Lung damage

Pulmonary tissue does not have a rich innervation, therefore, if the pleura is not involved in the process, no pain in the lungs is noted even with extensive damage, but the pain syndrome can develop due to irritation of the respiratory muscles and pleura during coughing. Physical and roentgenologic symptoms are very clear, especially in the development of hypoxia and respiratory failure.

Lesions of the lungs should be diagnosed by physicians of any specialty, although the specifying diagnosis is carried out by therapists, pulmonologists and thoracic surgeons. The most common lung injury is inflammatory diseases: bronchitis and pneumonia, but it is necessary to clarify the concepts. Under pneumonia is understood a large group of different in the etiology, pathogenesis and morphological characteristics of purulent (much less often exsudative) inflammation of the respiratory parts of the lungs. Other inflammatory processes are termed "pneumonitis", or they have a proper nosological name (tuberculosis, actinomycosis, echinococcosis, pneumoconiosis, etc.). For example, with a closed chest injury, 60% of the affected patients are identified by infiltrative shadows that appear on the 2-3rd day after the injury. But this is a consequence of the bruise and the process has the character of alterative inflammation, therefore it is defined by the term "traumatic pneumonitis", although pneumonia may develop on its background on the 5th-7th day. The term "pneumopathy" can be used only by specialists in pulmonology or thoracic surgeons, and even before the clarification of the underlying disease that caused lung pathology (this includes a certain group of syndromes requiring special studies, for example, Leffler, Wilson-Mikiti, Hammen-Richie, etc.) .

The defeat of the lungs and bronchi is clinically manifested by the presence of cough with or without phlegm, hemoptysis, attacks of suffocation, rapid breathing, wheezing with or without exercise, development of cyanosis of the face, lips, tongue, acrocyanosis, chills, fever, signs of intoxication, if not caused other causes (but also with them, the lungs are always interested, since they are not only the respiratory load, but also the non-respiratory ones, for example, the removal of toxins, waste products, etc.).

Auscultatory vesicular breathing is normally heard, there are no rales. The frequency of breathing is 16-18 per minute. With pathology in the bronchi, breathing becomes hard, often accompanied by whistling or buzzing rales. With the interest of lung tissue respiration becomes weakened (more often in the apical and basal regions), wheezing is of the nature of large, medium and small bubbles or crepitations. Breathing is not performed (or performed tracheal) with a sharp compaction of lung tissue (atelectasis, pneumosclerosis, pneumofibrosis, pneumocirrhosis or swelling). But we must remember that this is also noted in the pleural syndrome. Percutally determined clear pulmonary sound. With emphysema, tympanitis is revealed, while densification due to infiltration dullness of percussion sound, up to dullness at atelectasis, pneumofibrosis and cirrhosis or tumor.

In any case, a patient who has pulmonary involvement should perform an X-ray examination of the lungs (fluorography, or radiography) and, in the presence of pathology, he should be consulted by a therapist (preferably a pulmonologist) or a thoracic surgeon who will, if necessary, prescribe additional studies.

Special attention deserves edema, requiring immediate intervention resuscitator.

Edema is a pathological lesion of the lungs, caused by heavy sweating of plasma in the interstitium, and then into the lung alveoli. The most common cause is the cardiogenic factor in the development of left ventricular heart failure: ischemic heart disease, arterial hypertension, valvular heart prophecy, etc. Therefore, it is still defined as cardiopulmonary syndrome. In addition, this lung damage can develop with lung diseases and injuries, when pulmonary hypertension and right ventricular failure are formed, allergic conditions, portal hypertension, brain damage, intoxication, excessive and rapid introduction of fluids into the bloodstream.

The clinic is bright: the patient takes a forced semi-sitting position; breathing sharply rapid, hampered, bubbling, audible at a distance, with a large amount of foamy sputum, often pink in color; a heavy and painful gasp; rapidly growing cyanosis of the skin, especially the upper half of the trunk, and acrocyanosis. Hypoxic syndrome develops very rapidly with the formation of hypoxic coma.

For the diagnosis is mostly enough general clinical and physical examination; and for documentation and clarification - radiography and ECG. The lung radiographs reveal either intensive homogenous darkening of the lung tissue in the central part and roots in the form of "butterfly wings", or infiltrative-like darkening in the form of a "snow storm", bronchial occlusion is formed atelectasis of the lung with a homogeneous darkening of the lung tissue with a shift of the mediastinum towards the dimming, especially if the picture is performed on inhalation (a symptom of Westermarck), with thromboembolism of the pulmonary artery, the darkening has a triangular shadow directed at an acute angle toward the root of the lung.

Due to the development of thoracic surgery, pulmonary involvement in most cases is classified as surgical, so patients with the identified pathology, which is described below, should be hospitalized in specialized departments (thoracic or surgical pulmonology). First of all, they include the suppuration of the lungs.

Abscess - purulent-destructive lesion of the lungs with the formation of pathological cavities in it. It develops, as a rule, against the backdrop of pneumonia, which normally should be stopped within three weeks, longer its course should already be alarming regarding the formation of a pulmonary abscess.

To form an abscess in the lung, a combination of three conditions is necessary:

• introduction of pathogenic microflora (nonspecific or specific) in the parenchyma;
• violation of the drainage function of the bronchi (occlusion, stenosis, swelling, etc.);
• violation of blood flow in the lung tissue with the development of tissue necrosis.

There are acute purulent abscesses, staphylococcal lesions of the lungs, gangrenous abscesses, common gangrene. Abscesses can be single and multiple. During this period, two phases are distinguished:

1. formation of a closed abscess;
2. the phase of the abscess is absent in the bronchus (more often with acute and chronic abscesses) or the pleural cavity with the formation of pyopneuromotorax (more characteristic of staphylococcal destruction), or in both directions with the formation of bronchopleural fistula and pyopneumothorax.

This lesion of the lungs is found mostly in men.

An acute abscess has a typical phase flow. Until the opening of the abscess, the patient is troubled by weakness, fever remitting or intermittent type, chills, profuse sweat, persistent cough - dry or with a small amount of mucous sputum, resulting in pain in the muscles of the chest.

Breathing is rapid, often with shortness of breath, the phenomena of respiratory failure. At physical examination: the affected side of the chest lags behind in the act of breathing, reveals blunting of the percussion sound, breathing is hard, sometimes with a bronchial hue, dry and wet wheezing is heard. On the X-ray patterns, inflammatory infiltration of the lung tissue without clear boundaries is revealed, on the chest tomograms, the presence of vacuum in the infiltration zone is traced. When bronchoscopy, the bronchus is obturated with fibrin, and after elimination of occlusion, in most cases a large amount of purulent sputum immediately begins to flow. The duration of this phase, if the abscess is not opened through the bronchoscope to 10-12 days.

Transition to the second phase occurs suddenly: a strong cough occurs, during which a profuse separation of purulent sputum begins, usually with a full mouth, maximally in the postural position (on the healthy side, hanging from the bed with the trunk). The condition of the patients improves, the fever gradually decreases, the respiratory function is restored. Percutally above the thympanitis cavity, which is strengthened by opening the patient's mouth and sticking out the tongue (Wintrich's symptom), tympanic sound can go into dullness when the patient changes position (Weil symptom). The roentgenograms reveal a round or oval cavity filled with air and liquid, with a zone of perifocal inflammation, which decreases with treatment. With a favorable course of the abscess cicatrices within 3-4 weeks, if it exists more than three months it is a chronic abscess, which is subject to surgical treatment.

Staphylococcal destructive pulmonary involvement is predominantly observed in childhood. It develops very roughly, is accompanied by intoxication, hypoxia, often hypoxic eclampsia. Cough resistant with an increasing amount of purulent sputum. Auscultatory - breathing is weakened, cacophony of wheezing. On the radiographs of the lungs extensive infiltration of lung tissue, on the 2nd-3rd day of the onset of the disease multiple cavities located in the cortical layer of the lung are identified. In the process, the pleura is quickly involved with the formation of pleurisy, and on the third day, as a rule, a pleural puncture occurs with the formation of pyopneumotorax.

Gangrenous abscesses and gangrene develop against the backdrop of pneumonia when association with microorganisms putrefactive infection, predominantly protea. The condition of patients is burdened, intoxication and hypoxia progressively increase.

A distinctive feature is the early abundant supply of fetid (usually with a smear) smear. On X-rays, intense darkening of the lung tissue, the cavity, one or several, are formed by the 3-5th day, often the course is complicated by purulent pleurisy, pulmonary hemorrhage, sepsis.

Bronchoectatic disease is a nonspecific lesion of the lungs and bronchi accompanied by their enlargement and chronic purulent inflammation in them.

The secondary process, 90-95% of bronchiectasias are acquired, developing usually on the background of chronic bronchitis in childhood and adolescence, mainly the lower lobe bronchi are affected. There are one- and two-sided bronchiectasises. In form they can be cylindrical, saccular and mixed.

This lung lesion develops gradually, often giving an exacerbation in the spring and autumn, although there is no apparent seasonal dependence, but clear provoking factors are cold and damp.

The general condition for a long time does not change, the main manifestation is a frequent and persistent cough, bouts or persistent, at first with a small amount of sputum, then more and more, sometimes up to a liter a day, especially in the mornings. The temperature rises periodically, mostly subfebrile, although during exacerbations it can rise to 38-39 degrees.

As the disease progresses, due to increasing chronic hypoxia, the manifestations of the disease develop: the face becomes puffy, cyanotic, acrocyanosis appears, the fingers look like "drumsticks", nails - "watch glass". Patients lose weight. The thorax becomes bloated: the ribs bulge, the intercostal spaces widen, participation in the respiration of the auxiliary muscles (shoulder girdle and wings of the nose) is evident. Breathing is heavy, rapid, may be shortness of breath. Physical data and chest radiography in the initial stages do not give significant signs of bronchiectasis. With the obvious development of bronchiectasis - box percussion sound, and in the lower sections of its blunting. Breathing in the upper parts is more often rigid, and in the lower ones weakened, wheezing is dry, and damp. On roentgenograms, especially on the tomograms, the roots are compacted, the lower lobar bronchi are tight. A clear picture is given only by contrast bronchography. Bronchoscopy reveals the widening of the lower lobe bronchi, signs of chronic inflammation in them and the presence of a large amount of sputum.

Because of hypoxia and chronic intoxication all organs and systems suffer, therefore the main method of treatment is operative in specialized departments.

Cysts are a lesion of the lungs, which is characterized by intrapulmonary cavity formations of various genesis. There are true cysts that form as a result of the developmental defect of small bronchi (characterized by the presence of epithelial lining), and false as a result of trauma and inflammatory processes (do not have epithelial lining), less often echinococcal cysts. A typical clinical picture is not, mainly in medical examinations with fluorography or when complications occur (break with the formation of spontaneous pneumothorax, suppuration, bleeding). It is treated such a lung damage operatively.

[1], [2], [3], [4], [5], [6]