Symptoms of angioedema of the larynx
Angioedema (angioedema) - acute local allergic edema of the skin, subcutaneous tissue and mucous membranes.
Etiology. Many medications, food products (eggs, chocolate), pollen, household, fungal allergens, alcoholic beverages, insect bites, intestinal parasites can be the cause of the onset of angioedema-chaotic edema. Cooling and ultraviolet irradiation can have a provoking effect.
Pathogenesis. Circulating humoral antibodies cause the release of active biological amines, especially histamine, and also kinins, prostaglandins, from target cells (mast cells of tissues, basophils of blood, plasmocytes). Hyperhistemia-neemia causes the expansion of small vessels, increasing the permeability of the cachilar membranes and, as a result, the accumulation of edematous fluid in the tissues. This or that localization of edemas depends on the zone limited vascular lesion, which, apparently, is connected with the distribution of histamine-sensitive receptors. Physicochemical properties of loose connective tissue also contribute to local fluid accumulation in angioedema.
Clinic. The symptomatology of angioneurotic edema differs significantly in variety. He is localized more often on the face, then - "hands, chest; usually asymmetric. Edema can be confined to a small part of the body (half of the face and neck, or the wrist and forearm) or to capture several of its areas (face, neck, hand, chest part). In rare cases, edema can extend through the digestive tube (esophagus, stomach, intestines). The most dangerous and severe syndromes occur when there is localized edema in the pharynx and larynx.
Skin over the swelling can have a normal appearance, butit is often observed its hyperemia and in some cases with vesicular rashes. The oedematous skin and subcutaneous tissue acquire a moderately densely elastic consistency; when pressed or moderately painful, or completely painless. Swelling lasts from several hours to several days.
Depending on the location and extentPatients complain not only of the feeling of increase and tension in the corresponding part of the body (or its fragment), but also of the violation of certain functions: difficulty in swallowing the burning of the tongue, swelling of the voice, and difficulty breathing when the larynx is swollen. There is a deterioration of vision and Meniere's syndrome with the localization of edema in the field of vision and hearing, respectively.
Angioedema develops unusuallyquickly, sometimes literally before our eyes, with a pronounced picture - a face sharply puffy, with swollen cheeks and lips; Blurred eyelids almost do not allow the patient to open his eyes. The facial skin acquires a cyanotic-crimson color, the conjunctiva and sclera are injected, and sometimes bleeding to the sclera occurs. With ophthalmoscopy, a stagnant nipple can be detected.
The mucous membrane is edematic and hyperemic (vasomotor rhinitis syndrome), which greatly complicates nasal breathing. Swelling of the tongue and soft palate can be observed.
Swelling can only cover the face (head), butcan spread to the neck, one or both arms, part of the chest. Casuetic observations of the distribution of swelling in the cerebral subspecies of the brain with the development of a picture of serous meningitis are described.
Rarely, but no longer as casuistryoccurs avggeoneurotichesky edema, localized in the intestine. In these cases, there are so-called abdominal crises, sometimes occurring under the guise of dysentery and even intestinal obstruction.
The most dangerous localization of angioedemaedema in the pharynx and larynx, as in this case, usually manifested difficulties in breathing, up to asphyxia. Patients complain of rapid onset of shortness of breath or suffocation (especially difficult to breathe air), hoarseness of voice, rough cough. They are restless, cyanosis develops, cervical veins swell. The severity of the symptoms is determined by the localization and spread of the edema (local or diffuse form). Laryngoscopy reveals hyperemia and edema of the laryngeal mucosa.
The clinical course is more often characterized by quiterapid increase in difficulty breathing. Conditionally it is possible to distinguish: the initial, relatively compensated stage, when the patient, taking a vertical position and breathing deeply, achieves sufficient airflow into the airways, and a decompensated asphyxic stage, manifested by pronounced cyanosis, frequent surface breathing, psychomotor agitation. The condition quickly becomes heavier, there comes a loss of consciousness, convulsions. Without intubation or tracheostomy, a fatal outcome is inevitable here. Let us emphasize the transient nature of this formidable pathology. The account goes for tens of minutes, sometimes even for minutes. Laryngeal edema (vitreous edema) is one of the causes of sudden death occurring in allergic diseases. For diagnostics it is important to remember that the laryngeal edema is often combined with the edema of another localization, especially the face and oral cavity.
Diagnosis of the limited (wrist, forearm,person) angioedema, in view of the symptomatology described above, usually presents no difficulties. However, in some cases, differential diagnosis is not so simple. Thus, the acute edema of the forearm and hand may be due to either thrombosis (thrombophlebitis) of the superficial or deep veins of this area, or it may be allergic (Quincke's edema). The connection with microtrauma, sharp soreness in the area of edema, the absence of other allergic manifestations - all this rather speaks in favor of thrombophlebitis of the corresponding area. Relative persistence of the symptoms also confirms this diagnosis, which becomes fully demonstrable upon detection (careful palpation) of the affected vein.
On the contrary, the connection with the possible impactallergen (medicine, insect bite, odor, certain food), rapid rate of development, moderate soreness, the presence of urtikarno-erythematous rash in the area of edema or in other areas allow to speak in favor of angioedema.
The most dramatic conditions occur whendevelopment of the laryngeal edema: heaviness is increasing, there is almost no time for examination. The first stage of the diagnostic algorithm is the establishment of the acute laryngeal stenosis syndrome. It is important to differentiate angioedema from aspiration of a foreign body, an attack of bronchospasm, pulmonary edema. It is important to perform laryngoscopy. The second stage (the possible explanation of the causal dependence of the disease state on exogenous effects, if possible) is to obtain answers to three brief questions: have such "attacks" and, in general, allergic reactions happened before; with which the patient himself is bound by a morbid state; about taking medicines; unusual smells and food.
The third stage, almost simultaneously with the first andsecond: the identification of other signs of allergic reactions. You should carefully examine the skin of the face, chest, hands (there is no erythema, urticaria and urtiko-papular rash) and the mouth (swelling of the tongue, soft palate).