is realized with an additional reflex (contraction of the smooth muscles of the bronchi), which further narrows the airways.

2. Collapse of the lung tissue itself:

• When the air pressure inside the alveoli decreases (violation of inhalation anesthesia technique);
• Sudden change in ambient air pressure (fighter pilot atelectasis);
• Decreased production or absence of surfactant, leading to increased surface tension of the inner wall of the alveoli, causing them to collapse (neonatal respiratory distress syndrome);
• Mechanical pressure on lung pathological contents located in the pleural cavities (blood, hydrothorax, air), an enlarged heart or a large aneurysm of the thoracic aorta, a large focus of tuberculous lesions of lung tissue;
• When interstitial pressure exceeds intra-alveolar pressure (pulmonary edema).

3. Suppression of the breathing center in the brain

Occurs with traumatic brain injuries, tumors, general (intravenous, inhalation) anesthesia, excessive oxygen supply during artificial ventilation, and overdose of sedatives.

4. Violation of the integrity of the bronchus due to a simultaneous rapid mechanical impact on it

Observed during surgery (ligation of the bronchus as a method surgical treatment with) or with its injury (rupture).

5. Congenital malformations

Hypoplasia and aplasia of the bronchi, the presence of tendon septa in the form of intrabronchial valves, esophageal-tracheal fistulas, defects of the soft and hard palate.

With all equal opportunities, increased risk The following people have the occurrence of pulmonary atelectasis:

• Smoking;
• Having increased body weight;
• Suffering from cystic fibrosis.

Classification of pulmonary atelectasis

Depending on the order of involvement of the lungs in the pathological process:

Primary (congenital)

It occurs in children, most often immediately after their birth, when the lungs do not fully expand with the first breath. In addition to the already described intrauterine anomalies in the development of the lungs and insufficient production of surfactant, the cause of its occurrence can be aspiration of amniotic fluid, meconium. The main difference between this form is the initial absence of air from entering environment into a collapsed area of ​​lung tissue.

Secondary (acquired)

This form of atelectasis occurs as a complication of inflammatory and tumor diseases of organs, both respiratory and other systems, as well as with chest injuries.

Various forms of pulmonary atelectasis

According to the mechanism of occurrence, acquired forms of atelectasis are distinguished:

Obstructive atelectasis

It is observed when the cross-sectional area of ​​the bronchus decreases for the reasons stated above. Obstruction of the lumen can be complete or partial. Sudden closure of the lumen when a foreign body enters requires immediate action to restore patency bronchial tree for the reason that with every hour of delay, the likelihood of straightening the collapsed part of the lungs decreases. Restoration of lung ventilation in cases where complete obstruction of the bronchus lasted more than three days does not occur.

Compression atelectasis

Occurs when there is a direct impact on the lung tissue itself. A more favorable form in which full recovery ventilation of the lungs is possible even after a fairly long period of compression.

Functional (distensional) atelectasis

Occurs in areas of physiological hypoventilation (lower segments of the lungs):

1. In bedridden patients;
2. Those who have undergone severe and prolonged surgical interventions;
3. In case of overdose of barbiturates, sedatives;
4. With arbitrary limitation of the volume of respiratory movements, which is due to severe pain syndrome(rib fracture, peritonitis);
5. In the presence of high intra-abdominal pressure (ascites of various origins, chronic constipation, flatulence);
6. With diaphragmatic paralysis;
7. Demyelinating diseases of the spinal cord.

Mixed atelectasis

With a combination of different mechanisms of origin.

Depending on the level of bronchial obstruction and the area of ​​lung collapse, the following are distinguished:

• Lung atelectasis (right or left). Compression at the level of the main bronchus.
• Lobar and segmental atelectasis. Lesion at the level of the lobar or segmental bronchi.
• Subsegmental atelectasis. Obstruction at the level of the bronchi of the 4th-6th order.
• Discoid atelectasis. Disc-shaped atelectasis develops as a result of compression of several lobules located within the same plane.
• Lobular atelectasis. Their cause is compression or obstruction of the terminal (respiratory) bronchioles.

Signs of pulmonary atelectasis

The severity of the symptoms, due to which one can suspect the occurrence of atelectasis in the lungs, depends on a number of reasons:

1. The rate of compression of lung tissue (acute and gradually increasing atelectasis are distinguished);
2. Volume (size) of the respiratory surface of the lungs turned off from ventilation;
3. Localizations;
4. The mechanism of occurrence.

Dyspnea

It is characterized by an increase in the frequency of inhalation and exhalation per minute, a change in their amplitude, and arrhythmia of respiratory movements. Initially, the feeling of lack of air occurs during physical activity. With increasing or initially large area of ​​atelectasis, shortness of breath appears at rest.

Chest pain

Optional attribute. Appears most often when air enters the pleural cavities.

Change in skin color

Caused by excess carbon dioxide in tissues. In children, first of all, it turns blue nasolabial triangle. In adults, blueness of the fingers of the extremities (acrocyanosis) and the tip of the nose appears.

Changes in the performance of the cardiovascular system

• Pulse increases (tachycardia);
• After a short-term increase in blood pressure in the initial stages, it decreases.

In children, the indicated symptoms are also observed, which are most clearly manifested in newborns with primary atelectasis. These are accompanied by easily observed retractions of the intercostal spaces when inhaling from the side of the affected lung, as well as retractions of the sternum when air enters the lungs.

Diagnostics

During medical diagnosis, in addition to symptoms noticeable to the patient, following signs presence of atelectasis:

1. The sound when tapping the chest (percussion) in the area of ​​atelectasis becomes shorter and less sonorous (dullness), in contrast to the more “boxy” sound in the surrounding areas.
2. Weakening or complete absence of breathing during auscultation in the projection of atelectasis, asymmetry in the movements of the diseased and healthy half of the chest.
3. With atelectasis, which covers all or almost all of the lung, the heart shifts towards the collapsed organ. This can be detected by percussion of the borders of the heart, by changes in the localization of the apex beat zone, and by auscultation of the heart.

You should also remember:

• Signs of atelectasis occur against the background of an existing underlying disease, sometimes aggravating an already critical general state sick.
• The collapse of a segment (in some cases even a lobe) of the lung may go unnoticed for the patient. However, it is these small collapsed areas that can become the first foci of pneumonia, which is severe in such patients.

It helps to clarify the presence of atelectasis, its localization and volume to determine treatment tactics X-ray examination chest organs. It is carried out in at least two projections. In more difficult cases, tomography is used to diagnose cases.

X-ray signs that suggest the presence of atelectasis:

1. Change in density (darkening) of the shadow of a compressed area of ​​the lungs in comparison with the surrounding tissues, often following the contours of a segment or lobe;
2. Change in the shape of the dome of the diaphragm, displacement of the mediastinal organs, as well as the roots of the lungs towards atelectasis;
3. The presence of functional signs of bronchoconstriction (not necessary if the mechanism of atelectasis is not obstructive);
4. Approximation of the shadows of the ribs on the affected side;
5. Scoliosis of the spine with the direction of the convexity towards atelectasis;
6. Stripe-like shadows against the background of unchanged areas (disc-shaped atelectasis) of the lungs.

Atelectasis of the middle lobe right lung on an x-ray

Prognosis for pulmonary atelectasis

Sudden simultaneous total (subtotal) atelectasis one or two lungs, developed as a result of injury (air entering chest) or during complex surgical interventions in almost all cases ends in death immediately or in the early postoperative period.

Obstructive atelectasis, developed due to sudden blockage by foreign bodies at the level of the main (right, left) bronchi - also have a serious prognosis in the absence of emergency help.

Compression and distension atelectasis, developed during hydrothorax, with the removal of the cause that caused them, do not leave any residual changes and do not change the volume vital capacity lungs in the future.

The prognosis for the restoration of the functions of a compressed lung can be significantly changed by the attached lung, which in these cases leaves scar tissue replacing the collapsed alveoli.

Treatment

1. Elimination of the mechanism of atelectasis with restoration of ventilation in these areas

For obstructive atelectasis:

For compression atelectasis:

1. Pleural puncture with removal of effusion and air from the cavities, eliminating the causes of effusion and communication with the environment;
2. Surgical treatment of tumors of the lungs and lymph nodes, elimination cavity formations(cysts, abscesses, some forms of tuberculosis).

For distensional atelectasis:

• Breathing exercises with the creation of high intrabronchial pressure (inflating balloons);
• Inhalation with a mixture of air and 5% carbon dioxide to stimulate the respiratory center.

2. Artificial ventilation with the addition of oxygen

It is carried out when severe symptoms develop.

3. Correction of acid-base balance disorders in the blood

It is carried out by prescribing intravenous infusion therapy based on the patient’s biochemical blood data.

4. Antibiotic therapy

Aimed at preventing purulent complications.

5. Syndromic therapy

Includes elimination of the pain factor if present, correction of cardiovascular activity (normalization of pulse, blood pressure).

6. Physiotherapy

Chest massage is one of the methods of treating pulmonary atelectasis

It is carried out to prevent the formation of scars in the lungs and improve blood circulation in the area of ​​atelectasis. For this purpose, UHF irradiation is used in the acute phase, and during the recovery period, electrophoresis with drugs (platifillin, aminophylline, etc.) is used.

7. Therapeutic and preventive physical education and chest massage

Aimed at improving the functioning of the respiratory muscles. A light vibration massage promotes the removal of sputum and mucus from the bronchoalveolar tree.

Video: pulmonary atelectasis in the program “Live Healthy!”

The lungs are a paired organ that carries out human breathing, located in the chest cavity.

The primary task of the lungs is to saturate the blood with oxygen and remove carbon dioxide. The lungs are also involved in the secretory-excretory function, metabolism, and acid-base balance body.

The shape of the lungs is cone-shaped with a truncated base. The apex of the lung protrudes 1-2 cm above the collarbone. The base of the lung is wide and located in the lower part of the diaphragm. The right lung is wider and larger in volume than the left.

The lungs are covered with a serous membrane, the so-called pleura. Both lungs are located in the pleural sacs. The space between them is called the mediastinum. The anterior mediastinum contains the heart, large vessels of the heart, thymus. In the back - trachea, esophagus. Each lung is divided into lobes. The right lung is divided into three lobes, the left into two. The base of the lungs consists of the bronchi. They are woven into the lungs and form the bronchial tree. The main bronchi are divided into smaller, so-called subsegmental bronchi, and these are already divided into bronchioles. The branched bronchioles make up the alveolar ducts and contain the alveoli. The purpose of the bronchi is to deliver oxygen to the pulmonary lobes and to each pulmonary segment.

Unfortunately, the human body is susceptible to various diseases. The human lungs are no exception.

Lung diseases can be treated with medications; in some cases, surgery is required. Let's look at lung diseases that occur in nature.

Chronic inflammatory disease respiratory tract, at which constantly increased sensitivity bronchi leads to attacks of bronchial obstruction. It is manifested by attacks of suffocation caused by bronchial obstruction and resolving independently or as a result of treatment.

Bronchial asthma is a widespread disease, affecting 4-5% of the population. The disease can occur at any age, but more often in childhood: in about half of patients, bronchial asthma develops before the age of 10, and in another third - before the age of 40.

There are two forms of the disease - allergic bronchial asthma and idiosyncratic bronchial asthma; a mixed type can also be distinguished.
Allergic bronchial asthma (also exogenous) is mediated by immune mechanisms.
Idiosyncratic bronchial asthma (or endogenous) is caused not by allergens, but by infection, physical or emotional stress, sudden changes in temperature, air humidity, etc.

Mortality from bronchial asthma small. According to the latest data, it does not exceed 5,000 cases per year per 10 million patients. In 50-80% of cases of bronchial asthma, the prognosis is favorable, especially if the disease arose in childhood and flows easily.

The outcome of the disease depends on correctly selected antimicrobial therapy, that is, on the identification of the pathogen. However, isolation of the pathogen takes time, and pneumonia serious disease and treatment should be started immediately. In addition, in a third of patients it is not possible to isolate the pathogen at all, for example, when there is no sputum or pleural effusion, and the blood culture results are negative. Then the etiology of pneumonia can be established only by serological methods after a few weeks, when specific antibodies appear.

Chronic obstructive pulmonary disease (COPD) is a disease characterized by a partially irreversible, steadily progressive limitation of airflow caused by an abnormal inflammatory response of lung tissue to damaging environmental factors - smoking, inhalation of particles or gases.

IN modern society COPD, along with arterial hypertension, coronary heart disease and diabetes mellitus, constitute the leading group of chronic diseases: they account for more than 30% of all other forms of human pathology. The World Health Organization (WHO) classifies COPD as a disease with a high social burden, as it is widespread in both developed and developing countries.

A disease of the respiratory tract characterized by pathological expansion air spaces of the distal bronchioles, which is accompanied by destructive morphological changes in the alveolar walls; one of the most common forms of chronic nonspecific diseases lungs.

There are two groups of causes leading to the development of emphysema. The first group includes factors that impair the elasticity and strength of the elements of the lung structure: pathological microcirculation, changes in the properties of surfactant, congenital deficiency of alpha-1-antitrypsin, gaseous substances (cadmium compounds, nitrogen oxides, etc.), as well as tobacco smoke, dust particles in the inhaled air. Factors of the second group contribute to an increase in pressure in the respiratory part of the lungs and increase the stretching of the alveoli, alveolar ducts and respiratory bronchioles. The most important among them is airway obstruction that occurs with chronic obstructive bronchitis.

Due to the fact that with emphysema, the ventilation of the lung tissue is significantly affected and the functioning of the mucociliary escalator is disrupted, the lungs become much more vulnerable to bacterial aggression. Infectious diseases of the respiratory system in patients with this pathology often become chronic, and foci of persistent infection are formed, which significantly complicates treatment.

Bronchiectasis is an acquired disease characterized by a localized chronic suppurative process (purulent endobronchitis) in irreversibly altered (dilated, deformed) and functionally defective bronchi, mainly in the lower parts of the lungs.

The disease manifests itself predominantly in childhood and adolescence; a cause-and-effect relationship with other diseases of the respiratory system has not been established. Direct etiological factor bronchiectasis can be caused by any pneumotropic pathogenic agent. Bronchiectasis that develops in patients with chronic respiratory diseases is considered as a complication of these diseases, is called secondary and is not included in the concept of bronchiectasis. The infectious and inflammatory process in bronchiectasis occurs mainly within the bronchial tree, and not in the pulmonary parenchyma.

It is a purulent melting of an area of ​​the lung with the subsequent formation of one or more cavities, often delimited from the surrounding lung tissue by a fibrous wall. The cause is most often pneumonia caused by staphylococcus, Klebsiella, anaerobes, as well as contact infection with pleural empyema, subphrenic abscess, aspiration of foreign bodies, infected contents paranasal sinuses nose and tonsils. Characterized by a decrease in the general and local protective functions of the body due to the entry of foreign bodies, mucus, and vomit into the lungs and bronchi - when drunkenness, after a seizure or in an unconscious state.

The prognosis for treatment of lung abscess is conditionally favorable. Most often, patients with a lung abscess recover. However, in half of the patients with acute lung abscess, thin-walled spaces are observed, which disappear over time. Much less frequently, a lung abscess can lead to hemoptysis, empyema, pyopneumothorax, and bronchopleural fistula.

An inflammatory process in the area of ​​the pleural layers (visceral and parietal), in which fibrin deposits form on the surface of the pleura (the membrane covering the lungs) and then adhesions form, or accumulate inside the pleural cavity different types effusion (inflammatory fluid) – purulent, serous, hemorrhagic. The causes of pleurisy can be divided into infectious and aseptic or inflammatory (non-infectious).

pathological accumulation of air or other gases in the pleural cavity, leading to disruption of the ventilation function of the lungs and gas exchange during breathing. Pneumothorax leads to compression of the lungs and oxygen deficiency (hypoxia), metabolic disorders and respiratory failure.

The main causes of pneumothorax include: trauma, mechanical damage to the chest and lungs, lesions and diseases of the chest cavity - ruptures of bullae and cysts in pulmonary emphysema, abscess breakthroughs, rupture of the esophagus, tuberculosis, tumor processes with melting of the pleura.

Treatment and rehabilitation after pneumothorax last from 1-2 weeks to several months, it all depends on the cause. The prognosis for pneumothorax depends on the degree of damage and the rate of development of respiratory failure. In case of injuries and injuries it may be unfavorable.

This infectious disease is caused by mycobacteria. The main source of infection is a patient with tuberculosis. Often the disease is secretive and has symptoms related to many diseases. This is a prolonged low-grade fever, general malaise, sweating, cough with sputum.

The main routes of infection are:

1. The airborne route is the most common. Mycobacteria rush into the air when a patient with tuberculosis coughs, sneezes, or breathes. Healthy people inhale mycobacteria and carry the infection into their lungs.
2. Contact path infection cannot be ruled out. Mycobacterium enters the human body through damaged skin.
3. IN digestive tract Mycobacteria are acquired by eating meat contaminated with mycobacteria.
4. The intrauterine route of infection is not excluded, but is rare.

Bad habits aggravate the course of the disease, such as smoking. The inflamed epithelium is poisoned by carcinogens. Treatment turns out to be ineffective. Patients with tuberculosis are prescribed medication, and in some cases surgery is indicated. Treatment of the disease initial stage increases the chance of recovery.

Lung cancer - malignant tumor, developed from the epithelium of the lungs. The tumor is growing rapidly. Cancer cells Together with lymph, they spread throughout the body through the circulatory system, creating new tumors in organs.

Symptoms signaling the disease:

• streaks of blood are visible in the sputum, purulent discharge;
• deterioration of health;
• pain that appears when coughing, breathing;
• a large number of leukocytes in the blood.

Factors leading to the disease:

1. Inhalation of carcinogens. Tobacco smoke contains a huge amount of carcinogens. This is oluidine, benzpyrene, heavy metals, naphthalamine, nitroso compounds. Once in the lungs, they corrode the delicate mucous membrane of the lungs, settle on the walls of the lungs, poison the entire body, and lead to inflammatory processes. With age harmful effects smoking on the body increases. When you quit smoking, the body's condition improves, but the lung does not return to its original state.
2. Influence of hereditary factors. A gene has been identified whose presence increases the risk of developing cancer.
3. Chronic lung diseases. Frequent bronchitis, pneumonia, tuberculosis, weaken the protective functions of the epithelium, and cancer may subsequently develop.

The disease is difficult to treat; the earlier treatment is taken, the higher the chance of recovery.

Diagnostics plays an important role in identifying and treating lung diseases.

Diagnostic methods:

• x-ray
• tomography
• bronchoscopy
• cytology, microbiology.

Following a schedule of preventive examinations, adopting a healthy lifestyle and quitting smoking will help maintain healthy lungs. Definitely refuse bad habit even after 20 years of active smoking, it is healthier than continuing to poison your body with tobacco poisons. A person who quits smoking may have lungs very contaminated with tobacco soot, but the sooner he quit, the greater the chance of changing this picture for the better. The fact is that human body is a self-regulating system, and lungs of a quitter can restore their functions after various injuries. The compensatory capabilities of cells make it possible to at least partially neutralize the harm from smoking - the main thing is to start taking care of your health in time

Lung rupture is a violation of the integrity of its parenchyma (working tissue), as well as the visceral layer of the pleura (the connective tissue membrane that covers this organ). This term is used to refer to a rupture of the lung without damage to the chest wall.

The pathology is mainly observed when the pulmonary parenchyma is injured by fragments of broken ribs. It is diagnosed somewhat less frequently if there is a sharp tension in the tissues in the area of ​​the root of the lung - this can happen with a blow to the chest area or a fall from a height.

The main manifestations that signal a lung rupture are cyanosis (blue discoloration) of the skin and mucous membranes, severe shortness of breath, and, somewhat less frequently, hemoptysis and subcutaneous emphysema.

The damage is mechanical in nature, which means it requires surgical intervention to restore tissue integrity. But often a full-fledged abdominal thoracic operation is performed when the root of the lung is damaged. For peripheral (marginal) ruptures, puncture and drainage of the pleural cavity is sufficient.

Total information

Lung rupture is considered an extremely serious and life-threatening pathological condition that requires immediate attention. medical actions(exception is minor marginal damage to lung tissue). Often, even a slight delay can lead to death.

Pathology often occurs as a result of work-related injuries or road traffic accidents. Under these circumstances, experienced thoracic surgeons and traumatologists carry out diagnostic examination for a lung rupture, even if no clear symptoms characteristic of the described pathology are detected.

Patients with pulmonary rupture are jointly managed by traumatologists and thoracic surgeons.

Causes of lung rupture

A lung rupture is mainly formed when the lung and visceral layer of the pleura are damaged by fragments of damaged ribs. This is most often observed in severe cases (often combined) - mostly multiple (most often double, when three rib fragments are formed during a fracture). In this case, the condition for lung rupture is the displacement of fragments. It could be:

• primary;
• secondary.

Primary displacement observed directly at the moment of injury, when, under the influence of a force factor, rib fragments change their position and with sharp edges literally pierce the parenchyma of the organ.

Secondary displacement may occur some time after the injury - in the near or distant period. Rib fragments occupying their usual position are capable of displacement in the presence of such provoking factors as:

and others.

note

Due to the unpredictability of the “behavior” of rib fragments, secondary displacement is quite dangerous, as it is often a phenomenon that is difficult to predict. It often occurs against the background of a seemingly successful recovery of the patient after a chest injury.

Another mechanism of damage is less commonly diagnosed - partial separation of the lung from the root, which can occur due to excessive tension of the lung tissue during a sharp direct blow to the chest or a fall.

Lung ruptures are often identified as an element of combined trauma (also called polytrauma) - this happens under such circumstances as:

• road accidents;
• criminal showdowns;
• industrial (man-made) disasters;
• natural disasters (earthquakes, avalanches).

It should be remembered that a lung rupture can be combined with such disorders as:

• sternum fracture;
• clavicle damage;
• fractures of the bones of the upper extremities;
• damage to the thoracic spine;
• blunt trauma to the abdominal organs.

Somewhat less frequently, a lung rupture is diagnosed simultaneously with damage to the kidneys and kidneys, which form the pelvic ring.

Several factors contribute to the fact that even with a small physical strength, attached to the pulmonary parenchyma, rupture may occur due to its weakening. This:

• previous injuries;
• frequent and - especially those that are accompanied by frequent hacking cough;
• congenital malformations of the pulmonary parenchyma;
• bad habits – alcohol abuse, drug use.

Development of pathology

This violation is of a mechanical nature - hard bone tissue damage the soft lungs. In this case, the rupture of the lung is combined with damage to the visceral layer of the pleura, which surrounds this organ like a case. Damage to the parietal pleura is not always diagnosed.

If there is a partial separation of the lung at the root, then it can be fraught with a violation of the integrity:

• large vessels;
• large bronchi.

If large lobar bronchi are damaged, then a widespread lung is formed very quickly, followed by complete collapse of the lung. Bleeding from segmental and subsegmental arteries can:

• cause the formation of pronounced hemothorax;
• cause acute blood loss.

In the latter case, it develops hypovolemic shock – pronounced violation hemodynamics of the body due to a decrease in the amount of fluid in the bloodstream.

It is characteristic that when ruptured light bleeding from the pulmonary artery, inferior or superior vena cava to clinical practice almost never occur, since due to severe bleeding, victims usually die before the ambulance arrives medical care– such bleeding very quickly leads to blood loss incompatible with life.

Symptoms of a ruptured lung

The clinical picture of a lung rupture is based on:

• expressed;
• sharp when trying to take a breath;
• painful, in which painful sensations intensify even more;
• often - hemoptysis.

If a large vessel is damaged, severe bleeding may occur.

Clinical manifestations of lung rupture primarily depend on:

• characteristics of damage to lung tissue - their localization (location), depth and extent;
• the presence (or absence) of damage to large bronchi and vessels.

It was revealed that the closer the gap is to root of the lung, those clinical picture more pronounced, the patient's condition is more severe. This pattern is explained by the fact that when the central parts of the lung are injured, the integrity of the walls of large vessels and bronchi is inevitably compromised. But even peripheral damage lungs can often provoke life-threatening consequences, and in difficult cases they are incompatible with it - pneumothorax, collapse of most of the lung and the development of acute

In most cases, when a lung ruptures, the patient’s condition is serious or extremely serious. It does not correspond to the condition of patients with uncomplicated rib fractures - such a nuance helps to suspect a lung rupture.

Diagnostics

The diagnosis of a lung rupture is made based on the patient’s complaints, anamnesis (history) of pathology, and the results of additional research methods - physical, instrumental, laboratory. Since the condition is urgent, it is important to get as much full information based on complaints, medical history and examination. When performing instrumental and laboratory diagnostics It is necessary to limit ourselves to those research methods that will allow you to quickly obtain information for making a diagnosis and will allow you to avoid wasting precious time necessary for the earliest possible start of medical care.

Physical examination reveals the following:

• upon examination, a bluish discoloration of the skin and mucous membranes appears, which increases over time. Half of the victim’s chest on the side of the injury lags behind or does not participate at all in the act of breathing. Often such patients are excited and fussy;
• upon palpation (palpation), subcutaneous emphysema can be detected (accumulation in the tissues of air that has entered them from the damaged lung). With severe manifestations of emphysema, the symptom of “creaking snow” is observed;
• with percussion (tapping with fingers) – pathological changes may be different and mainly depend on the nature of the complications. So, over the area it is revealed dull sound as if someone is knocking on wood, and above the area of ​​pneumothorax the sound is usually abnormally loud, as if someone is beating on a drum;
• when auscultating the lungs (listening with a phonendoscope), breathing on the affected side is weakened, and if a total pneumothorax has developed, it is not audible at all.

note

The victim is examined several times (in this case it is called dynamic), and again while receiving qualified assistance, which will allow assessing the effectiveness of the prescriptions and identifying complications. As hemothorax or pneumothorax worsens, the patient's condition quickly deteriorates.

It is also important to monitor the hemodynamics of the victim. A decrease in blood pressure and an increase in heart rate may indicate:

• progressive pulmonary hemorrhage;
• increasing hypovolemic shock.

From instrumental diagnostics The optimal x-ray examination method is:

• fluoroscopy - studying the condition of the lung and pleural cavity on the monitor;
• – the same study using x-rays.

This determines the following:

Sometimes X-ray data confuse the diagnosis - this is typical for cases when there are adhesions (connective tissue cords) in the pleural cavity, which could arise as a result of injuries and/or diseases. In such patients, X-ray images reveal an atypical picture of pneumo- and hemothorax:

• limited hemothorax looks like a local darkening with clear contours in the lower or middle lobes of the lungs;
• pneumothorax, which arose in the space of the pleural cavity between the adhesions, is defined as a local clearing of irregular shape.

If quick execution is possible, they practice (CT), (MRI).

Of the laboratory research methods for lung rupture, the most informative is that a decrease in the number of red blood cells and hemoglobin signals acute blood loss.

Differential diagnosis

Differential diagnosis of lung rupture is primarily carried out with such diseases and pathological conditions, How:

• rib fracture without complications of lung rupture;
• rupture of the bulla - a pathological “bubble” that arose in the pulmonary parenchyma against the background of its pathology;
• – necrosis (death) of the heart muscle, which occurs due to critical violation blood flow by coronary vessels(arteries providing blood supply to the myocardium).

Complications

The critical condition of a patient with a ruptured lung (lungs) can develop precisely because of the complications that can accompany this pathology. These include:

Treatment of a lung rupture

If a lung rupture is suspected, all victims without exception are urgently hospitalized in the trauma department or thoracic surgery department (thoracic). The basis of treatment is the following:

• bed rest;
• drug therapy;
• blood transfusion;
• minimally invasive procedures or surgery– depending on the severity of the described pathology.

The basis of drug therapy is the following:

Transfusion of small portions of blood is performed for hemostatic (hemostatic) purposes. In this case, blood of the same group is transfused, also taking into account the Rh factor.

Minimally invasive manipulations for lung rupture involve pleural punctures– puncture of the chest wall and visceral pleura. They are performed when:

• pneumothorax - to evacuate (remove) air from the pleural cavity;
• hemothorax - to evacuate blood.

During puncture, blood and/or air is sucked out with a syringe.

If the pneumothorax is widespread or total, pleural drainage is advisable - in pleural cavity through a small hole in the chest wall made by a trocar (an instrument similar to a screwdriver with a sharp end), polyvinyl chloride tubes are inserted, the ends of which are brought out and lowered into a vessel with liquid. In this case, air is pushed out of the pleural cavity, but due to the fluid in the vessel it cannot get back.

Indications for surgical intervention for the described pathology are as follows:

• signs of severe lung rupture;
• inefficiency conservative methods treatment for small ruptures of lung tissue;
• deterioration of the patient’s condition – this is indicated by an increase in cyanosis and shortness of breath;
• the appearance of signs of complications.

The operation is performed urgently (emergency). During it:

• carry out an audit (examination) of the lung and pleural cavity;
• remove blood accumulated in the pleural cavity;
• wash the cavity with antiseptic solutions;
• damaged arteries are identified and ligated to stop bleeding.

Operational tactics regarding lung damage depends on factors such as:

• location (it matters whether the gap is located closer to the root of the lung or to its peripheral areas);
• depth of damage (the rupture is superficial or deep);
• presence of bronchial damage.

If the damage to the lung tissue is closer to the periphery, is superficial, and there is no damage to the bronchi, then sutures are placed on the wound (silk threads are used).

In case of severe (deep and extensive) wounds, as well as crush injuries of the lung tissue, wedge resection lung lobes – wedge-shaped excision.

Also, for the described pathology, lobetcomy is practiced - removal of the entire lobe of the lung. Indications for it are:

• particularly severe damage to lung tissue;
• wounds located at the root of the lung;
• injuries combined with damage to the segmental bronchus and vessel.

At the end of an operation of any volume, drainage of the pleural cavity is performed.

Postoperative treatment consists of the following:

• semi-sitting position - it makes breathing easier;
• humidified oxygen;
• introduction antibacterial drugs through the drainage system into the pleural cavity;
• intramuscularly – for the prevention of postoperative complications;
• painkillers – for pain;
• cardiac medications – for signs of dysfunction of the cardiovascular system.

Prevention

Prevention of primary lung ruptures consists of:

Prevention of secondary lung ruptures is:

• proper transportation of the victim;
• the patient avoids coughing, laughter, any excessive activity on the part of the body and in particular the chest (turning, bending);
• adequate treatment of rib fractures.

Forecast

The prognosis for a lung rupture varies and depends on:

• degree of damage;
• development of complications;
• timeliness of medical care.

Superficial single ruptures of the lung during timely diagnosis treated without any difficulty. Deep ruptures require quick decisions (in particular, in favor of surgery) and often lead to death.

Kovtonyuk Oksana Vladimirovna, medical observer, surgeon, consultant doctor

Various lung diseases are quite common in Everyday life person. Most of the classified diseases have severe symptoms of acute lung disease in humans and, if not treated correctly, can lead to bad consequences. Pulmonology deals with the study of respiratory diseases.

Causes and signs of lung diseases

To determine the cause of any disease, you should contact a qualified specialist (pulmonologist), who will conduct thorough research and make a diagnosis.

Lung diseases are quite difficult to diagnose, so you need to undergo the entire list of recommended tests.

But there are common factors that can cause acute pulmonary infection:

There is a large number objective signs characterizing lung disease. Their main symptoms:

Lung diseases affecting the alveoli

Alveoli, the so-called air sacs, are the main functional segment of the lungs. When the alveoli are damaged, individual lung pathologies are classified:

Diseases affecting the pleura and chest

The pleura is the thin sac that contains the lungs. When it is damaged, the following respiratory diseases occur:

Blood vessels are known to carry oxygen, and their disruption causes chest diseases:

1. Pulmonary hypertension. Violation of pressure in the pulmonary arteries gradually leads to the destruction of the organ and the appearance of primary signs diseases.
2. Pulmonary embolism. Often occurs with vein thrombosis, when a blood clot enters the lungs and blocks the supply of oxygen to the heart. This disease is characterized by sudden bleeding in the brain and death.

For constant pain in the chest, the following diseases are distinguished:

Hereditary and bronchopulmonary diseases

Hereditary respiratory diseases are transmitted from parents to child and can have several types. Basic:

Diseases of the bronchopulmonary system are based on acute respiratory infection. Most often, bronchopulmonary infectious diseases are characterized by mild malaise, gradually developing into acute infection in both lungs.

Bronchopulmonary inflammatory diseases caused by viral microorganisms. They affect the respiratory system and mucous membranes. Incorrect treatment can lead to the development of complications and the occurrence of more dangerous bronchopulmonary diseases.

The symptoms of a respiratory infection are very similar to the common cold, caused by viral bacteria. Infectious lung diseases develop very quickly and are of bacterial origin. These include:

• pneumonia;
• bronchitis;
• asthma;
• tuberculosis;
• respiratory allergies;
• pleurisy;
• respiratory failure.

Infection in inflamed lungs develops rapidly. To avoid complications, a full range of treatment and prevention should be carried out.

Chest conditions such as pneumothorax, asphyxia, and physical damage to the lungs cause severe pain and can cause breathing and lung problems. Here it is necessary to apply an individual treatment regimen, which has a sequence-related nature.

Suppurative diseases

Due to the increase purulent diseases the percentage of suppurative inflammations has increased causing problems with damaged lungs. Pulmonary purulent infection affects a significant part of the organ and can lead to serious complications. There are three main types of this pathology:

• X-ray;
• fluorography;
• general blood analysis;
• tomography;
• bronchography;
• testing for infections.

After all the studies, the doctor must determine an individual treatment plan, necessary procedures and antibacterial therapy. It should be remembered that only strict adherence to all recommendations will lead to a quick recovery.

Compliance preventive measures for lung diseases significantly reduces the risk of their occurrence. To exclude respiratory diseases, you should follow simple rules:

• conducting healthy image life;
• absence of bad habits;
• moderate physical activity;
• hardening of the body;
• annual vacation on the seaside;
• regular visits to a pulmonologist.

Every person should know the manifestations of the above diseases in order to quickly identify the symptoms of an incipient respiratory disease, and then seek qualified help in time, because health is one of the most valuable attributes of life!

The lungs are the main organ of the human respiratory system and consist of the pleura, bronchi and alveoli united into acini. In this organ, gas exchange of the body takes place: carbon dioxide, unsuitable for its vital functions, passes from the blood into the air, and oxygen received from the outside is carried through the bloodstream throughout all systems of the body. The basic function of the lungs may be impaired due to the development of any disease of the respiratory system or as a result of their damage (wound, accident, etc.). Lung diseases include: pneumonia, abscess, emphysema,.

Bronchitis

Bronchitis is a lung disease associated with inflammation of the bronchi, the constituent elements of the pulmonary bronchial tree. Most often, the cause of the development of such inflammation is the penetration of a viral or bacterial infection into the body, lack of proper attention to throat diseases, or entry into the lungs. large quantity dust and smoke. For most people, bronchitis does not pose a serious danger; complications of the disease usually develop in smokers (even passive smokers), people with weakened immune systems, chronic heart and lung diseases, the elderly and young children.

Clinical picture of the beginning acute bronchitis coincides with the clinic of a common cold. First of all, a cough appears, then a cough occurs, first dry, then with sputum discharge. An increase in temperature may also occur. If left untreated, the inflammation can spread to the entire lung and cause pneumonia. Treatment of acute bronchitis is carried out with the use of anti-inflammatory and antipyretic drugs, expectorants, and drinking plenty of fluids. If the cause of the disease is bacterial infection, antibiotics may be prescribed. Chronic bronchitis does not develop against the background of incompletely cured acute form, as is the case with many diseases. It can be caused by prolonged irritation of the bronchi by smoke or chemicals. This pathology occurs in smokers or people working in hazardous industries. Main symptom chronic form bronchitis - cough with sputum discharge. Elimination of the disease is facilitated by changing lifestyle, quitting smoking, and ventilating the work area. To relieve symptoms, bronchodilators are prescribed - special drugs, promoting the expansion of the respiratory tract and facilitating breathing, inhalation. During exacerbation, treatment with antibiotics or corticosteroids is recommended.

Alveolitis

Alveolitis is an inflammation of lung tissue with its subsequent degeneration into connective tissue. This disease should not be confused with alveolitis, which occurs after poor-quality tooth extraction. The main cause of the development of an inflammatory process in the lungs can be: allergies, infections, inhalation toxic substances. The disease can be recognized by such signs as: headache and muscle pain, fever, aching bones, chills, shortness of breath, cough. Lack of treatment for pulmonary alveolitis leads to the development of respiratory failure. Measures to eliminate the main signs of the disease depend on the cause of its occurrence. In case of allergic alveolitis, the patient’s interaction with the allergen should be excluded and an antiallergic drug should be taken. At elevated temperature It is recommended to take antipyretic drugs, in case of severe cough - antitussives, expectorants. Quitting cigarettes promotes rapid recovery.

Pneumonia

Pneumonia is an infection of the lungs that occurs independently or as a complication of certain diseases of the respiratory system. Some types of pneumonia do not pose a danger to humans, while other types can be fatal. Lung infection is the most dangerous for newborns due to their still fragile immunity. The main symptoms of the disease are: heat, chills, chest pain, aggravated by deep breath, dry cough, blue lips, headaches, excessive sweating. The most common complications of pneumonia include: inflammation of the lining of the lungs (pleurisy), abscess, difficulty breathing, pulmonary edema. Diagnosis of the disease is based on the results of a chest x-ray and blood test. Treatment can be prescribed only after its causative agent has been identified. Depending on what caused the pneumonia (fungus or virus), antifungal or antibacterial drugs are prescribed medications. At extreme heat It is recommended to take antipyretic drugs (no more than three days in a row). Developing as a result infectious lesion lung respiratory failure requires oxygen therapy.

Lung abscess

An abscess is an inflammation of a separate area of ​​the lung with the accumulation of a certain amount of pus in it. The accumulation of pus in the lung in most cases is observed against the background of the development of pneumonia. Predisposing factors may be: smoking, alcohol abuse, taking certain medical supplies, tuberculosis, drug addiction. Signs of the development of the disease are: coughing, chills, nausea, fever, sputum with minor blood. The heat that occurs when lung abscess, usually cannot be eliminated with conventional antipyretics. The disease requires treatment large doses antibiotics, since the drug must penetrate not just into the body, but also into the very source of inflammation and destroy its main pathogen. In some cases, drainage of the abscess is required, that is, removal of pus from it using a special syringe needle inserted into the lung through the chest. If all measures to eliminate the disease have not brought the desired result, the abscess is removed surgically.

Emphysema

Pulmonary emphysema is a chronic disease associated with impairment of the basic function of the lungs. The reason for the development of this pathology is Chronical bronchitis, as a result of which the processes of breathing and gas exchange in human lungs are disrupted. The main symptoms of the disease: difficulty breathing or its complete impossibility, blue discoloration of the skin, shortness of breath, widening of the intercostal spaces and supraclavicular area. Emphysema develops slowly, and at first its symptoms are almost invisible. Dyspnea usually occurs only when there is excessive physical activity, as the disease progresses this symptom observed more and more often, then it begins to bother the patient, even when he is in a state of complete rest. The result of the development of emphysema is disability. Therefore, it is very important to start treatment at initial stage diseases. In most cases, patients are prescribed antibiotics, drugs that dilate the bronchi and have an expectorant effect, breathing exercises, and oxygen therapy. Full recovery This is only possible if you follow all doctor’s instructions and stop smoking.

Pulmonary tuberculosis

Pulmonary tuberculosis is a disease caused by a specific microorganism - Koch's bacillus, which enters the lungs along with the air containing it. Infection occurs through direct contact with a carrier of the disease. There is a difference between open and closed form tuberculosis. The second occurs most often. The open form of tuberculosis means that the carrier of the disease is able to excrete its pathogen along with sputum and transmit it to other people. With closed tuberculosis, a person is a carrier of the infection, but is not able to transmit it to others. The signs of this form of tuberculosis are usually very vague. In the first months from the onset of infection, the infection does not manifest itself in any way; much later, general weakness of the body, fever, and weight loss may appear. Treatment for tuberculosis should be started as early as possible. This is the key to saving a person’s life. To achieve optimal results, treatment is carried out using several anti-tuberculosis drugs at once. Its goal in this case is the complete destruction of the Koch bacillus present in the patient’s body. Most often these are prescribed medicines, such as ethambutol, isoniazid, rifampicin. Throughout the entire treatment period, the patient is in inpatient conditions specialized department of a medical clinic.