2010 ? 12 ? 01 ?
congenital disease of the lung is a rare congenital lung abnormalities. Comparison of the pathological classification and naming confusion, disagreement, in the past referred to congenital lung cyst, more consistent now known as congenital disease of the lung, including bronchial cyst (lung cysts), pulmonary cysts, lung large leaf gas swelling (bullae), and congenital cystic adenomatoid malformation of the cystic bronchiectasis and so on.
embryonic development, because of the trachea, bronchial abnormalities caused by abnormal development of the bud or branch. Lesions can occur in different parts of bronchial branches and display different developmental stages. Multilocular cyst often pregnant, but also for a single room of. Multi-wall structure of the bronchial wall with a small, inner ciliated columnar epithelium, the outer scattered in small pieces of cartilage, smooth muscle wall can be seen within the bundles and fibrous tissue. Cystic lesions of the inner structure can be seen different Pip cells, columnar, cuboidal and round epithelial cells, which showed incomplete development of the bronchial tree branches of different levels. some columnar cells with mucus secretion, cavity filled with mucus.
small bronchogenic cyst is not showing clinical symptoms, only the chest X-ray examination or autopsy only to be found. once the communication between cystic lesions and small bronchi, causing secondary infection or produce tension gas cyst, cyst fluid, cyst fluid or gas pressure such as tension pneumothorax lung, heart, mediastinal and tracheal shift, can be symptoms.
(a) of the infants of tension bronchogenic cyst, pulmonary emphysema and lung bullae large leaves were more common. Frequent clinical presentation of intrathoracic pressure symptoms of tension, manifested as shortness of breath, cyanosis or respiratory distress and other symptoms. See contralateral tracheal shift examination, the affected side drum percussion sounds, breath sounds decreased or disappeared. Chest radiograph shows cystic lesions caused by ipsilateral lung atelectasis, mediastinum, tracheal shift, and may show ipsilateral mediastinal hernia and atelectasis in critical condition, not timely diagnosis and treatment, died of respiratory failure can be.
(b) were more common for childhood bronchial cyst. Clinical manifestations of recurrent pulmonary infections. Patients often fever, cough, chest pain treatment. Symptoms similar to bronchial pneumonia.
(c) more common in adult acquired secondary pulmonary bulla and bronchial cyst. Clinical symptoms are due to secondary infection such as fever, cough, purulent sputum, hemoptysis, chest tightness, asthma-like episodes, exertional dyspnea and recurrent pneumothorax and other symptoms. Need and lung abscess, empyema, bronchiectasis, tuberculosis, lung tumor cavity and identification.
congenital bronchial cyst is common in children’s cases, the cyst is located within the interstitial lung or mediastinum. about 70% in the lung, 30% in the mediastinum. As can be single or multiple cysts containing different amount of gas or liquid, which can be in the X-ray showed different performance:
1. a single liquid, the most common cysts, cysts of different sizes, we can see circular thin-walled cysts containing liquid. Wall of such cysts are characterized by meager, no inflammatory infiltration in lung tissue adjacent to lesions, fibrosis small, need and lung abscess, pulmonary tuberculosis and lung hydatid cyst cavity identification. X-line performance of thick abscess wall, surrounded by significant inflammation, tuberculosis is a long history of empty, surrounded by satellite lesions of tuberculosis. Epidemiology of pulmonary hydatid cyst in the regional characteristics, life history and occupational history, blood like, skin test and other help to identify.
2. a single gas cyst lateral chest radiograph shows pulmonary disease gas cyst, giant gas cyst may occupy the side of the chest, oppression, lung, trachea, mediastinum, heart, need to identify and pneumothorax. Pneumothorax is characterized by a decline toward the lung hilum, while the gas cysts in the lungs of air, often carefully observed in the apical and ribs can be seen every corner of the lung tissue.
3. Multiple gas cysts are often seen on chest X-ray showed multiple sizes, missing the edge of the gas cysts, need to identify with multiple bullae. especially in children, often accompanied by pneumonia, pulmonary bulla in the X line to translucent and circular thin-walled bleb size, number, shape characterized by volatility. Each follow-up in the short term changes to see more, and sometimes can be rapidly increased, the formation of pneumothorax or rupture. once the lung inflammation subsided, bullae and sometimes self-shrink or disappear.
4. Multiple liquid, gas cysts visible on chest X-ray multiple sizes of the liquid, gas chamber. in particular, lesions in the left side, the need to identify with congenital diaphragmatic hernia, which can also be present for more than one fluid level, if necessary, or the diluted barium oral iodized oil, in the chest to see if the contrast agent into the gastrointestinal tract, was diaphragmatic hernia.
generally clear diagnosis, in the absence of acute inflammatory situations, early surgery should be. Cyst easy because secondary infection, drug treatment not only can not cure, on the contrary, due to multiple infection inflammation around the wall, causing extensive pleural adhesions, caused by surgery more difficult, prone to complications. Young age is not an absolute contraindication to surgery. in particular, in the event of hypoxia, cyanosis, respiratory distress, and even more should be early surgery, and even emergency surgery to save lives.
surgical approach should be based on lesion location, size, infection may be: isolated subpleural cyst is not infected, can be used as a simple cyst; confined to the lung edge part of the cyst, can be used for wedge resection of lung surgery; cyst infection Erzhi around or near the bronchiectasis will be used for adhesion or resection of lung lobe. Bilateral lesions, there are surgical indications in the premise, first as a disease can be serious side. Children to try to retain the principle of normal lung tissue.
clinically diagnosed when the disease should be avoided as thoracentesis, chest infection or to avoid occurrence of tension pneumothorax. Only in individual cases, the performance of severe respiratory distress syndrome, cyanosis, severe hypoxia, and unconditional for emergency surgery, cyst puncture and drainage can be to achieve temporary relief, the lifting of respiratory distress, as a temporary emergency preoperative measures. General removal of cysts or lung disease, the prognosis is good.
adult patients before surgery if a lot of sputum, surgical anesthesia required for the double-lumen endotracheal intubation to avoid sputum back to the contralateral side. Children can be affected side of the low low chest prone position, after the first ligation of thoracic bronchopulmonary disease.
such lesions are too extensive, serious decline in lung function or a combination of serious heart, liver, kidney and other organic disorder, then the taboo surgery.