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If after 2–4 days there is still evidence of an air leak, various options are available. Negative pressure suction (at low pressures of –10 to –20 cmH 2 O) at a high flow rate may be attempted, particularly in PSP; it is thought that this may accelerate the healing of the leak. Failing this, surgery may be required, especially in SSP. [15]
Pulmonary contusion results in bleeding and fluid leakage into lung tissue, which can become stiffened and lose its normal elasticity. The water content of the lung increases over the first 72 hours after injury, potentially leading to frank pulmonary edema in more serious cases. [ 20 ]
Complications are not common but include infection, lung abscess, and bronchopleural fistula (a fistula between the pleural space and the bronchial tree). [4] A bronchopleural fistula results when there is a communication between the laceration, a bronchiole, and the pleura; it can cause air to leak into the pleural space despite the placement of a chest tube. [4]
Pneumothoraces of both lungs (large arrows), pneumomediastinum (small arrow) and subcutaneous emphysema in a patient with complete disruption of the right bronchus. Air leak was continual despite suction. [1] Signs and symptoms vary depending on what part of the tracheobronchial tree is injured and how severely it is damaged. [6]
A chylothorax is an abnormal accumulation of chyle, a type of lipid-rich lymph, in the pleural space surrounding the lung.The lymphatic vessels of the digestive system normally return lipids absorbed from the small bowel via the thoracic duct, which ascends behind the esophagus to drain into the left brachiocephalic vein.
Chest tube clogging can lead to retained blood around the heart and lungs that can contribute to complications and increase mortality. [11] A common complication after thoracic surgery that arises within 30–50% of patients are air leaks. If a chest tube clogs when there is an air leak the patient will develop a pneumothorax.
To rapidly counter the fast-growing tumour, chemotherapy is often initiated first by physicians. Limited stage small cell lung cancer is sensitive to chemotherapy and a rapid response is often observed. Thoracic radiotherapy generally begins with the first or second cycle when chemotherapy is used according to most guidelines. [19]
A diver with symptoms of mediastinal emphysema may also have any combination of arterial gas embolism, pneumothorax and subcutaneous or pulmonary interstitial emphysema. Factors which may prevent free escape of the compressed breathing gas include holding the breath or respiratory obstructions such as cysts, mucus plugs, or scar tissue.