Bronkhostenoz is the pathological state caused by reduction or full closing of a bronchial gleam with a foreign matter, a sdavleniye from the outside of or as a result of volume increase in a wall of body. The clinical picture depends on the reasons of a stenosis and duration of its existence. The main manifestation of sharp process is dry hoarse cough, breath difficulty. The long course of pathology is followed by office of a phlegm, inflammation signs. The diagnosis is established on the basis of anamnestichesky yielded, results of beam and tool methods of a research of a respiratory path. Taking into account the reason of a bronkhostenoz conservative or surgical treatment is appointed.
Bronkhostenoz arises at aspiration of a foreign matter, a number of diseases of bodies of a thorax of the inflammatory and tumoral nature. Congenital narrowing of a bronchial tube meets seldom – experts in the sphere of pulmonology described isolated cases. The full obliteration (atresia) most often meets in large bronchial tubes of the top share of the left lung. This pathology is quite often combined with malformations of a digestive tract, lobarny emphysema. Inhalation of foreign matters usually leads to development of stenoses of average or nizhnedolevy bronchial tubes on the right. Bronkhostenoz arising after aspiration of various objects comes to light mainly at children of younger age (to 60-80% of cases). Clinically significant cicatricial stenoses of large bronchial tubes complicate the course of pulmonary tuberculosis at 6-25% of the diseased.
Reasons of a bronkhostenoz
Violations of development of a membranozny part of airways are the reason of congenital narrowing of bronchial tubes. There is almost full short circuit of cartilaginous rings and formation of a resistant stenosis. The atresia of bronchial tubes presumably results from a pre-natal travmatization of body. Etiologichesky factors of the acquired bronkhostenoz can be divided into two big groups:
- Obturatsionnye. Sharp develops because of hit in pneumatic ways of foreign objects. It can occur at inhalation of a foreign matter, popyorkhivaniya during food, drowning, aspiration of blood or emetic masses. The chronic obturation is formed because of a local thickening of a wall of body. Specific and nonspecific inflammatory process, a tumor of a respiratory path with endobronchial growth can become the reason.
- Compression. Narrowing of a gleam happens because of a bronchial tube sdavleniye from the outside. The compression arises against the background of the external growth of a tumor, an excess of body, cicatricial changes of its wall, increase in intra chest lymph nodes. Pneumatic ways can squeeze aneurisms of large blood vessels and a cyst, including parasitic.
The pathogenesis of a disease depends on an etiologichesky factor and caliber of the affected airways. The full obturation of a bronchial tube a foreign matter leads to emergence of an atelektaz and switches off a part of a lung from participation in the act of breath. At partial filling of a bronchial gleam the foreign subject performs function of the valve, passing air on a breath and creating an obstacle during an exhalation. Emphysema of the pulmonary segment ventilated by this bronchial tube is formed. At damage of bronchial tubes of big caliber there is a sharp respiratory insufficiency.
Long presence of an alien subject, hyper plastic processes of a bronchial wall or its compression lead to violation of drainage function of respiratory ways. In a wall of the struck body chronic inflammatory process with the subsequent atrophy of a mucous membrane and a submucous basis, fibrous regeneration develops. Arises cicatricial . Below the stenozirovanny site bronkhoektaza appear. Violation of mukotsiliarny clearance and hypoventilation provoke an inflammation in the corresponding zone of a lung.
Taking into account an etiology, extent and depth of the stenozirovanny site several classifications of this pathological state are developed. On emergence time stenoses of airways happen congenital and acquired. At direct patomorfologichesky change of a bronchial wall arises primary , at its compression – secondary. Stenozirovany parts of a bronchial tube up to 2 cm long more than 2 cm – extended are considered limited. Distinguish the following extents of violation of bronchial passability:
- I - the bronchial tube is narrowed approximately on a third. Ventilating function remains not in full. There are signs of hypoventilation of the sites of a lung located below.
- II – note considerable (not less, than on two thirds) reduction of diameter of body. There is a violation of ventilation on valvate type. Valve inflation of the corresponding segment, share or the whole lung is observed.
- III – a full obturation of a pneumatic way. Intake of air in alveoluses stops, there is their falling off, develops .
Symptoms of a bronkhostenoz
Expressiveness of clinical manifestations in many respects depends on the reason of narrowing, the sharp or chronic course of pathological process, caliber of the struck pneumatic ways. Congenital often proceeds asymptomatically and it is found at the first preventive radiological inspection. When narrowing or a full obliteration of large bronchial tubes symptoms of congenital defect can be defined since the early childhood. The baby coughs, popyorkhivatsya when feeding. During sucking cyanosis of a nasolabial triangle appears. At the child recur and bronchitis accepts a long current, pneumonia repeatedly comes to light. Lag in physical development is observed.
At a sharp stenosis the sudden attack of hoarse dry ongoing cough is noted. The expressed short wind of the expiratory or mixed type is characteristic of an obturation of large bronchial tubes. Breath is noisy, whistling on an exhalation. The patient prefers to sit or stand as in horizontal position short wind considerably amplifies (). At it is long the existing stenosis cough becomes productive. The mucous or mucopurulent phlegm clears the throat. Sometimes in bronchial separated there is a blood impurity. In badly ventilated part of a lung there are secondary inflammatory processes which are followed by fever, strengthening of cough and symptoms of a general malaise.
The most widespread complications of a bronkhostenoz are bronkhoektaza and pyoinflammatory processes in lungs. Frequent pneumonia and bronchitis lead to cicatricial and dystrophic changes of a respiratory path and chronic respiratory insufficiency. The secondary changes of bronchopulmonary fabric arising against the background of a sharp stenosis of airways depend on properties of an aspirirovanny body. During the drowning or aspiration of emetic masses heavy destructive pneumonia which can end with the death of the patient develop.
Diagnosis of a disease is performed by pulmonologists. During the poll anamnestichesky data are specified. At a fizikalny research the box sound in a projection of valve inflation of the site of a lung is perkutorno defined. At an auskultation characteristic noisy whistle on an exhalation (an expiratory stridor) is listened. The final diagnosis is established after holding the following diagnostic events:
- Rentgendiagnostiki. On roentgenograms of lungs direct and indirect signs of bronchial narrowing are looked through. So, at aspiration in a gleam of a bronchial tube it is possible to reveal the foreign matter differing on contrast from surrounding fabrics. Atelektazirovanny or emphysematous sites of lungs, the deformed bronchial tubes are defined. Results of KT of a thorax and a bronchography confirm existence of bronkhoektaz.
- Bronkhoskopiya. Fibrobronkhoskopiya is carried out for detection and removal of alien objects. On a condition of a wall of a bronchial tube helps to establish the narrowing reason. Bronkhostenoz of an inflammatory etiology is characterized by hyperaemia and hypostasis of a mucous membrane. At a foreign subject in a bronchial tube easily bleeding granulations of bright red color are visible. If a foreign matter aspirirovano long ago, granulations get a whitish-yellow shade. There are certain criteria of existence of a tumor or a cicatricial stenosis in a bronchial gleam.
- Methods of functional diagnostics. The spirometry is an auxiliary method of a research. Gives the chance to specify degree and the nature of malfunction of external breath. Indicators of the maximum volume speed of a stream and peak expiratory volume speed are used for obstruction level assessment.
Bronkhostenoz is not an independent disease, leads other pathological process to its emergence. Therefore patients with a full or partial obturation of any department of a trakheobronkhialny tree often need consultations of other experts. Patients with new growths of a respiratory path go to the oncologist. Patients with tuberculosis of lungs are examined by the phthisiatrician.
Treatment of a bronkhostenoz
Tactics of treatment of stenoziruyushchy processes of airways is defined taking into account the pathology prime cause. Bronkhostenoz of inflammatory genesis well gives in to conservative therapy. Antibacterial medicines, bronchial spasmolytics and expectorant means in combination with an unleavened wheat cake of a bronchial tree, cauterization of granulations, endobronchial introduction of drugs are appointed. Alien objects are removed by means of the bronchoscope. At small benign adenomas of a bronchial tube organ-preserving operations – a bronkhotomiya with removal of a tumor are carried out. At cicatricial stenoses plasticity of bronchial walls is made. Malignant tumors are the indication for a torakotomiya. Depending on the sizes of a new growth the resection of a part of a lung, a forehead - or a pulmonektomiya is carried out.
Forecast and prevention
The forecast during timely removal of an aspirirovanny body favorable. Function of respiratory system is completely restored. After successful treatment it is long the existing stenosis of change in pulmonary fabric remain, however the health and quality of life of the patient considerably improve. Removal of a share or the whole lung allows to prolong life of the oncological patient, but leads to the expressed functional violations and disability. Preventive measures come down to timely identification and treatment of inflammatory processes of bronchopulmonary system, prevention of aspiration of liquids and solid foreign matters.