Valve pneumothorax: causes, symptoms, diagnosis and treatment

With such a disease as valve pneumothorax, oxygen enters the pleural region, the amount of which begins to gradually increase. The manifestation of such a pathology is associated with the peculiarity of the functioning of the valve. His work is disrupted in connection with the penetration into the pleura of air from the lungs and the impossibility of its reverse movement. Because of this, severe pain occurs in the chest area, because a significant decrease in lung volume occurs and the inhalation process becomes more difficult.

This pathological condition has been known for a long time, and it was associated with the consequences of pulmonary tuberculosis. But relatively recently it was found that the disease appears suddenly. Often this pathology is diagnosed if breathing problems are associated with rupture of bulla.

Kinds

Pneumothorax valve is internal and external and depends on the mechanism of formation. The internal appearance of pneumothorax arises from the damage to the large bronchus and the presence of a patchwork wound of the lung. The pleural cavity is filled with air through a defect in the visceral pleura. At the same time, a flap of pulmonary tissue appears in the role of the valve, which allows air to pass through the inhalation, and on expiration it does not allow gas to escape back into the lung.

The external appearance of pneumothorax is characterized by the fact that in the role of the valve in this case the soft tissues of the damaged thorax protrude. At the inhalation of the edge, the wounds begin to expand, the air freely penetrates into the pleural cavity, and with exhalation the hole of the wound recedes without releasing it back.

Causes of the disease

Valve pneumothorax has different causes. Most often it is a traumatic and spontaneous nature of the disease.

The cause of wound (traumatic) pneumothorax is closed trauma of the chest, accompanied by rupture of lung tissue or penetrating chest injury. At the same time, a fast enough "gluing" of a wound opening on the chest wall occurs, while the wound of the bronchus continues to glow. To injuries of this kind include:

• Broken ribs;
• Gunshot and knife wounds of the chest;
• Damage to the bronchus or esophagus by a foreign body;
• falling from height;
• Ruptures of the bronchi, etc.

Spontaneous pneumothorax is characterized by rupture of the altered area of the lung tissue. The following diseases contribute to the development of this pathology:

• tuberculosis;
• Bullous emphysema of the lung;
• Cystic fibrosis;
• Abscess of the lung ;
• Pneumoconiosis and others.

Predisposing factors to the development of spontaneous pneumothorax are coughing, diving, physical stress, etc.

Symptoms

Usually, with valve pneumothorax, the patient is in extremely serious condition. He becomes agitated, there is a pronounced pain in the chest, giving off in the shoulder blade, shoulder, abdominal cavity. Dyspnea, weakness, cyanosis begins to develop rapidly, a loss of consciousness is observed, intercostal spaces widen, the affected side of the chest increases in volume. Rapid surface breathing, arterial hypotension, tachycardia are also signs of valve pneumothorax.

Air, rapidly accumulating in the pleural cavity, is capable of causing cardiac or pulmonary insufficiency, as a result of which death occurs. Late complications of pathology include pleural empyema and reactive pleurisy.

Diagnostics

The doctor, when examining the patient, reveals subcutaneous emphysema, lagging during the breathing of the affected side of the chest, smoothness of the intercostal spaces. With the radiography of the lungs, there is a decrease in the lung and a shift to the healthy side of the shadow of the mediastinum.

Pleural puncture with manometry allows to distinguish open, closed and valve pneumothorax from each other. If liquid is present, aspiration and further examination of pleural effusion on the cellular composition and microflora is performed. To identify the location and size of pleural fistula, conduct diagnostic thoracoscopy and pleuroscopy.

Treatment

First of all, the treatment of valve pneumothorax should be aimed at decompression of the mediastinum and lung, and do it as quickly as possible. To do this, discharge puncture or transthoracic drainage of the pleural cavity is performed with obligatory application of passive drainage in Bülow. Only after carrying out such manipulations the patient is transported to a hospital for further treatment.

To stabilize the patient's condition, he is injected with non-narcotic and narcotic analgesics, cardiovascular drugs, antibiotics, antitussives.

It is very important to move the valve pneumothorax to the closed one. To do this, it is necessary to drain the pleural cavity permanently. If the air stops flowing through the drain, this indicates the sealing of the cavity. The drainage is removed after two days after complete spreading of the lung, if it is confirmed radiologically.

If the lung failed to spread, then the surgical treatment of pneumothorax is performed. Breaking the chest requires suturing the wound and performing thoracotomy. If there is a threat of re-formation of spontaneous valvular pneumothorax, surgical treatment of the underlying disease is used. Depending on the pathology, segmentectomy, bilobectomy, marginal resection of the lung, lobectomy, pleurectomy, pleurodesis and other interventions are performed.

Urgent help with the disease

There are situations where the patient may need urgent help with valve pneumothorax. To save his life, it is necessary:

• To calm a person;
• Provide him with fresh air;
• Urgently call a doctor.

The first help is to puncture the thick needle of the chest wall. Thanks to this, it is possible to quickly reduce the high pressure inside the pleura.

Prophylaxis and prognosis

The complication of valve pneumothorax is shock shock syndrome, pyopneuromotorax, cardiopulmonary insufficiency. Timely medical assistance helps to achieve recovery.

Preventive maintenance of disease is directed on the prevention of a traumatism. In addition, during the preventive examination pulmonologist, phthisiatrist and thoracic surgeon identify patients with pulmonary pathology.

Conclusion

Thus, valve pneumothorax is considered a very dangerous disease, in which untimely assistance is lethal. Therefore, a patient with this pathology should always consult a doctor, and as soon as possible.