Foreign matter of a bronchial tube – foreign objects, unintentionally aspirirovanny or got to pneumatic ways via wound channels and recorded at the level of bronchial tubes. The foreign matter of a bronchial tube has an effect pristupoobrazny koklyushepodobny cough, asphyxia, cyanosis of the person, stenotichesky breath, a blood spitting, vomiting, violation of a fonation. The foreign matter in bronchial tubes is distinguished on the basis of the collected anamnesis, a X-ray analysis of lungs, a tomography, a bronchography, a bronkhoskopiya. Removal of a foreign matter from a bronchial tube is carried out by an endoscopic way; at the put foreign matters resort to a bronkhotomiya.
Foreign matter of a bronchial tube
Foreign matters of airways are urgent and very serious problem of otolaryngology and pulmonology. According to clinical data, among all cases of foreign matters of pneumatic ways, foreign matters of a throat meet in 12%, foreign matters of a trachea - in 18%, foreign matters of a bronchial tube – in 70% of observations. Especially often foreign matters of pneumatic ways meet at children's age. 36% fall to the share of foreign matters of bronchial tubes at children; at the same time in a third of observations the age of children makes from 2 to 4 years. In 70% of cases foreign matters get into the right bronchial tube as it is wider and direct.
Foreign matters of a bronchial tube can pose a threat for life therefore they demand urgent specialized intervention. Out of time recognizable and in time not remote foreign matters of bronchial tubes lead to development of secondary complications: atelektaz, aspiration pneumonia, bronkhoektaz, pheumothorax, purulent pleurisy, lung abscess.
Reasons of penetration of a foreign matter into a bronchial tube
Hit of a foreign matter in a bronchial tube can come in the aspiration way (at its inhalation through a mouth, throwing from a gullet and a stomach at a gastro-ezofagealny reflux or vomiting), and also via the wound channel at injuries of a thorax and lung. Penetration of foreign matters is possible when carrying out surgical interventions: tracheotomies, adenotomiya, removals of a foreign matter from a nose, dental manipulations. The aspiration way of hit of foreign matters to bronchial tubes most often occurs among the listed mechanisms.
Aspiration of foreign matters in bronchial tubes is promoted by a habit of children and adults to hold small objects in a mouth. Hit of objects in bronchial tubes comes from an oral cavity during the game, laughter, crying, a conversation, cough, a sudden fright, falling etc. It serves frequent a background for aspiration of foreign matters in bronchial tubes the accompanying rhinitis and adenoidny growths, a condition of an anesthesia.
In character foreign matters of bronchial tubes share on endogenous and exogenous, organic and inorganic. Not taken pieces of fabrics at a tonzillektomiya and an adenotomiya, endoscopic removal of benign tumors of bronchial tubes belong to endogenous foreign matters, the extracted teeth, ascarids.
The most versatile group of finds is made by exogenous foreign matters of bronchial tubes: it can be small objects from metal, synthetic materials, phytogenesis objects. Objects occur among exogenous foreign matters of a bronchial tube as organic (food particles, seeds and grains of plants, nuts, etc.), and inorganic (coins, paper clips, screws, beads, buttons, details of toys and so forth). The greatest aggression and complexity in diagnostics are represented by objects of an organic origin, synthetic materials and fabrics. They are not contrasted at X-ray, can is long to be in a bronchial tube gleam where bulk up, crumble, decay; get into disteel departments of a bronchial tree, causing chronic suppurations of lungs.
The foreign matters of bronchial tubes having a smooth surface are capable to movement, progress to the periphery. Phytogenesis objects (cones of cereals and herbs), on the contrary, put in a wall of a bronchial tube and remain fixed. Cases of single and multiple foreign matters of a bronchial tube meet.
Pathological changes at foreign matters of a bronchial tube
Patomorfologichesky changes in bronchial tubes depend on the sizes, the nature of a foreign matter and time of its stay in airways. In an initial stage there is a generalized bronchospasm, local hyperaemia, swelling and an ulceration mucous a bronchial tube, the ekssudation phenomenon. In later terms around a foreign matter the capsule is formed, granulations with their subsequent scarring expand.
Foreign matters can take various positions in bronchial tubes in view of what different secondary changes of pulmonary fabric are observed. At the balloting foreign matters the gleam of a bronchial tube is blocked not completely, external breath critically is not broken, secondary inflammatory changes in pulmonary fabric moderate.
At valve obstruction of a bronchial tube leaky contact of a foreign matter with bronchial tube walls therefore on a breath air comes to a lung, and on an exhalation, owing to a bronchospasm takes place, cannot come out back. Thus, there is an air delay in pulmonary fabric to development of emphysema easy lower than the place of bronchial obstruction. At full obstruction of a bronchial tube and atelektatichesky pneumonia arises a foreign matter in the underlying not ventilated departments of a lung obturatsionny .
The foreign matter of a bronchial tube always brings with itself an infection that is followed by local inflammatory reaction. Therefore at it is long the existing foreign matters of bronchial tubes not allowed bronchitis, bronchial pneumonia, the deforming bronchitis, bronkhoektaziya, lung abscesses, bronkho-plevro-thoracic fistulas develops.
Symptoms of a foreign matter of a bronchial tube
In clinical symptomatology of foreign matters of a bronchial tube allocate three periods: debut phase, phase of relative compensation of respiratory functions and phase of secondary complications.
Sudden pristupoobrazny cough develops in a debut phase after aspiration of a foreign matter; an aphonia, violation of breath up to asphyxia. The similar picture is sometimes observed at diphtheria, however in this case there is no element of surprise, and pathological symptoms (sore throat, temperature increase, etc.) precede emergence of cough. At a false croup the catarrhal phenomena of the top airways also precede a fit of coughing and suffocation. At benign tumors of a throat the aphonia accrues gradually. Kashlevy attacks quite often are followed by vomiting and cyanosis of the person, reminding cough at whooping cough: it can serve as the reason of diagnostic mistakes, especially when the fact of aspiration "is seen".
Soon after penetration of a foreign matter into the main, share or segmentary bronchial tube, there comes the phase of relative compensation of respiratory function. During this period in view of a partial obturation of a bronchial tube and a bronchospasm at distance the whistling breath - an inspiratory stridor is heard. Moderate short wind, pains in the corresponding half of a thorax is noted.
Further dynamics of pathological process at foreign matters of a bronchial tube depends on expressiveness of the inflammatory changes developing in the site of a lung which is switched off from breath. In a phase of complications there is productive cough with a mucopurulent phlegm, temperature increase of a body, a blood spitting, . The clinical picture is defined by the developed secondary complication. In certain cases foreign matters of bronchial tubes remain unnoticed and are a casual find during operational interventions on lungs.
Diagnostics of a foreign matter of a bronchial tube
Complexity of recognition of foreign matters of bronchial tubes is caused by the fact that the fact of aspiration can be not always noticed. Not specificity of symptomatology often leads to what persons with foreign matters in bronchial tubes is long are treated at the pulmonologist concerning various bronchopulmonary diseases. The basis to suspect existence of a foreign matter in a bronchial tube is ineffectual therapy concerning asthmatic bronchitis, chronic bronchitis and pneumonia, whooping cough, bronchial asthma, etc.
Fizikalny data at foreign matters of a bronchial tube confirm existence of an atelektaz (sharp weakening or lack of breath, obtusion of a perkutorny sound) or emphysemas (perkutorny tone with a box shade, the weakened breath). At survey lag of the struck side of a thorax at breath, participation in the act of breath of auxiliary muscles, a zapadeniye of jugular poles and mezhreberiya etc. pays attention.
In all cases at suspicion on a foreign matter of a bronchial tube the X-ray analysis of lungs is shown. At the same time narrowing of a bronchial tube, local emphysema, , focal infiltration of pulmonary fabric, etc. can come to light. Specification of localization of a foreign matter and the nature of local changes in lungs is made by means of a x-ray or computer tomography, nuclear magnetic resonance, a bronchography.
The most reliable diagnostic method allowing to visualize foreign matters of a bronchial tube is the bronkhoskopiya. Quite often because of expressiveness of local changes the foreign matter does not manage to be found at once. In such cases make removal of granulations, careful sanitation of a bronchial tree (a bronkhoalveolyarny unleavened wheat cake), a course of antibiotic treatment and then repeat endoscopic survey of bronchial tubes.
Treatment of a foreign matter of a bronchial tube
Existence of a foreign matter of a bronchial tube is the indication to its extraction. In most cases it is possible to make endoscopic removal of a foreign matter of a bronchial tube during repeated bronkhoskopiya. At identification in a gleam of a bronchial tube of a foreign matter, carefully bring a bronchoscope tube to it, take a subject nippers and take it.
Metal objects can be taken by means of a magnet; small foreign matters of bronchial tubes – with use of an electrosuction. Then repeatedly enter the bronchoscope for implementation of audit of bronchial tubes regarding leaving of "splinters", wound of walls of a bronchial tube etc. In certain cases removal of foreign matters from bronchial tubes is made through a tracheostoma.
The foreign matters which densely put in a bronchial tube wall are subject to surgical removal in the course of a torakotomiya and a bronkhotomiya. Serve as indications to a bronkhotomiya fixed or driven a foreign matter which cannot be taken without considerable damage of walls of bronchial tubes. Also pass to surgical tactics in case of complications in attempts of endoscopic removal of foreign matters (a rupture of a bronchial tube, bleeding).
Forecast and prevention of foreign matters of a bronchial tube
At timely extraction of a foreign matter of a bronchial tube forecast good. Invalidiziruyushchy and life-threatening diseases can be complications of foreign matters of a bronchial tube – the empiyema of a pleura, fistulas (torakobronkhialny, esophageal and bronchial, bronkho-pleural), pheumothorax, pulmonary bleedings, a rupture of a bronchial tube, purulent mediastinit, etc. In certain cases there can be a death of children from sudden asphyxia.
Preventive measures have to include control from adults of quality of toys and compliance to their age of the child; breaking of children from a habit to take foreign objects in a mouth; explanatory and educational work among the population; respect for care when carrying out medical manipulations.