Spontaneous pneumothorax: its causes, clinic and therapy

Pneumothorax - a pathological condition in which air enters the pleural cavity, causing increased pressure in it.

This pathology has the following varieties:

• spontaneous pneumothorax. The causes of this form of the disease often remain unexplained (in cases when it arises primarily). Secondary spontaneous pneumothorax develops as a complication of various pulmonary diseases;

• traumatic. It is caused by wounds of the chest, in which atmospheric air enters the pleural cavity;

• iatrogenic. It is a complication in the incorrect treatment of pulmonary pathology and can occur with separate diagnostic interventions (for example, after pleural puncture , after thoracocentesis or pleural biopsy, and also as a result of catheterization of the central veins).

Let's consider features of development and course of spontaneous pneumothorax.

This form of the disease is primary and secondary. Primary spontaneous pneumothorax is often diagnosed in high and lean young people. It should be noted that smoking increases the risk of developing this lesion by almost 20 times. Against the background of this type of pneumothorax there is no obvious pulmonary pathology, but with further examination, subpleural bullae are very often detected, and these structures can be observed among patients who do not smoke (in almost 81% of cases). However, it is worth remembering that bulls are still formed due to the degradation of the elastic tissue of the lungs, which happens with excessive activation of neutrophils and macrophages that develops against the background of smoking.

Secondary pneumothorax always develops against the background of already existing pulmonary pathology. This form of the disease is difficult, because it is accompanied by significant cardiovascular disorders.

Among the main causes of secondary spontaneous pneumothorax are chronic obstructive pulmonary disease, asthmatic status, pulmonary tuberculosis, pneumonia, pneumosclerosis and connective tissue diseases (eg, rheumatoid arthritis or spondylitis). A certain etiological role can also be manifested with lung and sarcoma cancer.

Spontaneous pneumothorax leads to a decrease in the vital capacity of the lungs, which leads to hypoxemia - a decrease in the concentration of oxygen in the blood. It must be said that gas exchange in the lungs is not significantly disturbed, so hypercapnia does not develop (increase in the concentration of carbon dioxide in the body).

Often spontaneous pneumothorax develops at rest and manifests with acute pain in the chest and pronounced dyspnea. Subsequently, pain can become dull or aching. Excursion of the chest from the defeat is limited. Clinical manifestations of this pneumothorax independently disappear within the first 24 hours even in the absence of treatment.

If pneumothorax is insignificant, the pathological symptomatology in most cases is absent. Sometimes patients complain of tachycardia. With the development of intense pneumothorax, the frequency of cardiac contractions can reach 135 beats per minute and is accompanied by hypotension and cyanosis, as well as acute respiratory alkalosis.

Diagnosis of this condition is based on anamnestic data, and a specific line of the visceral pleura becomes visible on the X-ray. Sometimes for the diagnosis of a small-sized pneumothorax apply fluoroscopy or X-rays during exhalation.

Spontaneous pneumothorax: treatment

Therapy of the disease is directed to the evacuation of air from the pleural sacks, as well as to the prevention of relapses. The most optimal method for this is draining the pleural cavity and surgical intervention by thoracotomy or by thoracoscopic access.