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Lung contusion: symptoms and treatment. Lung contusion: signs, diagnosis and treatment

– lung injuries accompanied by anatomical or functional disorders. Lung injuries vary in etiology, severity, clinical manifestations and consequences. Typical signs lung injuries serve sharp pain in the chest, subcutaneous emphysema, shortness of breath, hemoptysis, pulmonary or intrapleural bleeding. Lung injuries are diagnosed using chest x-ray, tomography, bronchoscopy, pleural puncture, and diagnostic thoracoscopy. Tactics for eliminating lung damage vary from conservative measures (blockades, physiotherapy, exercise therapy) to surgical intervention(suturing the wound, resection of the lung, etc.).

Lung rupture includes injuries accompanied by injury to the pulmonary parenchyma and visceral pleura. “Companions” of a lung rupture are pneumothorax, hemothorax, cough with bloody sputum, and subcutaneous emphysema. A bronchial rupture may indicate state of shock patient, subcutaneous and mediastinal emphysema, hemoptysis, tension pneumothorax, severe respiratory failure.

Open lung injuries

The uniqueness of the clinic open damage lungs is caused by bleeding, pneumothorax (closed, open, valve) and subcutaneous emphysema. Blood loss results in pale skin, cold sweat, tachycardia, drop in blood pressure. Signs respiratory failure symptoms caused by lung collapse include difficulty breathing, cyanosis, and pleuropulmonary shock. At open pneumothorax During breathing, air enters and leaves the pleural cavity with a characteristic “squelching” sound.

Traumatic emphysema develops as a result of air infiltration of the periwound subcutaneous tissue. It is recognized by a characteristic crunch that occurs when pressure is applied to the skin, an increase in the volume of soft tissues of the face, neck, chest, and sometimes the entire torso. Particularly dangerous is the penetration of air into the mediastinal tissue, which can cause compression mediastinal syndrome, deep respiratory and circulatory disorders.

In the late period, penetrating lung injury complicated by suppuration of the wound canal, bronchial fistulas, pleural empyema, pulmonary abscess, gangrene of the lung. The death of patients can occur from acute blood loss, asphyxia and infectious complications.

Ventilator-induced lung injury

Barotrauma in intubated patients occurs due to rupture of lung or bronchi tissue during mechanical ventilation with high pressure. This condition may be accompanied by the development of subcutaneous emphysema, pneumothorax, lung collapse, mediastinal emphysema, air embolism and threat to the patient’s life.

The mechanism of volumotrauma is based not on rupture, but on hyperextension lung tissue, entailing an increase in the permeability of alveolar-capillary membranes with the occurrence of non-cardiogenic pulmonary edema. Atelectotrauma is the result of impaired evacuation of bronchial secretions, as well as secondary inflammatory processes. Due to a decrease in the elastic properties of the lungs, on exhalation, the alveoli collapse, and on inhalation, they become unstuck. The consequences of such lung damage can be alveolitis, necrotizing bronchiolitis and other pneumopathy.

Biotrauma is damage to the lungs caused by increased production of systemic factors inflammatory reaction. Biotrauma can occur with sepsis, disseminated intravascular coagulation syndrome, traumatic shock, long-term compartment syndrome and others severe conditions. The release of these substances not only damages the lungs, but also causes multiple organ failure.

Radiation damage to the lungs

Depending on the severity of respiratory disorders, there are 4 degrees of severity of radiation damage to the lungs:

1 - a slight dry cough or shortness of breath on exertion is bothering you;

2 – a constant hacking cough is bothering you, the relief of which requires the use of antitussive drugs; shortness of breath occurs with slight exertion;

3 – a debilitating cough is bothersome, which is not relieved by antitussive drugs, shortness of breath is pronounced at rest, the patient requires periodic oxygen support and the use of glucocorticosteroids;

4 – severe respiratory failure develops, requiring constant oxygen therapy or mechanical ventilation.

Diagnostics

Possible lung injury may indicate external signs injuries: the presence of hematomas, wounds in the chest area, external bleeding, air suction through the wound channel, etc. Physical data vary depending on the type of injury, but most often a weakening of breathing is determined on the side of the affected lung.

To correctly assess the nature of the damage, a chest x-ray in two projections is required. X-ray examination allows you to identify mediastinal displacement and lung collapse (with hemo- and pneumothorax), spotty focal shadows and atelectasis (with lung contusions), pneumatocele (with rupture of small bronchi), mediastinal emphysema (with rupture of large bronchi) and others characteristic features various lung injuries. If the patient's condition and technical capabilities allow, it is advisable to clarify the X-ray data using computed tomography.

For lung contusions, it is usually limited conservative treatment: adequate pain relief is performed (analgesics, alcohol-novocaine blockades), bronchoscopic sanitation respiratory tract to remove phlegm and blood, breathing exercises are recommended. In order to prevent suppurative complications, antibiotic therapy is prescribed. Physiotherapeutic methods are used to quickly resolve ecchymoses and hematomas.

In case of lung injuries accompanied by the occurrence of hemopneumothorax, priority is aspiration of air/blood and expansion of the lung through therapeutic thoracentesis or drainage of the pleural cavity. If the bronchi and large vessels are damaged and the lung collapse persists, a thoracotomy with revision of the thoracic cavity organs is indicated. The further scope of intervention depends on the nature of the lung damage. Superficial wounds located on the periphery of the lung may be

Literature

1. Traumatic rupture of the main bronchus/Petukhov V.I.//News of surgery. – 2008 – T.16, No. 1.

3. Surgery of breast injuries / Wagner E.A. – 1981.

A lung contusion is a closed injury to the soft tissues of the chest, which has some consequences. At the time of injury, hemorrhage develops in the lung tissue, blood vessels and bronchi are damaged. At the same time, the pleura, the natural shell of the organ, retains its integrity. Rarely, the formation of air or blood-filled cavities in the organ itself can occur.

Probable causes of injury

Closed injury occurs as a result of physical external influence- impact, compression, concussion, etc. The severity of the pathology depends on the level of damage to the blood vessels and bronchi. The most common cause of this type of injury is a traffic accident, especially for drivers. During sudden braking, the driver falls with his chest on the steering wheel. In addition, the cause may be an unsuccessful fall on a blunt object or a fall from a great height.

In other words, the obvious circumstances under which a lung contusion can occur are:

falling from height;
car accident;
a strong directed blow to the chest area;
blow with a blunt object.

It is not always possible to prevent such situations, just like wearing soft breast pads - you will look stupid. That is why, if an injury occurs, it is necessary to seek specialized help.

Clinical picture

It is not always possible to diagnose lung injury due to the fact that a bruise often accompanies more serious injuries chest - fracture of the ribs or chest, disturbances in the functioning of the heart.

Lung injury is divided into three types: mild degree, medium and heavy. The severity of the damage will depend further treatment pathology.

Early stages of injury are hidden under primary signs other injuries to the victim’s chest. Characteristic clinical symptoms appear after some time.

Symptoms of the resulting damage are as follows:

pronounced edema forms, soft fabrics breasts become very swollen;
it is not possible to palpate - the victim experiences pain;
aching pain that gets worse with breathing;
breathing is shallow, frequent and gusty - the victim feels that he is suffocating;
moist rales in the lungs;
severe shortness of breath;
tachycardia - increased heart rate;
high blood pressure;
hematoma or bruise at the site of injury;
severe state of shock;
sputum with blood during coughing.

Important! Having diagnosed a concomitant injury, a possible pulmonary contusion should not be ruled out. Its signs may appear several hours after the injury has occurred.

Diagnosis of pathology

The danger of such an injury lies in late detection. That is why additional complications may develop, which can be avoided by providing timely and correct therapy. The doctor must not only examine the victim, but also prescribe everything necessary examinations to establish an accurate diagnosis.

External examination reveals severe hemorrhage and extensive tissue swelling. The victim is interviewed: when and under what circumstances the injury occurred. The doctor performs auscultation - listening to the damaged lung. To do this, you can use a stethoscope, a special tool, or simply apply your ear to the bruise. The lungs exhibit moist rales, which may sound like bursting air bubbles. Simple examination and palpation is not enough to make a diagnosis, so more in-depth studies are carried out.

Modern medicine to establish a diagnosis of “pulmonary contusion” practices the following: diagnostic methods How:

Ultrasound, or ultrasound examination, which detects a positive shadow in the echo image;
X-ray examination - pictures are taken in several projections to exclude other types of injuries. On the images, the lungs will be polymorphically darkened at the site of damage. Various hematomas and capsules filled with air are clearly visible. This phenomenon is called “pneumatocele”;
the fiberoptic bronchoscopy method is used to detect internal edema mucous surfaces of the bronchi, determining the fullness of the lung tissue with blood - hyperemia. The accumulation of blood in the lumens of the bronchial network is also determined.

Important! Only timely diagnosis and treatment will help get rid of the bruise without consequences.

Urgent Care

The damage manifests itself much later after the moment of receipt, so it is not possible to provide assistance immediately. The basics of first aid for bruises, however, are not very different from the procedure for any other injury. Therefore, if a bruise accompanies a fracture or crack, then the first aid provided will be comprehensive.

How competently first aid is performed is a guarantee of the victim’s further recovery. To the main actions to provide urgent assistance The following points include:

Cold compress.

An effective method to reduce and relieve swelling, as well as local anesthesia. In addition, cold constricts blood vessels and prevents hemorrhages.

Cold is a kind of panacea for bruises and traumatic injuries. Dry ice used in hospitals may not always be on hand, or just ice that can be stored in the refrigerator. Therefore you can use plastic bottle With cold water. If there is no alternative, you can use frozen semi-finished products - cutlets or dumplings.

You can apply the compress for no longer than 15 minutes, after which you need to take a break for 20 minutes and apply ice again. The procedure should be repeated the first day after the injury.

Important! The cold object must be placed in soft tissue to avoid complications in the form of frostbite.

Immobilization.

Despite the fact that the chest is damaged, the victim must take a position of complete rest. In this case, it is necessary to carefully monitor the absence of even the slightest movements. This is dangerous because if the bruise accompanies a displaced fracture, bone fragments can dig in and cut internal organs.

Medicines.

It is strictly forbidden to give any painkillers or anti-inflammatory drugs. Their use can seriously complicate subsequent treatment of a bruise, as well as making an erroneous diagnosis.

If the victim exhibits acute symptom- cough with blood, then he should be hospitalized immediately. The hospital will provide him with timely and correct treatment.

Sputum with blood may be evidence internal bleeding, which can only be stopped with the help of surgical intervention.

It is very important not to touch the damaged area, reducing contact with clothing. There is no need to heat or rub the injured area, this will increase swelling and spur inflammation in the tissues.

Therapeutic therapy for lung contusion

Treatment depends entirely on the severity of the injury, as well as what symptoms appear. The main goal of therapy is to prevent pneumonia from developing and stop pulmonary hemorrhage.

Mild bruises practically do not show dangerous symptoms, so all therapy is aimed at relieving pain. It is necessary to maintain complete rest and use painkillers. The pain usually goes away after a week or a little more, depending on the body's recovery ability. However, even with minor injury There may be consequences such as difficulty breathing, as well as expiratory shortness of breath.

Severe degree, characterizing severe bruise, comes down to anti-inflammatory drug therapy. In order to prevent concomitant pneumonia, antibiotics are prescribed intramuscularly.

Important! Pneumonia as a result of a bruise often leads to death, that is, the death of a person.

Since breathing is also very difficult due to sputum in the lungs, sanitation bronchoscopy is used - suction of sputum and blood from the bronchi.

As rehabilitation during the recovery period, physiotherapy is prescribed, aimed at relieving inflammation and resolving hematomas. In addition, you should be aware that extensive hematomas formed by blood clots in soft tissues can develop into a pathology that causes tissue necrosis.

In addition, during the rehabilitation period it is prescribed physiotherapy. The set of classes mainly consists of breathing training by performing various exercises. However breathing exercises can be performed only after complete recovery of the lungs. It is recommended to additionally take long walks on foot. Coniferous air has a good effect on the restoration of the respiratory system.

Complications after injury

Like any other pathology, bruise has a number of various complications. One of the most dangerous is post-traumatic pneumonia. Pneumonia develops rapidly, often leading to death. However, cases fatal outcome They happen quite rarely, since timely treatment is provided.

If you move carelessly immediately after an injury, especially if the bruise is accompanied by a displaced fracture, the damaged lung is punctured by fragments of rib bones. Internal bleeding develops.

In most cases, with proper care, the damage goes away within two weeks. The prognosis for treatment of such injuries is only favorable. The most important thing is to seek help in time.

The human body is a huge assembly of interconnected mechanisms. As soon as any node fails, a breakdown immediately occurs in its work, and the state of health worsens. There is no one vital organ in the body; they are all equal in importance and priority of their functions.

Great value for work human body plays respiratory system, which supplies oxygen to all tissues and organs. When the respiratory organs are damaged, the entire body suffers. The most common injury to the respiratory system is lung contusion.

Causes

More often this injury occurs as a result of damage associated with the impact of objects on the body, i.e. under the influence of force, a shock and pressure is created on chest and as a result, compression and injury to the respiratory organs occurs. Lung contusion characterized by the integrity of the shell. The organ consists of lung tissue, through the bottom there are pulmonary arteries, veins, main bronchi, etc. In case of a bruise, a cavity with blood or air may form.

Bruise most often occurs as a result of:

work injury;
road traffic accident;
falling from a height;
outdoor games;
playing sports, etc.

A lung contusion that occurs as a result of an accident occurs mainly from the impact of the chest on the steering wheel of a car. Lung contusion in children is most often observed during outdoor games and when falling.

Signs of a lung contusion

Important symptoms of injury:

localization of pain at the site of the blow;
increase pain during take a deep breath and changes in body position;
there is blood in the sputum;
color change skin(a bluish tint appears);
shortness of breath or rapid breathing;
change in heart rate;
wet rales;
bruises, hemorrhages, swelling and swelling.

Signs of injury may not appear immediately, but after several days, so if you receive a blow to the chest, you should contact a pulmonologist to identify and prescribe symptoms and treat accordingly.

First aid

Providing first aid consists of ensuring immobility for the victim. The use of painkillers is prohibited, because the clinical picture may be disrupted.

It is necessary to apply cold to the site of injury without tightening the affected area with a tight bandage. After the event, you must call medical staff and transport the victim to the hospital.

Diagnostic methods

During the examination, the doctor will conduct a survey, palpation and listening, in order to confirm and clarify the final diagnosis. In case of unclear listening, additional examinations are prescribed.

Methods for diagnosing a bruise:

ultrasound examination;
radiography;
fiberoptic bronchoscopy method.

Treatment

A lung contusion is diagnosed after a visual examination by a specialist and therapy is prescribed. Treatment for a lung contusion is usually carried out using the following methods:

antibacterial therapy;
maintaining complete peace;
removal of sputum using a special device;
incentive spirometry.

In more difficult cases held artificial ventilation lung In the lung area there are many nerve endings, so such injuries are very painful. During treatment, pain medication is prescribed.

Rehabilitation

Restoring respiratory function requires special attention. To eliminate the inflammatory process, physiotherapeutic measures are prescribed. Further procedures are carried out only by the victim and the result of recovery depends only on the exact implementation of:

breathing exercises;
daily walks outside, best spent in a pine forest;
restrictions on physical activity.

During the flow recovery period It is possible to visit a sanatorium whose profile is the treatment of diseases of the respiratory system.

It should be noted that a lung injury accompanied by multiple injuries cannot be independently identified and treated, because There are a lot of deviations that only a specialist can identify.

Consequences

The consequences of lung damage are quite serious, since there is a possibility hidden current inflammatory process in the patient. Often the symptoms of a bruise may not be noticeable, which entails untimely treatment injuries. A patient who does not start treatment on time experiences respiratory failure, which leads to hypoxia (lack of oxygen).

A lung contusion is easily diagnosed and treated if detected early. If you delay visiting a doctor, various consequences may occur, such as post-traumatic pneumonia, which can lead to the death of the victim. However, upon receiving a competent and timely treatment the prerequisites for recovery are always positive.

Which is characterized by a violation of the integrity of the lung parenchyma, as a result of which air from external environment enters the cavity between the layers of the pleura, the pressure of the cavity is balanced with atmospheric pressure, which leads to collapse damaged lung and disruption of gas exchange function.

Pathological changes in lung rupture

Normally, there is negative pressure in the pleural cavity, under the influence of which air enters the lungs from environment. The difference in indicators is main reason through which we breathe. Gas exchange is also provided by the intercostal muscles, diaphragm and abdominal muscles.

When the lung is damaged, the alveoli and bronchi rupture, and air flows freely between the layers of the pleural cavity. Diaphragm, chest muscles, abdominal wall unable to maintain normal breathing.

The lung collapses, that is, it becomes smaller in volume, as a result of which less oxygen enters the body and less is excreted carbon dioxide, respiratory system develops. It is this condition that is dangerous for the patient’s life, especially if there is a negative dynamics of the increase in symptoms.

Reasons for the formation of a lung rupture

Lung rupture can occur even in a state of complete rest, provided that the patient has had pathological changes from the lungs. However, traumatic rupture is more common.

Pneumothorax is identified. It develops against the background of absolute lung health. The reasons are:

Injury to the lung parenchyma by a bone fragment of a broken rib as a result of various injuries
For penetrating puncture wounds of the pleural cavity and lung acute an object from outside
With compression of the chest during an accident, building collapse, fall from a great height

Secondary pneumothorax. This pathological condition a consequence of previous lung diseases, often chronic:

Clinical manifestations of lung rupture

The pathological process doesn't happen locally. It involves not only the affected lung, but also healthy heart, all internal organs suffer from a lack of oxygen saturation in the blood. Respiratory failure develops. Also, the symptoms depend on the reasons that caused the lung rupture.

The main symptoms observed in all cases:

Pain during lung rupture. In most cases, patients give a clear description of the pain: sharp on the affected side, radiating to the shoulder on the affected side.
Shortness of breath, even at rest, increased breathing movements per minute, tachycardia (increased heart rate).
Cough as a reflex manifestation of irritation of receptors on the pleura.
When examining the chest, you may notice a delay in movement on the affected side.

The clinical picture of respiratory failure due to lung rupture will vary depending on several criteria:

Area of lung rupture.
Location of damage, relationship with bronchi and vessels.
Severity of pneumothorax. The most dangerous is the valve one. As a result of damage, a valve is formed - air leaks into the pleural cavity, but at the exit the valve prevents it. This condition threatens the rapid development of respiratory failure, lung collapse, and a shift in vital signs. important organs mediastinum to the side and squeezing them.

Clinical features for secondary lung ruptures:

At traumatic injury lung with ribs, the above symptoms will be accompanied by bleeding from the vessels supplying the lung and ribs, damage to the frame of the chest cavity and vital organs. This condition can be complicated by shock.
Pulmonary bullae have asymptomatic. They do not cause any discomfort until any force is applied to the chest. In case of injury, physical activity bullae may rupture with symptoms of pneumothorax.
An abscess always gives a clear clinical picture. Temperature rises to 39-40 degrees, with copious sputum discharge. When does an abscess rupture? pleural cavity, the patient experiences relief for a while, but during the formation purulent pleurisy the condition worsens sharply.
Cancer patients may not experience much pain syndrome due to exhaustion of the body, intoxication and ongoing pain therapy. Therefore, their condition can be monitored from objective data: breathing rate, pulse, skin color. If the condition worsens: increased heart rate, pulse, cyanosis (blueness) of the skin, you should consult a doctor for help.
lung - a state with bright clinical picture. Sharply increasing shortness of breath, cough with bloody sputum, severe pain, sallow complexion. People with blood clots in the veins of the lower extremities are prone to thromboembolism.