Lung hernia
Introduction
Introduction to pulmonary sputum Pulmonary hernia (pulmonary hernia) is a disease in which lung tissue protrudes beyond the chest cavity through local weakness, and its pathogenesis is related to congenital dysplasia and acquired damage. Congenital pulmonary spasm is often accompanied by congenital malformations such as rib or spine deformity, cleft palate, and cleft lip. The site of the fistula includes the neck, mediastinum, chest wall, and diaphragm. The neck and chest wall are the most common, and the symptoms are often inconspicuous. Cold abscess, subcutaneous emphysema and jugular vein tumor. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: intestinal obstruction, abdominal pain
Cause
Cause of pulmonary sputum
Local dysplasia or weakness (28%):
(1) There is a fissure between the sternocleidomast of the neck and the anterior scalene muscle, and the tension of the tip of the lung is high, and the difference in expansion and contraction is large, which may cause local muscle relaxation, especially the Sibsons fascia defect. When weak or torn, the lung tissue can penetrate the neck through this weak fissure, causing the neck to be paralyzed. (2) There is a physiological weak point in the anterior superior part and the posterior part of the mediastinum. When the weakness is obvious or there are other developmental defects (such as lack of one side of the lung), the lung tissue easily protrudes into the mediastinum through this, forming a mediastinal lung fistula. Because the mediastinum is in communication with the neck, the lesion can continue to extend to the neck to form a mediastinal-neck-type pulmonary sputum.
Trauma (30%):
Trauma can lead to chest wall defects and weakness. When the chest or lung pressure is abnormally increased, the lung tissue can break into the intercostal space, leading to chest (intercostal) pulmonary spasm. (1) rib fractures, pleural wall and chest wall muscle tear can cause chest wall defects, weakness or pneumothorax, which in turn causes pulmonary spasm. (2) Local nerve damage caused by trauma, etc., causing local muscle atrophy, decreased tension and formation of pulmonary sputum. (3) improper treatment of pleural wall layer and intercostal tissue damage, such as penile wall penetrating wound with long wound, only suturing the chest wall skin, but not suturing the chest wall muscle and pleural wall layer, which may cause pulmonary fistula.
Increased chest or intrapulmonary pressure (25%):
For example, pneumothorax can promote the lung tissue to be removed from the defect and weak parts.
Genetic factors (15%):
Whether the pulmonary sputum is a dominant genetic disease remains to be confirmed.
Pathogenesis
1. Pathology: The hernia sac of the pulmonary sac is the pleural wall layer, and the internal iliac crest of the neck is the fissure between the sternocleidomast muscle and the anterior scalene muscle. The mediastinum of the mediastinum is the medial anterior pleura. And the lower part of the physiological weakness, the chest wall (intercostal) of the iliac crest is the chest wall injury defect, the sputum content is the lung tissue, and most of them are "sliding type", rarely incarcerated, lung sputum Hours, no significant effect on the physiological functions such as breathing; if the sputum is large, incarceration or compression symptoms may occur, such as large neck and lung sputum compression of the carotid artery and corresponding symptoms.
2. Classification: pathological classification according to the cause of the disease and the location of the lung.
(1) According to the cause classification: there are congenital lung hernia and acquired lung hernia, the latter has traumatic pulmonary hernia, spontaneous pulmonary spasm (spontaneous) Lung hernia) and pathological lung hernia, pathological pulmonary fistula is mostly caused by tumor or infection.
(2) Classification according to the site of occurrence: cervical lung hernia, intercostal lung hernia, diaphragmatic lung hernia and mediastinal lung hernia Among them, the incidence of cervical lung sputum is the highest, accounting for 50% to 60% of the disease.
Prevention
Pulmonary fistula prevention
Without special precautions, early detection and early treatment are the key to prevention. Avoid food that is too greasy and should not be chosen: foods such as fermented bean curd, onion, pepper, and leeks are not conducive to wound healing because they are prone to infection.
Complication
Pulmonary fistula complications Complications, intestinal obstruction, abdominal pain
(1) Intestinal incarceration: Under normal circumstances, the contents of the sputum (usually the intestine) can enter the sac through the ankle ring under the pressure of the abdominal cavity, and can be returned to the abdominal cavity by itself (or by external force). When various reasons (such as friction, adhesion, etc.) make the contents of the reversible sputum suddenly unable to return, and the local lumps increase, it indicates that the intestinal incarceration is concurrent, which is called incarcerated sputum. The clinical manifestations of intestinal obstruction mainly occur after intubation of the intestine.
(2) Intestinal tube strangulation: If the incarcerated sputum persists and cannot be treated and treated in time, the contents of the sputum (mainly the intestinal tract) have blood circulation disorders, and intestinal obstruction, intestinal necrosis, and even intestinal perforation have serious consequences. , and the twisted sputum is concurrent. The clinical manifestations of intestinal narrowing are:
1 paroxysmal, persistent, severe abdominal pain.
2 shock performance such as rapid pulse, shortness of breath, and elevated white blood cell count.
2 peritoneal irritation (local tenderness, rebound tenderness, muscle tension, etc.).
4 The bowel sounds change from hyperthyroidism to weakening or disappearing, and you can smell the sound of gas over water.
5 hematemesis (or bloody fluid), blood in the stool.
6 Abdominal can be seen with obvious swelling, swelling and mass.
7X-ray examination showed that the isolated intestine or small intestine with expanded protrusion in the abdomen changed, the intestinal lumen was widened and increased, and there was peritoneal effusion.
8 do abdominal puncture can draw hemorrhagic fluid.
Symptom
Pulmonary symptoms, common symptoms, dyspnea, carotid pain, hematemesis
The symptoms and signs of pulmonary sputum are related to their location, size and type.
1. When the neck and lungs are small, there is generally no obvious discomfort. Only when the cough and asthma are seen, the soft tissue mass is seen in the neck. When the mass is blocked, the soft tissue block is obvious when the force is applied, and the lung tissue is more likely to appear locally. Feeling of bloating, causing discomfort when turning heads, a few cases of breathing difficulties, and even the corresponding symptoms of compression of the carotid artery, physical examination: concave in the clavicle, neck and soft tissue mass, force, obvious when holding the breath, the mass can be heard Breathing sound.
2, chest wall (intercostal) patients with pulmonary sputum have a history of chest wall injury, usually in the weeks or months after the injury, the main symptoms and signs are the bulging mass of the chest wall injury, the chest wall mass formed by intercostal pulmonary spasm It is characterized by an increase in exhalation, a decrease in inhalation, and no discomfort. It can also cause local pain with local swelling, and it is obvious when coughing and holding breath; the softness of touch can disappear after pressing.
Examine
Pulmonary examination
1. X-ray perspective film inspection:
(1) X-ray fluoroscopy of the neck and lungs, showing that the soft tissue shadow of the neck is connected with the lung tissue of the lung tip. The size of the soft tissue of the neck was significantly positively correlated with the pressure in the thoracic cavity. The soft tissue shadow increased during inhalation, and decreased during exhalation, which showed a regular periodic increase and decrease.
(2) Chest radiographs were taken from the chest, and the bulging mass with enhanced transparency was connected to the lung tissue.
2. CT scan: can clearly display the thoracic, pleural cavity and lung tissue, such as cervical lung fistula CT scan can be found on the cervical vertebrae level of lung texture.
Diagnosis
Diagnosis of pulmonary sputum
In other parts of the lungs, unless there is incarceration, there are generally no obvious symptoms and signs, many patients are occasionally found when examining the body.
1. History: There is a mass in the neck or chest, and the breath changes with deep breathing.
2. Physical examination: the mass is soft, the pressing can disappear, and the local auscultation can smell and breathe.
3. X-ray performance:
(1) Locally see a soft tissue mass containing gas and connected to the lung tissue.
(2) The mass changes with the breathing movement.
(3) Dynamic observation under fluoroscopy can be found that the lung tissue that is extracted can increase and decrease with the pressure in the chest cavity.
Combined with the above medical history, physical signs and imaging characteristics, the diagnosis of this disease is not difficult, but it needs to be differentiated from cystic lymphangioma of the neck (saccular water tumor), chest wall lipoma, subcutaneous emphysema and abscess.
