Lung damage

Lung tissue does not have rich innervation, therefore, if the pleura is not involved in the process, pain in the lungs is not noted even with extensive damage, but pain syndrome can develop due to irritation of the respiratory muscles and pleura when coughing. Physical and radiological symptoms are very clear, especially with the development of hypoxia and respiratory failure.

Lung damage should be diagnosed by doctors of any specialty, although clarifying diagnostics are carried out by therapists, pulmonologists and thoracic surgeons. The most common lung damage is inflammatory diseases: bronchitis and pneumonia, but it is necessary to clarify the concepts. Pneumonia is understood as a large group of purulent (much less often exudative) inflammations of the respiratory parts of the lungs, varying in etiology, pathogenesis and morphological characteristics. Other inflammatory processes are designated by the term "pneumonitis", or they have their own nosological name (tuberculosis, actinomycosis, echinococcosis, pneumoconiosis, etc.). For example, with a closed chest injury, 60% of victims have infiltrative darkening, appearing on the 2nd-3rd day after the injury. But this is a consequence of a bruise and the process has the nature of alterative inflammation, therefore it is defined by the term "traumatic pneumonitis", although against its background, pneumonia can develop on the 5th-7th day. The term “pneumopathy” can only be used by pulmonologists or thoracic surgeons, and even then only until the underlying disease that caused the lung pathology has been clarified (this includes a certain group of syndromes that require special studies, for example, Leffler, Wilson-Mikiti, Hamman-Ritchie, etc.).

Damage to the lungs and bronchi is clinically manifested by the presence of a cough with or without sputum, hemoptysis, attacks of suffocation, rapid breathing, dyspnea with or without exertion, the development of cyanosis of the face, lips, tongue, acrocyanosis, chills, fever, signs of intoxication, if they are not caused by other reasons (but even with them the lungs are always interested, since they bear not only the respiratory load, but also non-respiratory, for example, the removal of toxins, waste products, etc.).

Auscultation normally reveals vesicular breathing, no wheezing. Respiration rate is 16-18 per minute. In case of pathology in the bronchi, breathing becomes harsh, often accompanied by whistling or buzzing wheezing. If the lung tissue is involved, breathing becomes weakened (more often in the apical and basal sections), wheezing is of a large, medium and small bubble or crepitation nature. Breathing is not performed (or tracheal) with a sharp compaction of the lung tissue (atelectasis, pneumosclerosis, pneumofibrosis, pneumocirrhosis or tumor). But it should be remembered that the same is noted in pleural syndrome. Percussion reveals a clear pulmonary sound. In emphysema, tympanitis is detected; with compaction due to infiltration, dullness of percussion sound, up to dullness in atelectasis, pneumofibrosis and cirrhosis or tumor.

In any case, a patient who has lung damage needs to undergo an X-ray examination of the lungs (fluorography, or radiography) and, if there is pathology, he should be consulted by a therapist (preferably a pulmonologist) or a thoracic surgeon, who will prescribe additional studies if necessary.

Edema deserves special attention and requires immediate intervention by a resuscitator.

Edema is a pathological lung lesion caused by abundant plasma leakage into the interstitium and then into the alveoli of the lung. The most common cause is a cardiogenic factor in the development of left ventricular heart failure: ischemic heart disease, arterial hypertension, valvular heart disease, etc. Therefore, it is also defined as cardiopulmonary syndrome. In addition, this lung lesion 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 clinical picture is vivid: the patient assumes a forced semi-sitting position; breathing is sharply accelerated, difficult, gurgling, audible at a distance, while a large amount of foamy sputum is released, often pink; severe and painful suffocation; rapidly increasing cyanosis of the skin, especially of the upper half of the body, and acrocyanosis. Hypoxic syndrome develops very quickly with the formation of hypoxic coma.

General clinical and physical examination are usually sufficient to establish a diagnosis; and radiography and ECG are used for documentation and clarification. Chest radiographs reveal either intense homogeneous 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 blizzard"; with bronchial occlusion, pulmonary atelectasis is formed with homogeneous darkening of the lung tissue with a shift of the mediastinum toward the darkening, especially if the image is taken during inhalation (Westermark symptom); with pulmonary embolism, the darkening has a triangular shadow directed at an acute angle toward the root of the lung.

Due to the development of thoracic surgery, lung damage in most cases is classified as surgical, therefore patients with the identified pathology described below should be hospitalized in specialized departments (thoracic or surgical pulmonology). This primarily includes suppurative lung damage.

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

For an abscess to form in the lung, three conditions must be combined:

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

There are acute purulent abscesses, staphylococcal lung lesions, gangrenous abscesses, and widespread gangrene. Abscesses can be single or multiple. There are 2 phases during the process:

1. formation of a closed abscess;
2. the phase of an opened abscess - into the bronchus (more often with acute and chronic abscesses) or the pleural cavity with the formation of pyopneumothorax (more typical for staphylococcal destruction), or in both directions with the formation of a bronchopleural fistula and pyopneumothorax.

This lung disease occurs mostly in men.

An acute abscess has a typical phased course. Before the abscess opens, the patient is bothered by weakness, remittent or intermittent fever, chills, profuse sweating, persistent cough - dry or with a small amount of mucous sputum, leading to pain in the chest muscles.

Rapid breathing, often with dyspnea, signs of respiratory failure. During physical examination: the affected side of the chest lags in the act of breathing, dullness of percussion sound is revealed, breathing is harsh, sometimes with a bronchial tint, dry and wet wheezing are heard. Radiographs reveal inflammatory infiltration of the lung tissue without clear boundaries, tomograms of the chest show the presence of rarefaction in the infiltration zone. Bronchoscopy reveals a bronchus obstructed by fibrin, and after eliminating the 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 a bronchoscope, is up to 10-12 days.

The transition to the second phase occurs suddenly: a strong cough appears, during which abundant separation of purulent sputum begins, usually a full mouthful, maximally in a postural position (on the healthy side, hanging with the body from the bed). The condition of the patients improves, the fever gradually decreases, the respiratory function is restored. Percussion over the cavity reveals tympanitis, which intensifies when the patient opens the mouth and sticks out the tongue (Wintrich's symptom), the tympanic sound can turn into dullness when the patient changes position (Weil's symptom). Radiographs reveal a round or oval-shaped cavity filled with air and fluid, with a zone of perifocal inflammation, which decreases with treatment. With a favorable course, the abscess scars within 3-4 weeks, if it exists for more than three months, we are talking about a chronic abscess, which is subject to surgical treatment.

Staphylococcal destructive lung disease is mainly observed in childhood. It develops very rapidly, accompanied by intoxication, hypoxia, often hypoxic eclampsia. The cough is persistent with an increasing amount of purulent sputum. Auscultation - breathing is weakened, cacophony of wheezing. On chest radiographs, there is extensive infiltration of the lung tissue, on the 2nd-3rd day from the onset of the disease, multiple cavities are detected, located in the cortical layer of the lung. The pleura is quickly involved in the process with the formation of pleurisy, and on the third day, as a rule, a pleural rupture occurs with the formation of pyopneumothorax.

Gangrenous abscesses and gangrene develop against the background of pneumonia when putrefactive infection microorganisms, mainly Proteus, join the association. The condition of patients is aggravated, intoxication and hypoxia progressively increase.

A distinctive feature is the early abundant flow of foul-smelling (usually with a rag smell) sputum. On radiographs, there is intense darkening of the lung tissue, a cavity, one or more, is formed by the 3rd-5th day, the course is often complicated by purulent pleurisy, pulmonary hemorrhages, sepsis.

Bronchiectatic disease is a non-specific lesion of the lungs and bronchi, accompanied by their expansion and chronic purulent inflammation in them.

The process is secondary, 90-95% of bronchiectasis are acquired, usually developing against the background of chronic bronchitis in childhood and adolescence, mainly the lower lobe bronchi are affected. There are unilateral and bilateral bronchiectasis. In shape, they can be cylindrical, saccular and mixed.

This lung disease develops gradually, often causing exacerbations in spring and autumn, although there is no obvious seasonal dependence, but clear provoking factors are cold and dampness.

The general condition does not change for a long time, the main manifestation is frequent and persistent cough, attacks or constant, at first with a small amount of sputum, then an increasingly larger volume, sometimes up to a liter per day, especially in the morning. The temperature rises periodically, mainly subfebrile, although during exacerbations it can rise to 38-39 degrees.

As the disease progresses, due to increasing chronic hypoxia, pronounced manifestations of the disease develop: the face becomes puffy, cyanotic, acrocyanosis appears, the fingers acquire the appearance of "drumsticks", the nails - "watch glasses". Patients lose weight. The chest acquires a swollen appearance: the ribs protrude, the intercostal spaces are widened, the participation of accessory muscles (shoulder girdle and wings of the nose) in breathing is visible. Breathing is heavy, rapid, there may be shortness of breath. Physical data and chest X-ray in the initial stages do not give significant signs of bronchiectasis. With obvious development of bronchiectasis - a box percussion sound, and in the lower sections it is dulled. Breathing in the upper sections is often harsh, and weakened in the lower ones, wheezing is dry and wet. On radiographs, especially on tomograms, the roots are compacted, the lower lobe bronchi are sluggish. Only contrast bronchography gives a clear picture. Bronchoscopy reveals dilation of the lower lobe bronchi, signs of chronic inflammation in them and the presence of a large amount of sputum.

Due to hypoxia and chronic intoxication, all organs and systems suffer, so the main method of treatment is surgery in specialized departments.

Cysts are lung lesions characterized by intrapulmonary cystic formations of various origins. A distinction is made between true cysts, which form as a result of malformations of small bronchi (they are distinguished by the presence of an epithelial lining), and false cysts as a result of trauma and inflammatory processes (they do not have an epithelial lining), less often echinococcal cysts. They do not have a characteristic clinical picture, they are detected mainly during medical examinations with fluorography or when complications arise (rupture with the formation of spontaneous pneumothorax, suppuration, bleeding). Such lung lesions are treated surgically.

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