Secondary pulmonary emphysema can be focal or diffuse.
There are the following forms of focal emphysema: okolorubtsovaya (perifocal), infant (share) paraseptalnaya (interstitial) and unilateral emphysema, lung or lobe.
Around a scar emphysema occurs around the foci of pneumonia, tuberculosis, sarcoidosis. Around a scar emphysemais usually localized in the tops of the lungs. Infant lobar emphysema - is emphysematous change in one lobe of the lung in infants, usually due to atelectasis in other parts. Most affected upper lobe of the left lung and right middle lobe. Infant lobar emphysema is manifested severe shortness of breath. McLeod syndrome (unilateral emphysema) - usually develops in childhood, after suffering a unilateral bronchiolitis or bronchitis.
Paraseptalnaya emphysema - a hotbed of altered lung tissue adjacent to the thickened connective tissue septum or pleura. Usually develops as a result of focal bronchitis or bronchiolitis. Clinically manifest the formation of bullae and spontaneous pneumothorax.
The main cause of diffuse pulmonary emphysema and its development is chronic bronchitis. It is known that the restriction of small bronchi and increased airway resistance occur both during inhalation and exhalation. In addition, the positive expiratory intrathoracic pressure creates additional compression of an already bad traversed the bronchi, which naturally leads to the gradual development of pulmonary emphysema. It is essential to the spread of inflammation to the small bronchi in the respiratory bronchioles and alveoli.
In secondary diffuse emphysema develops precapillary pulmonary hypertension. In turn, pulmonary hypertension contributes to fibrosis functioning of small arteries.
The clinical picture of secondary pulmonary emphysema
Shortness of breath. This is the main complaint of patients. At the beginning of the disease, it occurs only when a significant physical exertion, then the progression of emphysema, becomes permanent. Shortness of breath during the primary emphysema differs from apnea in secondary emphysema. In primary emphysema changing nature of the breathing becomes deep breath and exhale long, through closed lips. Patients tend to increase during the expiratory pressure in the airways, so as you exhale a few cover your mouth and cheeks swell, which reduces the expiratory collapse of small bronchi. This type of breath puffing like.
Cough. Is a characteristic symptom of primarily chronic obstructive bronchitis. Of course, it continues to disturb the patient, and when complicated by chronic bronchitis obstruktivnyi emphysema, hacking cough is unproductive in nature. In the early development of primary diffuse emphysema coughing does not bother the patients. But, with the progression of primary pulmonary emphysema develops chronic bronchitis and a cough.
Color of the skin and visible mucous membranes, the degree of cyanosis. In patients with primary pulmonary emphysema breach of ventilation-perfusion ratio is expressed not so much as the secondary emphysema. The patients developed hyperventilation, which promotes blood arterialization. In this regard, in patients with primary pulmonary emphysema hypercapnia is absent for a long time, the skin and visible mucous membranes pink rather than cyanotic. Patients with primary pulmonary emphysema are called "pink pyhtelschikami." However, as the depletion of the reserve capacity of the respiratory system comes with alveolar hypoventilation with arterial hypoxemia and hypercapnia, there may be marked cyanosis. For patients with secondary pulmonary emphysema (as a complication of chronic bronchitis) is very characteristic of the diffuse cyanosis. He first noted in the distal extremities, followed by disease progression and development of hypercapnia and hypoxemia, apply to face and mucous membranes. In severe hypercapnia in patients with emphysema secondary language appears bluish tinge ("heather" language).
Loss of body weight. In patients with emphysema there is considerable weight loss. Patients with thin, subtle. The marked weight loss associated with large energy consumption for the hard work of respiratory muscles. Participation of the auxiliary respiratory muscles in breathing. On examination, patients can be seen giperfunktsionirovanie auxiliary respiratory muscles, abdominal muscles, upper body and neck. Evaluation of the auxiliary respiratory muscles performed in the supine position and sitting. As the progression of emphysema occurs fatigue of respiratory muscles, patients can not lie (horizontal aperture is hard work), and prefer to sleep sitting up.
Thorax. The chest becomes barrel-like shape, the edges take a horizontal position, their mobility is limited; intercostal spaces widened, dull epigastric angle, shoulder and neck are lifted seems truncated; bulging supraclavicular region.
Percussion and auscultation of the lungs. There is a restriction or complete lack of mobility of the lower pulmonary region, hyper light aircraft cover the heart. A characteristic feature of emphysema is a sharp weakening of the vesicular breath ("padded breath"). The appearance of wheezing is not a characteristic of emphysema, and indicates the presence of chronic bronchitis.
The cardiovascular system. Characterized by a tendency to hypotension, because of this there are dizziness and fainting when standing up from bed. Fainting may occur during coughing due to increased intrathoracic pressure and impaired venous return of blood to the heart. The borders of the heart are determined with difficulty, seem to be reduced. Cardiac sharply muted. In patients with primary pulmonary emphysema chronic pulmonary heart develops much later (usually already in the terminal phase).