The INFARCTION is a disease caused by embolism or thrombosis of the branches of the pulmonary artery (mainly equity and smaller arteries). Believe that the infarction develops in 10-25% of cases of pulmonary embolism (PE). Etiology, pathogenesis. The basis cause of the disease is often thrombosis of the veins of the systemic circulation (lower extremity, pelvic, iliac, inferior Vena cava, and so on), much less is thrombosis of the right cavities of the heart. To the development of peripheral phlebothrombosis predispose surgery, postpartum, chronic heart failure, fractures of long tubular bones, malignant tumors, prolonged immobilization (in particular, in bed).
Thrombosis of vessels
To thrombosis of vessels of the lungs are stagnation and slowing of blood flow in the lungs, stable pulmonary hypertension, pulmonary vasculitis. Obturation of the vessel is accompanied by reflex spasm in the system pulmonary arteries, leading to acute pulmonary hypertension and peregruzka the right departments of heart. Arise violation of diffusion and arterial hypoxemia, which is exacerbated by the bypass oxidized blood through arteriovenous anastomoses in the lungs and intersystem anastomoses.
The infarction often occurs against a background of existing venous stagnation and is usually hemorrhagic in nature due to the outpouring of the bronchial arteries in the lung tissue of blood flowing inter anastomoses, as well as back flow of blood from the pulmonary veins. The infarction is formed through the day after obturation of pulmonary vessel; its full development is completed by the 7th day. In some cases, the vessel embolism can lead to incomplete development of the heart in the form of focal apoplexy easy and is not accompanied by irreversible destruction of lung tissue.
Infection of infarction leads to the development of perifocal pneumonia (bacterial, Candida) often with abecedarian-eat; when subpleural the location of the infarction occurs fibrinous or more hemorrhagic pleurisy. Symptoms, the course is determined by the caliber, localization and number obturated vessels, state compensatory mechanisms, the underlying pathology of lungs and heart.
The most frequent signs:
- sudden shortness of breath (or suddenly increased);
- chest pain; pale with ashy skin tone, rarely cyanosis;
- tachycardia, possible cardiac rhythm in the form of arrhythmia, less atrial fibrillation;
- hypotension up to the collapse;
- symptoms of myocardial hypoxia, cerebral disorders (agitation phenomenon of brain edema, focal lesions of the brain associated with hemorrhage, polyneuritis);
- cough with mucous or bloody sputum; hemoptysis;
- dullness of percussion sound;
- diminished breath, noise pleural friction and fine bubble moist rales in a limited area;
- unilateral exudative pleurisy in the presence of peripheral phlebothrombosis, pulmonary-pleural pain in the chest.
Occasionally observed abdominal syndrome, manifested by acute pain in the right hypochondrium, paresis of the intestine, pseudobiological symptom Shchetkina, Ortner, Pasternack, leukocytosis, persistent hiccups, vomiting, dysgraphia, liquid stools (syndrome caused by damage to the diaphragmatic pleura). The signs of acute pulmonary hypertension and overload of the right departments of heart (increased heart push offset laterally of the right border of the heart, pulsation in the second intercostal space to the left, the accent and the splitting II tone, systolic murmur in the pulmonary artery, signs of right ventricular failure) is observed only when the obturation of the large trunks of the pulmonary artery.
There are a variety of combinations of the above characteristics, the different degree of their intensity, which makes the diagnosis of pulmonary embolism and infarction sometimes difficult. Diagnosis help: identification of the ECG signs of acute overload of the right departments of heart; x-ray examination, which is determined by unilateral paresis of the diaphragm, extending the root of the lung, bronchial seal any form, zadushevnost part of the lung fields (often in the bone-diaphragmatic sinus), the asymmetry of the shadows and subpleural its location, the presence of effusion without an outline. A crucial role in the diagnosis of pulmonary embolism play radioisotope scanning of the lungs, selective angophora-FFL.