Pneumotorace
Table of Contents
Definizione
Lopneumotoraceè una patologia piuttosto frequente, ha una distribuzione per età che non conosce frammentazione per cui è tanto frequente nelgiovane quanto nell’adulto,soprattutto se quest’ultimo è affetto daBPCOoppure da patologia degenerativa degli epiteli come l’enfisema bolloso.Lo pneumotorace è lapresenza d’ aria tra i due foglietti pleurici,quella parietale e quello viscerale. Tra i due foglietti pleurici vi è un’ esigua quantità di liquido fisiologico; in condizioni patologiche, o per versamento o per pneumotorace, i polmoni risultano compressi, schiacciati.
Classificazione
• Pneumotorace spontaneo(primitivo e secondari)
• Pneumotorace traumatico
• Pneumotorace iatrogeno
Differenze principali tra questi tre tipi:
Pneumotorace spontaneo
Lo pneumotorace spontaneo insorge spontaneamente, lo dice la stessa parola, senza,apparentemente,una causa evidente. Una condizione piuttosto frequente nei soggetti di sesso maschile (4:1 maschi-femmine), soprattutto se si tratta di soggetti longilinei, che praticano attività sportiva. Può manifestarsi per una condizionecongenita, bollosa, caratterizzata dalla presenza di micro bolle sulla superficie, che per un’ aumentata pressione al loro interno dovuta a sforzi improvvisi o per sforzi relativamente banali, come allacciarsi le scarpe, possono provocare la rottura di queste bolle e quindi uno Pnx spontaneo. Il secondo è determinato da patologie polmonari, tra le quali, l’enfisema polmonare.
Pneumotorace traumatico
Se una determinata forza agisce sui polmoni, sui bronchi, sull’ esofago e sulla parete toracica, per esempio incidente stradale, colluttazione, ferita da arma da fuoco. A causa del trauma, tra il polmone e la parete toracica, si accumula aria che provoca il collasso totale o parziale del polmone.
Il soggetto accusadolore toracico e difficoltàrespiratoria.
Di solito viene eseguita una radiografia del torace e inserito nel torace un catetere ( drenaggio toracostomico) per rimuovere l’aria e dare la possibilità al polmone di espandersi.
Pneumotorace iatrogeno
Le cause di uno pnx toracico c possono essere:
• pneumocentesi
•agobiopsia transparietale
• procedure legate all’ incannulamento di vasi centrali, come la succlavia.
Dolore caratteristico a esordio improvviso, trafittivo, tipo una coltellata.
Il polmone non si espande per come dovrebbe, potrà esserci nelle fasi più avanzate un’ insufficienza respiratoria, con cianosi, e soprattutto una sub-cianosi a livello delle labbra. Può essere presente un enfisema sottocutaneo.
• Dispnea
• Ipossia
• Tachicardia
• Vertigini
Se lo pneumotorace è parziale, ovvero se soltanto una piccola quantità di aria è entrata all’interno del cavo pleurico, il polmone continuerà a respirare e la sensazione di affaticamento respiratorio sarà più o meno intensa.
La diagnosi è clinica e strumentale. Richiede l’esecuzione di unaradiografia toracica; questo esame consente di evidenziare l’entità del problema e il grado di gravità del collasso polmonare.
La prima manovra da effettuare è ilripristino del cavo pleurico,posizionando il drenaggio.Viene utilizzato untubo di drenaggiocollegato a una valvola unidirezionale, inserito all’interno del cavo pleurico per aspirare tutta l’aria in esso contenuta. La percentuale di rischio di nuovo episodio aumenta a ogni evento successivo per cui di norma si interviene interviene chirurgicamente dopo il secondo episodio. L’intervento chirurgicoconsiste nell’asportare la zona di polmone occupata dalle bolle d’aria, in genere molto piccola, la cui rottura ha causato la fuoriuscita dell’aria.
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