Pulmonary infarction

Pulmonary infarction - a disease due to embolism or thrombosis of the pulmonary artery branches (mainly equity and smaller arteries). It is believed that the lung infarction develops in 10-25% of cases of pulmonary embolism (PE).

Etiology, pathogenesis. The disease is most often venous thrombosis systemic circulation (lower extremities, pelvis, iliac, inferior vena cava, and so on. D.), Much less -tromboz right heart cavities. By the development of peripheral phlebothrombosis predispose surgery, post-natal period, chronic heart failure, fractures of long bones, malignancy, prolonged immobilization (eg, bed rest). For pulmonary vascular thrombosis and stasis are slowing of blood flow in the lungs, stable pulmonary hypertension, pulmonary vasculitis. Obturation vessel is accompanied by reflex spasm in the system of the pulmonary arteries, which leads to acute pulmonary hypertension and right heart perezruzke. There are a violation of diffusion and arterial hypoxemia, aggravated by shunting of blood through the unoxidized arteriovenous anastomoses in the lungs and intersystem anastomoses.

lung infarction often occurs against a background of already existing venous congestion and is usually hemorrhagic in nature due to the outpouring of the bronchial arteries in the lung tissue of blood, flowing into by intersystem anastomoses, as well as the return flow of blood from the pulmonary veins. lung infarction formed a day after the obstruction of pulmonary vessels; complete the development of its ends to the 7 th day. In some cases the vessel may cause emboli to incomplete development in the form of focal myocardial apoplexy light and is not accompanied by the irreversible destruction of lung tissue. Infection of pulmonary infarction leads to the development of perifocal pneumonia (bacterial, candidiasis) often with abscess-em; when subpleural location infarction occurs more often hemorrhagic or fibrinous pleurisy.

Symptoms within defined caliber, localization and number of vessels obturated, state compensatory mechanisms, the initial pathology of the lungs and heart. The most common symptoms: the sudden shortness of breath (sudden or effort); chest pain; pallor tinged with ashy skin, rarely cyanosis; tachycardia, cardiac arrhythmias may be in the form of arrhythmia, atrial fibrillation less frequently; hypotension until collapse; symptoms of myocardial hypoxia; cerebral disorders (agitation, the phenomenon of brain edema, focal lesions of the brain associated with hemorrhage, polyneuritis); fever; cough with mucous or bloody sputum; coughing up blood; dullness; diminished breath, pleural friction noise and finely crackles in a limited area; unilateral pleural effusion in the presence of peripheral phlebothrombosis, pulmonary pleural chest pain. Occasionally there is abdominal syndrome, manifested by severe pain in the right upper quadrant, paresis bowel, symptoms of pseudo Shchetkina, Ortner, Pasternatskogo, leukocytosis, persistent hiccups, vomiting, dysgraphia, loose stools (syndrome caused by lesions of the diaphragmatic pleura). Signs of acute pulmonary hypertension and overload of the right heart (increased cardiac impulse, shifting outwards the right heart border, pulsation in the second intercostal space on the left, the focus and the splitting of II tone, systolic murmur in the pulmonary artery, the symptoms of right heart failure) are observed only in the obturation of large trunks of the pulmonary artery .

There are various combinations of the above symptoms, varying degrees of severity, making a diagnosis of pulmonary embolism and pulmonary infarction sometimes difficult. Diagnosis helps: identifying the ECG signs of acute overload of the right heart; X-ray examination, in which the aperture is defined by a one-sided paresis, increased lung root, focal seal any shape zatushevannost of the pulmonary field (often in the field of bone-diaphragmatic sinus), the asymmetry of the shadows and subpleural its location, the presence of effusion without contour. A crucial role in the diagnosis of pulmonary embolism play radioisotope scanning light, selective angiopupmonogra-phy. Prognosis depends on the underlying disease, the magnitude of heart attack.

Treatment. If you suspect a pulmonary embolism immediately administered heparin (15 000-20 000 IU), aminophylline (10 ml of 2.4% solution in / in); It shows the urgent hospitalization. When self-diagnosis used fibrinolytic agents (streptokinase, fibrinolysin) in combination with heparin. Heparin treatment is continued for 7-10 days followed by replacement indirect anticoagulants. In addition, the use aminophylline, reopoligljukin antibiotics.