Bullae

Introduction to lung bullae Pulmonary bullae refers to bullous emphysema, a localized emphysema. The alveoli are highly inflated, and the alveolar wall ruptures and fuses with each other, usually caused by the occlusion of the small bronchi. At present, most of the alveolar bullae surgery can be performed under video-assisted thoracoscopic surgery (VATS), and 2/3 of the patients have obvious improvement in postoperative symptoms. basic knowledge The proportion of illness: the incidence rate is about 0.01%-0.02% Susceptible people: no special people Mode of infection: non-infectious Complications: spontaneous hemothorax spontaneous pneumothorax

Cause of pulmonary bullae

Cause:

Inflammatory lesions of the trachea: Pulmonary bullae are generally secondary to inflammatory lesions of the bronchioles, such as pneumonia, emphysema, and tuberculosis. Due to inflammatory lesions, the small bronchial mucosa has edema, which causes partial obstruction of the lumen, which produces a valve function. The air can enter the alveoli and is not easily discharged, because the pressure in the alveoli is increased.

Emphysema: secondary to emphysema, often multiple, in addition to large bubbles, often accompanied by most vesicles. The wall of the lung vesicle is very thin and consists of squamous epithelial cells of the alveoli, or it may be only a fibrous membrane. The large bubble is expanding, which can occupy one side of the chest cavity, oppress the adjacent lung tissue, and even push the mediastinum to the opposite side, shaped like a tension pneumothorax. If the pressure in the alveoli is increased, the pleural cavity is ruptured, and the large bubble formed, a part of the wall is composed of the pleura, and the large bubble thus formed is called a subpleural bubble. Some large vesicles have a small volume and often form beaded at the edge of the lungs. They are clinically called pulmonary vesicles and often coexist with huge vesicles. Regardless of the large vesicles, if there is a rupture, a so-called spontaneous pneumothorax is produced.

Lung abscess: pulmonary bullae secondary to pneumonia or lung abscess is more common in infants and young children, there are multiple single and multiple. Secondary to tuberculosis, most of them are single, and there is no obvious emphysema.

Pulmonary bub prevention

1, although the diet has no special requirements, but should increase nutrition, eat more high-quality protein, eat more foods rich in vitamins, eat less irritating food, drink, avoid alcohol and tobacco, to avoid infection.

2, patients and their families are often worried about the cost, surgical efficacy, and even fear of surgery, so careful psychological care during the perioperative period can ease the patient's nervousness and reduce the stress response.

3, pre-operative smoking cessation, deep breathing training, effective cough and expectoration and other respiratory preparations can improve the clearance of secretions, relieve bronchospasm, reduce respiratory secretions.

Pulmonary bullous complications Complications spontaneous hemothorax spontaneous pneumothorax

Spontaneous pneumothorax is the most common complication of bullous bullae, followed by infection and spontaneous blood pneumothorax.

1. Spontaneous pneumothorax: Pulmonary bullae can be free of any symptoms. Sudden exertion, such as severe coughing, sudden increase in pressure during lifting or lifting, pulmonary bullous rupture, gas entering the pleural cavity from the lung, forming a spontaneous pneumothorax When you have difficulty breathing, shortness of breath, palpitation, rapid pulse, etc., the pneumothorax causes the negative pressure in the pleural cavity to disappear, and the gas compresses the lung tissue to collapse toward the hilum. The degree of collapse depends on the amount of gas entering the chest, and The pathological condition of the original lesions of the lung and pleura, the amount of gas entering the chest cavity is large, the original lesion of the lung tissue is light, the compliance is still good, the lung collapses more, sometimes it can reach 90% of the side of the chest cavity, and the gas quickly enters the chest cavity. Rapid atrophy of the lung tissue, the symptoms are severe, and even have blemishes, if the patient has pulmonary emphysema, pulmonary fibrosis, long-term chronic infection of the lung tissue, etc., although some of the gas enters the lung bullous rupture The chest cavity, and the degree of lung tissue collapse can be lighter, but because the patient's original lung function has subsided, the symptoms are also heavier, X-ray can be seen in the compressed lung formed by the pneumothorax line If there is adhesion, the pneumothorax line is irregular. After the bullous rupture, a small part of the rupture is small. After the lung tissue shrinks, the rupture itself closes, the air leak stops, the pleural effusion gradually absorbs, the chest negative pressure recovers, and the lung complex Zhang Yuyu.

2, tension pneumothorax: If the bullae rupture forms a flap, the negative pressure of the chest increases when inhaling, the gas enters the chest cavity, the flap is closed when exhaling, the gas can not be discharged, especially when coughing, the glottis closes the airway pressure When the gas enters the chest cavity, the airway pressure is reduced and the gap is closed. Each breath and cough increases the amount of gas in the chest cavity, forming a tension pneumothorax. When the tension pneumothorax is completely atrophied, the affected lung tissue is completely atrophied. The mediastinum is pushed to the healthy side. When the healthy lung tissue is compressed, the large blood vessels of the heart are displaced. The large veins are distorted and deformed, which affects the blood return, causing serious disturbance of the respiratory cycle. The patient may have difficulty breathing, fast pulse, and blood pressure. Even suffocation, shock, ipsilateral thoracic uplift, more with subcutaneous emphysema on the affected side, the trachea is obviously shifted to the healthy side, the condition is critical, often requiring emergency treatment.

3, spontaneous hemothorax: spontaneous hemothorax caused by bullous bullae, most of the lungs around the tip of the bullae or the bull tissue around the bullae and the top of the chest adhesion and adhesion tear bleeding, the diameter of the small artery in the adhesion zone Up to 0.2cm, the blood vessels originate from the systemic circulation, the pressure is high, and the negative pressure in the thoracic cavity increases the tendency of bleeding. In addition, due to the defibration of the lungs, heart and diaphragm muscles, the blood in the chest cavity does not coagulate. Therefore, bleeding is difficult to stop automatically. The clinical symptoms may vary depending on the speed of bleeding. When the bleeding is slow, the patient may show a progressive increase in chest tightness, difficulty in breathing, X-rays showing blunt angles, or parabolic images of pleural effusions, bleeding. When it is rapid, there may be shock performance in the short term.

4. Spontaneous blood pneumothorax: When the bullae and the surrounding lung tissue and the chest wall are torn apart, if there is a blood vessel rupture in the adhesion zone and the lung tissue is also damaged, a spontaneous blood pneumothorax is formed.

In recent years, some scholars have pointed out that the amplitude of diaphragmatic activity may play a decisive role in the occurrence of spontaneous blood pneumothorax. In the case of vigorous activities such as hernia and exertion, the amplitude of diaphragmatic muscles increases, and the adhesion of the thoracic crest is suddenly or Indirect tension, because the lung tissue is looser than the pleura, it is easy to tear in the lung side to cause blood and pneumothorax that is both bleeding and leaking. If it is avulsed in the wall side or the central segment of the cord, only the blood chest, elongated young The diaphragm muscle activity is relatively large, and the lean and pectoral muscles are more underdeveloped, relying more on abdominal breathing, but the accumulation of fat in the abdominal cavity gradually increases after middle age, which limits the diaphragm muscle activity to varying degrees, so even if the above pathological changes exist, it is very Less onset, women with chest-type respiration, the incidence is low, the right lung is a three-leaf, the leaf gap has a certain buffer effect on the sudden downward pull, and there is still liver under the right lung, may be the right side The cause of less incidence, therefore, spontaneous blood pneumothorax patients are younger, more men than women, the left side is more than the right side, mostly elongated and long body type, bilateral spontaneous pneumothorax also occurs, more Starting on the left, the right side of the hair and in some cases are bilateral simultaneous critical condition, even life-threatening.

5, secondary infection of lung bullae: In most cases, bullous bullae occur in the distal end of the bronchus above the eighth grade, the vast majority are not infected, but if the drainage bronchial blockage, the bullous bronchi is filled with inflammatory secretions Patients may develop symptoms such as fever, cough, and cough. Sometimes, after anti-infective treatment, the clinical symptoms will improve, and the signs of infection on the chest radiograph will continue for a long time.

Pulmonary vesicular symptoms Common symptoms Chest tightness, shortness of breath, difficulty in breathing, chest tightness, suffocation

Small lung vesicles do not cause symptoms themselves. Patients with simple pulmonary blebs often have no symptoms. Some lung vesicles can be changed for many years, some lung vesicles can gradually increase, and lung vesicles increase or are in other parts. There are also new pulmonary bullae, which can cause pulmonary function disorder and gradually appear symptoms. Giant lung bullae can make patients feel chest tightness, shortness of breath, sudden enlargement and rupture of lung bleb, which can produce spontaneous pneumothorax and cause severe breathing difficulties. Chest pain similar to angina can also occur.

Patients with pulmonary bullae often have chronic bronchitis, bronchial asthma, emphysema, and clinical symptoms are mainly caused by these diseases. However, after the formation of pulmonary bullae, clinical symptoms are further aggravated, and secondary infection of the lungs can cause coughing. , cough, chills and fever, cyanosis in severe cases, if the drainage bronchial obstruction, the large cavity of the lung is filled with inflammatory substances, the cavity can disappear, the clinical symptoms may disappear after treatment, and the lungs on the chest Bubble shadows last for weeks or months without regression.

Lung signs are often the manifestations of the original lung disease.

Pulmonary bullae examination

1, chest X-ray examination: is the best way to diagnose bullous bullae, lung tip bullae showed a very thin transparent cavity at the edge of the lung field, can be round, oval or flat rectangular, Different sizes, larger lung bullae, sometimes visible across the interval, multiple lung bullae close together can be multi-faceted, generally not directly connected with the larger bronchus, no liquid level, bronchial contrast can not Into the lung bullae at the bottom of the lungs, often not easy to see on the chest radiograph, some can be completely below the dome level, and some are only partially above the dome, the lung bullae wall is not shown as Coherent ring-shaped shadows are easily mistaken for top-of-the-line pleural adhesions. Giant lung bullae generally have tension, and there may be a layer of compulsive atelectasis around them, making the blister wall appear thicker and close to the chest wall. The nearby lungs are pushed to cause partial atelectasis, the lungs are gathered, the brightness is reduced, and the bullae can fuse with each other to form a large bullae that looks like a localized pneumothorax. The bullae can also rupture. A limited pneumothorax is produced.

2, fluoroscopy and expiratory chest X-ray: help to find bullae, due to gas retention during exhalation, the lung bubble volume appears relatively enlarged, the edge is more clear, the fault to clear the outline of the lung bubble and display the surrounding lung tissue The compression and displacement are also helpful, and when the lobular emphysema is present, the tomogram can also show abnormalities in the shape of the pulmonary vessels.

3, CT examination: can be found under the pleura is not easy to show the common chest X-ray bullae with a diameter of less than 1cm.

4, pulmonary angiography: can accurately show the extent of pulmonary vascular damage, as well as the compression of blood vessels around the lung bubble.

Diagnosis and identification of pulmonary bullae

Differential diagnosis

Pulmonary bullae and pulmonary vesicles and pulmonary cysts are similar because of their similar clinical manifestations, and are strictly confused as follows:

Lung vesicle (bleb)

After the alveolar rupture, the air enters the pleural space of the visceral layer, forming a bleb, also known as the subpleural pulmonary vesicle, which is an extra-alveolar air cavity between the visceral pleura and the lung parenchyma, not strictly speaking. Large lungs. The general characteristics of pulmonary vesicles are: their size is miliary to 3-100px, the outer wall is composed of visceral pleura, usually multiple, and the basal lung tissue is basically normal. Mostly located at the tip of the upper lung, it can also be distributed along the upper edge of the dorsal segment of the lower lung or the edge of any lung. Because of the poor stretchability of the visceral pleura, this type of lung blister can not expand very much, and it is easy to develop into a spontaneous pneumothorax.

Pulmonary cyst (cyst)

Refers to an abnormal balloon-containing cavity located in normal lung tissue, which may be a congenital bronchogenic cyst (bronchogenic cyst) or an acquired cyst. The former is a congenital balloon-containing cavity of non-emphysema, which is a structure in which cells are separated from the laryngotracheal groove during abnormal embryonic development. The cyst is located in the lung or mediastinum, and is covered with a ciliated columnar airway epithelium containing bronchial glands, connective tissue, smooth muscle, cartilage, and the like. The acquired cyst is a thin-walled air cavity that is secondary to the trauma or infection of the lung. It may be due to the formation of a small bronchus flap after trauma, which causes the distal lung tissue to swell and fuse into a cavity, or because of the bronchial wall. Caused by inflammatory necrosis.

Substantial lung bullous (bulla)

An abnormally enlarged air cavity of more than 25px diameter formed in the lung parenchyma may be secondary to emphysema. There is not necessarily a curved line on the chest radiograph that clearly demarcates from the surrounding lung tissue. The most common in the upper lung field, the air cavity of the large lung bubble is covered by a film composed of the visceral pleura, connective tissue and transverse small blood vessels. The walls of the pulmonary bullae are formed by structurally disrupted lung tissue.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.