The Importance of X-Ray in Examination of Lungs in Patients with Inhalation Trauma

• Published in: Neotložnaâ Medicinskaâ Pomoŝʹ Vol. 8; no. 3; pp. 279 - 287
• Main Authors: Beresneva, E. A., Spiridonova, T. G., Zhirkova, E. A., Barinova, M. V., Semenova, T. I., Brygin, P. A., Zabavskaya, O. A., Sokolova, E. P., Lapshina, E. A., Orlov, A. S.
• Format: Journal Article
• Language: English; Russian
• Published: Sklifosovsky Research Institute for Emergency Medicine, Public Healthcare Institution of Moscow Healthcare Department 06-11-2019
• Subjects: airway burn; function of external respiration; isolated inhalation trauma; morphological examination of the peripheral parts of the lungs; network deformation of pulmonary pattern; x-ray computed tomography; x-ray of the lungs
• ISSN: 2223-9022; 2541-8017
• DOI: 10.23934/2223-9022-2019-8-3-279-287

Relevance
Inhalation trauma (IT) is a combined injury of the respiratory tract, lung parenchyma and the central nervous system. Alterations of a mucous membrane during thermochemical airway burn as a result of inhalation of combustion products is most fully described in the literature, while the lesion of pulmonary parenchyma hasn’t been studied.
The aim of the study
To determine the capabilities and significance of the X-ray method in the study of lungs in patients with IT.
Material and methods
We examined 184 victims with IT, of which 53 patients had airways burn of the 1st degree, 92 patients had airways burn of the 2nd degree, and 39 patients had airways burn of the 3rd degree. Methods used: X-ray, chest X-ray computed tomography, ultrasound of the chest, study of the function of external respiration, morphological examination of lungs, statistical methods.
Results
X-ray studies in patients with IT revealed changes in peripheral parts of both lungs like network deformation of pulmonary pattern to forms resembling “mulberries” or “a bunch of grapes”. A study of the function of external respiration revealed signs of decreased lung ventilation and obstructive changes in bronchioles. The X-ray computed tomography of peripheral regions of the lungs in some patients revealed multiple local areas of reduced density with no visible walls corresponding to alveoli holding the air. Histological examination of the peripheral parts of the lungs found round air formations and significantly expanded alveoli. These changes are associated with exhalation disorders due to the constriction of respiratory bronchioles.
Conclusion
The X-ray method allows to detect signs of damage to the pulmonary parenchyma in patients with IT. Using a statistical evaluation, we showed that the presence of network deformation of the pulmonary pattern under the conditions of IT is an objective feature, confirmed with Cohen’s kappa coefficient (0.6±0.14; 95% CI [0.32–0.88]).