Spontaneous pneumothorax

As is known, pneumothorax may be artificial, i.e. treatment, you may receive as a result of injuries and, finally, can be spontaneous, i.e. to occur suddenly with spontaneous penetration of air in the pleural cavity. Spontaneous pneumothorax is a serious complication of some congenital or acquired, but until a certain time clinically manifested lung diseases (often tuberculosis, then emphysema, in particular bullous, congenital and acquired air cysts, tumors of lungs, bronhoektatical disease, heart lung and so on).
The most common form of spontaneous pneumothorax is called idiopathic spontaneous pneumothorax that occur regardless of inflammatory or neoplastic processes in the lungs. It is of great interest to sports doctors. Idiopathic spontaneous pneumothorax occurs in practically healthy people, mainly men, more often than generally assumed that 50 % of all cases of spontaneous pneumothorax. The emergence idiopaticescoe spontaneous pneumothorax contributes natureline and other forms of physical stress, especially when closed, the glottis. Under these conditions occurs on average 15 % of the total number of diseases spontaneous pneumothorax . In these conditions cause pneumothorax may be: 1) the breakdown of the pleura healthy light when there are high intrabronchial pressure during exhalation; 2) the gap pleural adhesions, with breath due to a sharp shift pleura relative to each other; 3) termination of a single bubble alveoli (localized bullous emphysema) in the expiratory phase when the local disorders bronchial obstruction. The last mechanism can lead to the development of spontaneous pneumothorax and at rest.
The disease comes suddenly, in the midst of perfect health. On exertion appear chest pain and shortness of breath. The pain is usually very intense, is pricking or cutting in nature and occurs on the side of pneumothorax, rarely in the abdomen. Appear dry coughing, cyanosis, the degree of which depends on the severity of the disorders of respiration. With significant uteshenie mediastinum in the healthy side there is an insufficiency of blood circulation. The patient may die from suffocation or from acute circulatory failure. It is therefore important to timely diagnosis that determines the appropriate emergency therapy, after which required hospitalization for treatment and the reasons pneumothorax.
Because among sportsmen there are cases of spontaneous pneumothorax, it is important to know the main symptoms of this condition. Diagnosis of spontaneous pneumothorax sometimes is very difficult. However, its timely detection allows you to take appropriate, and sometimes an emergency, measures, as usually there are severe violations of the functions of the respiratory and circulatory and severe systemic reaction.
Differential diagnosis should be performed with angina pectoris (sometimes chest pain), acute appendicitis, perforated gastric ulcer or duodenal ulcer (if localized pain in the abdomen), acute pleurisy, bronchial asthma, etc.,
Athletes suffer spontaneous pneumothorax easier and number of complications in them is less than that of persons not involved in sports, as confirmed by our observations.
Student of the II course M, 22 years old, basketball player of the first category, regularly trains and plays competitions over the last 5 years. Warm-up before the game felt a sharp pain in the left side of the chest. Was called "ambulance", introduced subcutaneously promedol. From hospitalization refused, as was the next day to judge the competition. Only 2 days after x-ray of the chest, was diagnosed left spontaneous pneumothorax, and the athlete was immediately hospitalized. Discharged in satisfactory condition after a week at the urgent request of the patient. On the x-ray of the chest at discharge left lung is not completely straightened, gas bubble at the level of collarbones. The student was liberated from the physical loading to the end of the semester. The conclusion of the TB dispensary in a month after discharge: focal and infiltrative changes, left in the apex of the lung pleura thickened, gas in the pleural cavity not. The student was admitted to practice in 4 months after the beginning of disease. Of anamnestic data are only left dry pleurisy after influenza postponed for six months before this disease. In this case, spontaneous pneumothorax was the result of bullous emphysema. From the beginning of illness prior to admission, i.e. within 2 days, the patient led a normal life: he judged the competition, was at the party, etc., Despite this recovery was swift and disease proceeded without complications.
Master of sport of Nordic combined With 19 years, being at the gathering, held at the height of 3500 m above sea level, was training 3 times a day for 2.5 hours Load endured well. The last day to 2-week gathering suddenly felt a sense of strong compression in the area of the left half of the front of the chest, shortness of breath. Repeatedly took analgin, nurse collection twice a day for 2 consecutive days put banks. Health gradually improved, disturbed only by the feeling of "shocks" in the chest on the left when you walk, and then (when returning from the gathering) in the car. Continued to lead a normal life: bed rest is not complied with, participated in an evening of relaxation. On the 3rd day made the long trip from Karakol to Moscow. In the plane felt satisfactorily. On the same day I went to the doctor and was hospitalized. The radiological survey found that the left lung throughout collaborano. On the 9th day of hospitalization was held pleural puncture, the extracted air. On the 12th day of hospitalization at repeated x-ray examination: easy dealt, free air in the pleural cavity not. No complaints. The health and status during hospitalization satisfactory. Is issued in 2 weeks with a diagnosis of spontaneous left pneumothorax".
Apparently, in this case, too, had bullous emphysema.
Methods of treatment of such patients there are many: from passive tactics of peace and drug maintenance therapy until very radical proposals to make bilateral surgical interventions on the lungs and pleura in all cases without exception. This situation is caused, apparently, different views about the nature of spontaneous pneumothorax and features of its clinical course.
Radical surgical treatment of spontaneous pneumothorax in specialized thoracic departments shown only with frequent relapses and heavy pleuropulmonary complications. If proven tuberculosis nature of spontaneous pneumothorax (which always have to think in the first place), patients should be treated against tuberculosis, if not,in the usual therapeutic hospital.
The prognosis for idiopathic spontaneous pneumothorax, if it is not caused by active tuberculosis or any inflammatory changes in the lungs and uneventful (pyopneumothorax, hemopneumothorax), favorable, and for 3-6 weeks the air is absorbed and easy short shrift. Depending on the General condition and the cause of spontaneous pneumothorax should decide on further sports activities athlete and the deadlines for admission to training. However, physical activity should be limited for at least 3 months. At admission to training for this athlete should be careful medical supervision and very gradually increase the training load.