EMPHYSEMA (Greek emphysema swelling) — stretching of body or fabric air or the gas formed in fabrics. Distinguish emphysema of lungs, hypodermic, mediastinal, fabric emphysema.
Emphysema of lungs proceeds in the form of two main forms differing on the nature of defeat of pulmonary fabric: vesicular (actually emphysemas), characterized by changes of interalveolar partitions and expansion of alveoluses. and intersticial, representing accumulation of air traps in interstitial tissue of a lung. Also other seldom found forms of emphysema of lungs are possible (see).
Hypodermic E. it can be observed at injury of adnexal bosoms of a nose (see), wounds of a mucous membrane of an oral cavity, sometimes it complicates a tracheostomy (see), tracheotomy (see), can develop at wound of soft tissues in a joint when air gets to surrounding hypodermic cellulose through a wound. In these cases hypodermic E. has local character and usually does not constitute danger to the patient.
The hypodermic emphysema developing at the closed and open injury of a breast is a reliable sign of injury of lungs. According to E. A. Wagner (t. 15, additional materials), hypodermic E. it is noted in 44,6% of cases at the closed injury of a lung without injury of bones of a thorax and in 59,9% of cases — with their damage. At open, including fire, wounds of a breast hypodermic E. it is noted infrequently. By data A. A. Bocharova (1949), it arises at 18% of wounded with the getting wounds of a breast, and more than in half of cases insignificant. Especially sharply expressed hypodermic E. it is observed at valve pheumothorax (see). According to S. JI. Libova (1949) who is sharply expressed hypodermic E. was absent only at 5 of 55 wounded with this form of valve pheumothorax in this connection hypodermic E. in these cases gains diagnostic value. At tension valve pneumothorax hypodermic E. quickly accrues,
extends from the hypodermic cellulose surrounding a wound to a breast, a face, a back, sometimes to all trunk and extremities, transforming appearance of the wounded beyond recognition (fig., a). Emergence hypodermic E. after lung operation, napr, pneumonectomies (see), can be a consequence of insufficiently tight sewing up of a wound of a thorax, but more often it demonstrates existence of bronchial fistula, through to-ry air comes to a pleural cavity, and then to a postoperative wound. Main wedge, sign hypodermic E. — ravnomer-
Fig. The wounded with the getting wound of a breast and the valve pheumothorax which caused development of widespread hypodermic emphysema (and — in the first days after wound; 6 — in 10 days after elimination of pheumothorax).
but - the diffuse swelling of various extent covered with not changed skin. In the field of a swelling characteristic crepitation is defined (see), at percussion — a tympanic sound. Diagnosis hypodermic E. put hl. obr. on the basis a wedge, pictures; for identification of its reason resort to radiological and to other methods of a research.
Treatment consists in the actions directed to the termination of intake of air in fabrics. Often intake of air stops spontaneously, in other cases apply an operative measure then in several days air in fabrics resolves (fig., b).
Mediastinal emphysema develops at hit of air in cellulose of a mediastinum or directly from the surrounding atmosphere (e.g., at wounds of a neck), or from other bodies (a gullet, a stomach, retroperitoneal department of a large intestine or from respiratory tracts) at various injuries, patol. processes, during operations. Especially dangerously big accumulation of air in a mediastinum at patients with valve pheumothorax. Tsri it is observed a prelum of an org
is new mediastinums, followed by the phenomena of suffocation and the increasing cordial weakness (see the Pneumomediastinum).
Fabric emphysema develops at patients with a mephitic gangrene (see), especially at an emphysematous form. At the same time fabrics in the field of defeat become the porous, as if stuffed vials of gases (see tsvetn. the tab. to St. Mephitic gangrene, t. 1, Art. 521, fig. 11 and 12), produced by pathogenic anaerobe bacterias (see). Existence of the phenomena of early and heavy intoxication, changes in a wound and surrounding skin of poses drags to define the nature of emphysema.
A special type of the fabric emphysema called also heights
ache fabric emphysema,
the niya of external pressure (results considerable sudden to a snizha at rise on height, escaping of a caisson,
emersion on a water surface).
Renny gases in blood and a lymph of the victim are emitted to Rastvo, forming bubbles that conducts to a number of the painful phenomena and life-threatening frustration (see. Compressed-air disease). The outcome depends on degree and duration of a sudden decompression and timeliness of rendering medpo
Bibliography: Wagner E. A. Hirurgiya of injuries of a breast, M., 1981; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 9 — 10, M., 1949 — 1950; Corners F. G., Puglee-va V. P. and Yakovlev A. M.
Complications at intrathoracic operations, page 216, L., 1966. S. A. Rusanov.