Etiology.
1, artificial pneumothorax – artificial injection of filtered air into the pleural cavity for CXR observation of intrapulmonary lesions.
2, traumatic pneumothorax – pneumothorax caused by thoracic trauma, puncture
3. spontaneous pneumothorax – mostly with underlying lung disease, COPD, tuberculosis, idiopathic pneumothorax (ruptured subpleural pulmonary blisters, mostly seen in thin, tall young men).
Classification: according to the different opening states of pleural rupture
1, simple pneumothorax – the pleural rupture is relatively small, and the rupture closes by itself after the lung atrophy under pressure; the pressure in the pleural cavity is close to or slightly higher than atmospheric pressure; the pressure does not rise after pumping (does not continue to leak), and the residual gas can be absorbed
2.Tension pneumothorax – the rupture has the role of a live valve, and some gas enters the pleural cavity with each breath, but cannot be discharged, and the pressure in the pleural cavity keeps increasing (10cmH2O); the pressure decreases temporarily after pumping and recovers immediately
3, traffic pneumothorax – the rupture is large, and gas can enter and exit the pleural cavity during inspiration and expiration; the intrapleural pressure is maintained at about atmospheric pressure, and the pressure remains unchanged after pumping.
Clinical manifestations.
1. Symptoms.
(1) laughing, excessive force, breath-holding, and violent coughing as triggers.
(2) sudden onset of chest pain, shortness of breath, chest tightness, and cough on one side; inability to lie flat, with the affected side on top when lying on the side.
(3) extreme increase in intrathoracic pressure in tension pneumothorax, compressing venous return and lowering CO, which can lead to accelerated heart rate, elevated blood pressure, shock, and arrhythmia.
2. Signs.
(1) displacement of the trachea to the healthy side, thoracic expansion, reduced respiratory movements and fibrillation, buckling drum sounds, and reduced auscultatory breath sounds.
(2) air over water sound in liquid pneumothorax.
3.Auxiliary examinations.
(1) increased translucency beyond the CXR-pneumothorax line, no lung texture (lung atrophy during expiration, more pronounced), and sharp rib-diaphragm angle.
(2) The presence of translucent bands next to the mediastinum indicates mediastinal emphysema; the mediastinum is displaced to the healthy side.
(3) CT-very low density gas shadow in the pleural cavity with varying degrees of atrophy and compression of the lung tissue.
4.Differential diagnosis: chest pain + dyspnea
(1) asthma and COPD – both manifest shortness of breath and dyspnea, with a history of recurrent attacks of asthma and progressive exacerbation of COPD, if bronchodilators and antibiotics are not effective and the symptoms are more important, consider combined pneumothorax.
(2) Acute infarction – a history of heart disease, ECG, and myocardial enzyme profile can differentiate.
(3) Pulmonary infarction – risk factors, deep vein thrombosis, prolonged bed rest, fracture, etc., CXR, CTPA can be identified.
(4) Unruptured subpleural blister-blind puncture and aspiration may lead to traumatic pneumothorax; fine texture within the blister, no pneumothorax line around the blister.
Treatment.
1, conservative treatment.
Absolute bed rest, oxygen absorption to promote gas absorption (oxygen concentration 20% thoracic volume, general condition is better, puncture exhaust available, 20% each time generally poor traffic, tension, recurrent).
2, surgery – traffic rupture does not heal.