unilateral emphysema
Introduction
Introduction to unilateral emphysema The narrow definition of unilateral emphysema refers to lung disease in which the lungs can pass more X-rays than normal lung tissue due to congenital lung tissue and abnormal pulmonary circulation. Some people also refer to obstructive or compensatory emphysema, bullous bullae, and gastropulmonary cysts as transparent lungs. This can be understood as a broad category. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications: spontaneous pneumothorax respiratory failure
Cause
Cause of unilateral emphysema
External bronchial compression (10%):
About 7%, there are many reasons for compression of the bronchus, the most common abnormal blood vessels, such as large forbidden arterial catheter, abnormally running pulmonary vein or vagus pulmonary artery (left pulmonary artery originated from the right side), etc., can also be seen in abnormal enlargement The compression of the lymph nodes or parabronchial masses (bronchogenic cysts) causes emphysema in the distal lung tissue of the compressed bronchus.
Endobronchial obstruction (20%):
Can be congenital or acquired, the former includes mucosal folds or localized bronchoconstriction, the latter including mucus plug or granulation tissue, the literature reports: 25% to 40% of the excised specimens can be seen bronchial cartilage defects or deformation, there are still 50 More than % of the cases are unknown, 40% to 50% of infants and young children with other malformations, such as: congenital heart disease, cleft palate.
Abnormal bronchial wall (35%):
About 2/3 of the cases were clear or suspected of bronchial cartilage deficiency or dysplasia, resulting in tracheal collapse, obstruction, and secondary obstructive emphysema of the distal lobe.
(1) Causes of the disease
1. Congenital pulmonary edema has congenital pulmonary dysplasia, but there are also cases of acquired bronchial oppression. Therefore, this disease is also called "neonatal" lobular emphysema or "infant" lobular emphysema. It is called congenital pulmonary edema, which is characterized by excessive swelling of a leaf or a piece of lung tissue, compression of normal lung tissue, mediastinal organs and cardiovascular system, which is one of the common causes of acute respiratory distress in infants and young children. Newborns or young children, 1/3 of cases immediately after birth, 50% occurred 1 month after birth, only 5% occurred 6 months after birth, more male than female, common in the upper lobe of the lungs (to the left upper lobe The most common), followed by the right middle lobe, the lower lobe is rare, the clinical manifestations of single-leaf or unilateral hyaline membrane disease, theoretically abnormal lung parenchyma is a possible cause of the disease, but has not been confirmed, some studies on the resected lung lobe Morphology, showing an increase in the number of alveoli, more than 50% of normal, and alveolar size is normal or increased, the number and structure of the trachea and blood vessels are normal, suggesting that the disease is an enlarged lung vesicle or an abnormal increase in alveolar postnatal.
2. Specific emphysema (Swyer-James syndrome) Swyer and James (1953), first reported as a 6-year-old boy. In 1954, Macleod reported 9 similar patients in adults, so the disease was also Called Macleods syndrome or MSJ syndrome, pathology: mainly manifested as chronic inflammatory changes, no bronchoconstriction, obstructive manifestations, which is different from congenital pulmonary edema; pulmonary artery development, and filling, but smaller, this does not occur with the pulmonary artery Or not developed differently.
(two) pathogenesis
1. There are many causes and pathogenesis of congenital pulmonary edema overexpansion. This disease is considered to be a clinical pathological syndrome. It may be better than a single lesion. The primary lesion may be in the leaf bronchus (resulting in partial obstruction). And secondary expansion) or in the lung parenchyma, the former accounted for about 50%.
2. Specific emphysema is different from congenital pulmonary edema, can be seen in children or adults; can be a leaf or a side of the lung, is an independent syndrome different from other hyaline membrane disease, Swyer believes: The disease is due to a wide range of diseases of the acquired lung leading to right pulmonary dysfunction, the cause is not clear, may be related to viral infection, may also be caused by a congenital or acquired factors.
Prevention
Unilateral emphysema prevention
Keep warm, avoid getting cold and prevent colds. Improve environmental sanitation, protect personal labor, and eliminate and avoid the effects of smoke, dust and irritating gases on the respiratory tract. Avoid colds and prevent cold.
Complication
Unilateral emphysema complications Complications spontaneous pneumothorax respiratory failure
1. Spontaneous pneumothorax spontaneous pneumothorax complicated by obstructive emphysema is not uncommon, mostly due to rupture of the subpleural pulmonary bullae, air leakage into the pleural cavity. If the patient's basic lung function is poor, the pneumothorax is tension, even if the amount of gas is not much, the clinical performance is heavier, and it must be taken carelessly. Patients with emphysema have high lung field transparency, and often have large pulmonary vesicles, and the signs are not typical, which brings certain difficulties to the diagnosis of localized pneumothorax.
2. Respiratory failure Obstructive emphysema is often severely impaired in respiratory function. Ventilation and ventilation are affected by certain causes such as respiratory infection, dry secretion of secretions, inappropriate oxygen therapy, application of intravenous excess, and surgery. Dysfunction is further aggravated and can induce respiratory failure.
Symptom
Symptoms of unilateral emphysema Common symptoms Dyspnea, breath sounds, lung pressure, hair loss, silicosis
1. The symptoms of congenital emphysema are divided into two types: early onset and late onset. Only 5% of patients develop onset 6 months after birth. Half of the patients have respiratory distress in the first month after birth, and few people are asymptomatic. Typical early onset symptoms range from day 4 to weeks after birth. Symptoms progress very rapidly, manifesting as progressive dyspnea, inspiratory and expiratory wheezing, tachycardia, cyanosis, etc. Symmetrical, the thoracic fullness of the affected side, the percussion is unvoiced, the breath sounds weakened, the trachea, the mediastinum is shifted, similar to pneumothorax, the delayed symptoms are repeated respiratory infections, the examination: the affected side of the thoracic bulging, the percussion response is enhanced, the auscultation breath sound Decreased, may smell wheezing or snoring.
2. Specific emphysema can be seen in children and adults, clinical manifestations vary in severity, mild can be asymptomatic, severe cough, cough, dyspnea or repeated respiratory infections and massive hemoptysis, physical examination and congenital lobes The emphysema is similar.
Examine
Unilateral emphysema examination
1. Radiological examination of congenital emphysema can be seen in the upper lobe of the lesion, mainly on the left side, the lower lobe is rare, characterized by increased single-leaf lung translucency, reduced vascular texture, significantly increased leaf volume, adjacent The lungs are compressed, atelectasis, the mediastinum is displaced, the diaphragm is moved down or normal, and the fluoroscopy shows that the mediastinum moves to the affected side when inhaling, and the exhalation shifts to the healthy side. Occasionally, the lung density increases, instead of High transparency, this is because of the liquid emptying disorder secondary to bronchial obstruction, but other radiological features still exist, the liquid can be cleared within 24h to 2 weeks, after which the radiological characteristics (high transparency) recover. X-ray of specific emphysema showed increased lung transfusion brightness, reduced vascular texture of the hilar, bronchography: proximal bronchial filling, small distal end, bronchial volume below 5-6, no fluoroscopy, see fluoroscopy: mediastinal affected side Displacement, the diaphragmatic activity of the affected side is weakened, and the lung volume does not change with respiratory movement.
2. Cardiovascular angiography congenital emphysema can be seen abnormal blood vessels or cardiac malformations, radionuclide lung scan can be seen in the affected area of blood perfusion reduction, bronchoscopy and bronchography to exclude other lesions, pulmonary angiography: the affected side of the pulmonary artery is small, peripheral blood vessels Rare; radionuclide examination: a significant reduction in lung perfusion.
3. Bronchoscopy examination of bronchial mucosa congestion, edema, thickening and other acute, chronic inflammation.
4. Pulmonary function tests suggest ventilatory dysfunction.
Diagnosis
Diagnosis and diagnosis of unilateral emphysema
Combined with clinical manifestations and X-ray examination, the single-leaf lung transillumination is increased, the vascular texture is obviously scattered and thin, and the hyaline membrane disease can be clearly diagnosed. For children with congenital emphysema and older age, bronchoscopy can be performed to exclude the trachea. Internal lesions, an important feature of radiology, are that vascular texture distinguishes between bullae.
Congenital emphysema attention and atelectasis differentiation, pulmonary lobe emphysema and atelectasis, compensatory emphysema difference is the latter side of the diaphragmatic muscle, the mediastinal side shift, the important feature of radiology is single Leaf lung translucency increases, vascular texture is clearly scattered and thin, and can be distinguished from pulmonary bullae according to vascular texture.
