Syndrome of air accumulation in the pleural cavity

Pneumothorax - one of complication in the destructive lungs and pleura processes (abscess, hungrena, bronchiectasis, tuberculosis and tumor).

Pathogenesis. In pneumothorax developing the primary point belongs to the effortless lung's tissue destruction with air entrance to pleural cavity in circumstance of preceding pulmonary tissue or pleura pathology that occurs during intensive coughing, laughing, deep inspiration, extremely physical activity or trauma.

Depending on the localization, widespread and particularities of development there are distinguish the next forms of pneumothorax:

/. According to the localization:

- unilateral;

- bilateral.

//. According to the widespread:

- partial;

- total.

III. According to the mechanism of development:

- closed;

- opened;

- valve.

IV. According to the etiologic factors:

- spontaneous;

- traumatic;

- surgical;

- artificial (treatment).

Clinical features

The main complaints in patients with syndrome of air accumulation in pleural cavity are characterized by the symptoms of acute respiratory and right ventricle failure: dyspnea, pain in the chest, cough and palpitation.

Dyspnea - has acute onset, mixed character, rapidly increased and transmit to asphyxia. Its degree depends on pleural cavity's air volume, the speed of air accumulation, grade of vital lung capacity and ventilation diminish via their compression and mediastenum displacement. The most grave dyspnea assessed in valve type of pneumothorax with total lung's atelectasis.

Chest pain - has a sharp stabbing and knife-like character, localized on the affected side and may radiated to the neck, arm, epigastrium and accentuated by respiratory movement and coughing.

Cough - more commonly reflectors and has dry character via pleural receptors irritation.

Palpitation - has compensatory character due to the gradually increased hypoxia, intrathoracic pressure elevation and mediastenum organs displacement.

Objective examination. General patient's condition is from grave to extremely grave.

The posture of the patients is frequently forced (lying on the affected side) in order to revile the pain via limitation of the pleural layers movement and revile dyspnea via decrease pressure of the air on mediastenum and therefore its displacement.

The color of the skin and visible mucous is characterized by diffuse cyanosis.

Inspection of the chest reveal its asymmetry; enlargement of the affected side with increased distance between umbilicus and median line and from inside edge of scapula to the spine; asymmetry of the clavicles, protrusion and raise in wide of the interspaces. The type of respiration is mixed, affected side falls in breathing act, may be observed tachypnea with rapid shallow breathing.

Palpation of the chest. Elasticity of the chest is decreased (rigid chest), the chest is painful. Vocal fremitus is badly transmitted or absent on the affected side.

Percussion of the lungs. In comparative percussion of the lungs occurs unilateral tympanic or metallic percussion sound. In opened pneumothorax the cracked-pot percussion sound is observed.

In topographic percussion of the lungs is observed unilateral lowering of the lower lung's border with decreased its respiratory mobility.

Auscultation of the lungs. In auscultation of the lungs over affected side the breathing isn't determined or observed decreased vesicular breathing; over the healthy lung - pathologically increased vesicular breathing.

In opened pneumothorax is typical bronchial breathing ("metallic" - the variant of bronchial breathing with loud intensity and high pitch).

In valve type of pneumothorax is typical bronchial breathing with determination of breathing only during inspiration.