pemphigus



Overview

Due to the pressure rise in the alveolar cavity, the alveolar wall rupture, the formation of air-containing cystic cavities with a diameter of more than 1 cm in the lung tissue, most of them are asymptomatic, pulmonary blisters with a large size or multiple pulmonary dysfunction, chest tightness, shortness of breath and other manifestations of asymptomatic people can not be treated, the pulmonary blisters are huge and cause lung function damage or cause pneumothorax or hemopneumothorax can be surgically resected and actively treated with a good result.

What is Lung Blisters?

Definition

Pulmonary blisters are abnormal air-containing cavities with a diameter of more than 1 cm that appear when the pressure inside the alveoli increases, the alveolar walls rupture, and the alveoli fuse due to various reasons.

Types

Pulmonary pustules are most commonly located in the apical part of the lungs and the margins of the upper lobes of the lungs, and are often categorized into three types based on their morphology and relationship to normal lung tissue.

Type I: narrow-basal pulmonary pustules. It protrudes from the surface of the lung and has a narrow hilum connected to the lung parenchyma. Often single, can also be seen multiple large bubbles in clusters of concentrated composition. The upper lobe of the lung is common, the blister wall is thin and easy to rupture, after rupture, spontaneous pneumothorax can be formed.

Type II: wide-base superficial pulmonary blisters. Located in the superficial layer of lung parenchyma, between the pleura of the dirty layer and lung tissue. Connective tissue septa can be seen in the lung blister cavity and can occur in any lobe of the lung.

Type III: Broad-based deep pulmonary herpes. The site is deeper, the structure is similar to type II, it can extend to the hilum, and it can occur in any lobe of the lung.

Questions you may be concerned about

Is right lung apical segmental lung pustule serious?

Right apical lung pustules are not serious if they are not very large and have no clinical symptoms; they can be reviewed regularly and do not require treatment.

Huge pulmonary blisters (the volume occupies half of the thoracic cavity), blisters compressing more functional lung tissue or non-functional lung tissue with progressive expansion, chest tightness, shortness of breath, dyspnea and other symptoms; or combined with recurrent pneumothorax, infections, hemoptysis, or even accompanied by fine bronchopleural fistulas, are more serious and need surgical treatment to avoid delaying the condition.

Can lung pustules be cured by traditional Chinese medicine?

Lung herpes Chinese medicine can improve the symptoms, but the efficacy is not exact, need to review the CT comparison. Surgery is recommended for the vast majority of people with symptoms or complications.

Lung pustules are usually asymptomatic and can be reviewed regularly without treatment. When chest tightness, shortness of breath, infection or hemoptysis occurs, Chinese medicine can be applied to identify and treat lung pustules. For phlegm and turbidity obstructing the lungs, use Su Zi Descending Qi Soup combined with San Zi Nourishing Family Soup; for insufficient lung qi, use Yu Ping Feng San or Sheng Wei San; and for deficiency of lung and kidney qi, use Tonify Deficiency Soup combined with Ginseng and Clam San, but none of the treatments are exact.

Will a pulmonary alveolus rupture if I am angry?

Anger does not usually cause rupture of pulmonary herpes.

Lung blisters are usually caused by localized bronchial inflammation, resulting in localized narrowing of the bronchial tubes, so that the gas can enter the alveoli when inhaling, and the gas in the alveoli can’t be completely exhaled when exhaling, resulting in gradual growth of localized alveoli and the formation of lung blisters.

The pressure of the lung blisters increases when coughing or exerting oneself, causing the lung blisters to rupture. When you are angry, your body is in a state of stress, which increases the secretion of adrenaline, but generally does not cause coughing or exertion unless there is a violent breathing movement.

Causes

Causes

Congenital pulmonary pustules: Congenital bronchial developmental abnormalities, mucosal folds in the form of valves, and cartilage dysplasia may lead to the appearance of pulmonary pustules.

Acquired pulmonary pustules: most of the causes of acquired pulmonary pustules are inflammatory diseases such as emphysema, tuberculosis and chronic bronchopneumonia.

Pathogenesis

The elasticity of the alveolar wall itself is weakened, and the air cannot be completely discharged during exhalation, resulting in insufficient space to hold oxygen-rich fresh air, and the alveoli expand, rupture, and fuse to form pulmonary blisters.

Diseases of the fine bronchial tubes of the lungs, edema, narrowing, blockage, resulting in expiration of the alveoli can not expel gas, alveolar expansion, rupture, fusion, the formation of pulmonary blisters.

Inflammation caused by repeated infections, bronchospasm, and other i i urea cause narrowing of small airways and valve airway obstruction, resulting in over-inflation and expansion of alveoli, destruction of alveolar walls, fusion of alveoli with each other, and the formation of inflated cavities, which are called pulmonary blisters.

Symptoms

Main Symptoms

Small, solitary pulmonary blisters usually do not show obvious symptoms.

As the lung blisters increase in size or new lung blisters appear in other areas, the following symptoms may occur when lung function is affected:

Chest tightness.

Shortness of breath.

Chest pain.

Hemoptysis.

The following symptoms may occur when there is a combination of infections:

Cough.

Coughing up sputum.

Chills.

Fever.

Severe bruising of the lips and nails.

Complications

Spontaneous pneumothorax

It is the most frequent complication of pneumothorax. Clinical manifestations include sudden chest pain, wheezing, cough and dyspnea.

Spontaneous hemopneumothorax

In addition to the manifestations of pneumothorax such as chest pain, wheezing, cough and dyspnea, there may also be blood loss symptoms such as dizziness, palpitations, pallor and even shock.

Lung infection

Secondary infection of pulmonary herpes manifests as cough, sputum, fever and aggravation of existing wheezing symptoms.

Consultation

Department of Medicine

Respiratory Medicine

If symptoms of chest tightness, shortness of breath, chest pain, hemoptysis occur, prompt medical attention is recommended.

Thoracic Surgery

Physical examination suggests the possibility of pulmonary blisters, or those who have been diagnosed with pulmonary blisters and need surgery may consult the Department of Thoracic Surgery.

Emergency Department

When there is a large amount of hemoptysis, severe respiratory distress, lip and nail bruising, or sudden severe chest pain, it is recommended to go to the Emergency Department or call 120 emergency immediately.

Preparation for medical treatment

Preparation for medical consultation: registration, preparation of information, common problems

Tips for medical treatment

Chest X-ray or CT scan is often needed, so avoid wearing clothing made of metal, and inform your doctor if you are pregnant or planning to become pregnant.

Preparation Checklist

Symptom list

Pay particular attention to the time of onset of symptoms and special symptoms.

Any shortness of breath, chest tightness?

Is there any chest pain? What aggravates or relieves it?

Is there hemoptysis? What is the amount of hemoptysis?

Do you have a cough? Is the cough severe?

Is there any sputum? What kind of sputum?

How long have the symptoms lasted?

List of medical history

Have you had tuberculosis or pneumonia before?

Do you smoke? How long have you been smoking and how many cigarettes a day?

Any emphysema, chronic bronchitis?

Checklist

Test results of the last six months, which can be brought to the doctor’s office

Laboratory tests: blood test, nucleic acid test

Imaging tests: chest X-ray, chest CT scan

Lung Function Test

Diagnosis

Diagnosis is based on

Medical history

Patients often have a history of pneumonia and tuberculosis.

Clinical manifestations

Includes chest tightness, shortness of breath, chest pain, etc.

There may be dry or wet rales on lung auscultation.

Imaging

Chest X-ray

Chest X-ray is the best way to diagnose pulmonary herpes. Apical lung blisters appear as thin, translucent cavities located at the edge of the lung fields, which may be round, oval, or flattened rectangular in shape, varying in size. In larger blisters, transverse intervals may sometimes be seen, and multiple blisters may appear multifaceted when placed close together, and are usually not in direct contact with the larger bronchi, with no planes of gas or fluid connection.

In combination with infection, gas-liquid planes may be seen.

Chest CT

It provides better visualization of lung changes, better discrimination of smaller lung blisters that cannot be visualized by X-ray, ability to determine the size and number of lung blisters, high sensitivity and specificity, and ability to anticipate the outcome of lung blister resection and/or surgical lung volume reduction procedures, etc.

Lung Function Tests

Lung function tests will involve a series of non-invasive tests that can help the doctor determine the patient’s impaired lung function.

Diagnostic Criteria

X-ray radiographs and CT are the main methods of diagnosing pulmonary hernias. CT can further define the number and size of the hernias and whether they are accompanied by other lung diseases.

Differential Diagnosis

Pneumothorax

Similarities: both have symptoms such as dyspnea, chest pain and shortness of breath.

Differences: Chest radiographs of patients with pneumothorax are more translucent, with no localized lung texture, and the lung tissue is compressed towards the hilum, with the opposite curvature to that of pulmonary hernias. Pneumothorax is often a sudden onset of disease, rapid change in condition, while the development of pulmonary herpes is slower.

Tuberculosis cavity

Similarity: both manifest as chest tightness, chest pain, cough and other symptoms.

Differences: Patients with tuberculosis cavities have a history of night sweats, fever, thicker cavity walls on imaging, nearby tuberculosis lesions, and tubercle bacilli detected in sputum.

Treatment

Principles of treatment

Pulmonary pemphigoid is an irreversible lung lesion for which there is no effective medication or so-called “local remedies”.

Lung pustules without any symptoms can be left untreated, and it is sufficient to avoid strenuous exercise in daily life.

Patients with primary disease or secondary infection are mainly treated for the primary lesion or secondary infection.

For patients with severe symptoms of pulmonary herpes, surgical treatment is required.

Treatment Methods

Surgery

Surgery is usually indicated for those with severe symptoms. Surgery is performed to remove damaged lung tissue, lung blisters, or to perform a lung transplant. Major surgeries include pulmonary herpetic resection and lung reduction surgery.

Conditions that require surgery

Lung blisters exceeding 30% of the volume of the chest cavity.

Recurrent pulmonary herpes or pneumothorax.

Pneumothorax or hemopneumothorax.

Simultaneous rupture of both blisters.

Surgical Procedure

Pulmonary herpetic resection

Lung Decomposition Surgery

Prognosis

Cure

Asymptomatic or mildly symptomatic pulmonary hernias do not affect the patient’s life expectancy.

Single or multiple simple pulmonary blisters with essentially normal lung function and no other primary or secondary infections have a good outcome after surgical treatment.

If the lungs have been extensively affected, or there are other more serious lung diseases, surgery does not completely restore lung function, and it is recommended to cooperate with pulmonary rehabilitation training after surgery, which can improve the patient’s symptoms.

If the damage to the lungs is too large, lung transplantation needs to be considered, which can be cured after transplantation.

Hazards

When the lung blisters are large in size, they can affect lung function and seriously affect the patient’s quality of life.

Repeated rupture of the lung blisters may result in pneumothorax or hemopneumothorax, and in severe cases, symptoms such as dyspnea and shock may occur, requiring immediate treatment, otherwise the patient’s life may be in danger.

Daily

Daily Management

Dietary management

Avoid spicy and stimulating foods, especially for postoperative patients.

High protein diet: Inadequate protein intake can cause malnutrition and may lead to symptoms of respiratory muscle weakness. Eating more protein helps to repair diseased and damaged tissues. Therefore, it is advocated that emphysema patients should appropriately increase their high-protein diet, such as lean meat, animal liver, tofu, soy milk, etc., on the basis of adequate energy intake. However, dairy intake should be limited, because dairy products can make sputum thickened, not easy to discharge, may aggravate the infection.

High-fiber, high-vitamin diet: Fresh vegetables and fruits are high-fiber, high-vitamin foods, such as carrots, pumpkin, apricots, jujubes, grapefruit, green peppers, tomatoes and so on.

Eat mushrooms, fungus, shiitake mushrooms and other fungal foods: emphysema patients eating the above foods can help to improve the body’s immune system

Drinking more water: patients with emphysema should usually drink more water (at least 2,000 ml per day). Drinking more water helps to dilute phlegm, promote the elimination of phlegm, and maintain the smoothness of airways.

Exercise management

Physical exercise: Physical exercise helps to develop good mood and energy. You can start with an amount of exercise that suits you and exercise 2 to 4 times a week for 20 to 40 minutes each time. Do not perform loaded strength training and very strenuous exercise to prevent tearing of the pulling lung blisters and subsequent spontaneous pneumothorax.

Breathing exercises: Relax the neck and arm muscles, inhale through the nose for 2 seconds, and then exhale through puckered lips for 4 seconds. Try to slow down your breathing rate during the exercise and focus your attention on the pouting and exhaling process.

Others

Smoking cessation: Smoking is the most important cause of emphysema, once diagnosed with emphysema and lung pustules, you should quit smoking immediately.

Avoid exposure to irritating gases and dusts: including second-hand smoke, haze, smog, chemical gases, etc.

Prevention

Actively treat primary diseases such as emphysema to stop them from progressing to pulmonary pustules.

Avoid exposure to high-risk factors, such as smoking and dust.

Do not perform strenuous breathing maneuvers to avoid producing lung tissue damage.

Keep exercising to improve your immunity and lung function.