I. Definition of pneumothorax
Pneumothorax means that the gas enters the pleural cavity, resulting in a state of pneumatization, which is called “lung rupture” in common parlance. Most of the pneumothorax is caused by lung disease or external force, resulting in the rupture of lung tissue and dirty pleura, or the rupture of fine emphysema bubbles near the surface of the lung, and the air in the lung and bronchus enters the pleural cavity.
Second, the classification of pneumothorax
Pneumothorax caused by trauma is called traumatic pneumothorax, and pneumothorax caused by lung disease caused by the rupture of lung tissue is called “spontaneous pneumothorax”. Pneumothorax can also be divided into closed pneumothorax, open pneumothorax and tension pneumothorax. Spontaneous pneumothorax is mostly seen in male young adults or patients suffering from bronchiectasis, emphysema and tuberculosis. Pneumothorax is one of the pulmonary emergencies, which can be life-threatening in serious cases and can be cured by timely treatment.
Third, the triggering factors of pneumothorax
Common factors include strenuous exercise, lifting heavy objects or upper arms, coughing, forceful defecation and external impact, etc. When strenuous exercise or forceful defecation, the pressure in the alveoli rises, resulting in the rupture of the original damaged or defective lung tissue causing pneumothorax.
There are also some special types of pneumothorax.
(1) Menstrual pneumothorax
That is, the recurrent pneumothorax related to menstrual cycle.
(2) Pregnancy-associated pneumothorax
Pneumothorax is more common in young women during their childbearing years. Pneumothorax occurs with each pregnancy.
(3) Spontaneous pneumothorax in the elderly
The occurrence of spontaneous pneumothorax in people over 60 years of age is called spontaneous pneumothorax in the elderly. In recent years, the incidence of this disease has been increasing. It is more frequent in men than in women. Most of them are secondary to chronic lung diseases, among which chronic obstructive pulmonary disease is the first.
(4) Traumatic pneumothorax
Mostly due to trauma, the lung is punctured by the broken end of rib fracture, and it is mostly hemopneumothorax or pneumothorax. Occasionally in closed or penetrating diaphragm rupture accompanied by gastric rupture and cause pus pneumothorax.
Fourth, the symptoms of pneumothorax
The severity of symptoms depends on the rapidity of onset, the degree of lung compression and the condition of the primary lung disease. Typical symptoms are sudden onset of chest pain, followed by chest tightness and difficulty in whistling, and irritating cough. This chest pain is often pins-and-needles or knife-like and is brief in duration. The irritating dry cough is caused by gas irritation of the pleura. Most patients with an acute onset and a large pneumothorax, or those with pre-existing lung lesions, have significant shortness of breath. Some patients have triggers such as violent cough, forceful breath-holding stool or heavy lifting before the occurrence of pneumothorax, but many patients develop it during normal activities or quiet rest. Young healthy people with moderate pneumothorax rarely experience discomfort, and sometimes patients are only detected during physical examination or routine chest fluoroscopy; while elderly people with emphysema can have significant inspiratory difficulties even if the lung compression is less than 10%.
Five, in addition to the introduction of a more dangerous pneumothorax: tension pneumothorax.
Patients with tension pneumothorax often show a high degree of nervousness, fear, irritability, shortness of breath, a sense of suffocation, cyanosis, sweating, and a weak and fast pulse, blood pressure drop, wet and cold skin and other shock states, and even unconsciousness, coma. If not rescued in time, it often causes death. 3. Bilateral pneumothorax
Sixth, how to diagnose pneumothorax
1.X-ray examination is an important method to diagnose pneumothorax. Chest X-ray is a routine means of pneumothorax diagnosis. If the clinical suspicion of pneumothorax is high and the posterior anterior chest X-ray is normal, lateral chest X-ray or lateral recumbent chest X-ray should be performed. Most of the pneumothorax chest films have clear pneumothorax lines, i.e. the junction line between atrophied lung tissue and the gas in the pleural cavity, which is a convex line shadow, outside the pneumothorax line is a translucent area without lung texture, and inside the line is compressed lung tissue. The mediastinum and heart can be displaced to the healthy side when there is a large amount of pneumothorax. In the case of combined pleural effusion, the pneumothorax surface can be seen. A restricted pneumothorax is easily missed on posteroanterior X-ray, and lateral chest radiographs can assist in the diagnosis, and can also be detected by turning the body under X-ray fluoroscopy. A mediastinal emphysema should be considered if there is a transilluminated band around the parietal border of the heart. CT is more sensitive and accurate than X-ray chest radiograph for the differentiation of small pneumothorax, limited pneumothorax, and pneumomediastinum from pneumothorax. The basic CT manifestation of pneumothorax is the appearance of extremely low-density gas shadow in the pleural cavity, accompanied by different degrees of compression and atrophy changes of lung tissue.
2.Blood gas analysis and pulmonary function test
Most patients with pneumothorax have abnormal arterial blood gas analysis, with PaO2 below 80 mmHg in more than 75% of patients. 16% of patients with secondary pneumothorax have PaO2 < 55 mmHg and PaCO2 > 50 mmHg. pulmonary function tests are not very helpful in detecting the occurrence of pneumothorax or the size of the volume, so they are not recommended.
VII. Diseases that need to be differentiated from pneumothorax
1.Pneumomediastinum
Pneumothorax has a slow onset and a long course, while pneumothorax often has a rapid onset and a short history. x-ray examination of pulmonary blister is a round or oval translucent area, located in the lung field, which still has a small striated texture, while pneumothorax is a striped shadow, located in the lung field within the chest cavity. Pulmonary herpes in the peripheral parts of the lung are easily misdiagnosed as pneumothorax, and the line of pulmonary herpes on the chest film is concave toward the lateral chest wall; while the convex side of pneumothorax is often toward the lateral chest wall, and chest CT helps in the differential diagnosis. After a longer period of observation, the size of pulmonary blister rarely changes, while the form of pneumothorax changes gradually and finally disappears.
2.Acute myocardial infarction
There are clinical manifestations similar to pneumothorax, such as acute chest pain, chest tightness, dyspnea, shock and other clinical manifestations, but patients often have a history of coronary heart disease, hypertension, change in the nature of heart sounds and rhythm, no pneumothorax signs, electrocardiogram or chest X-ray examination helps to differentiate.
3.Pulmonary embolism
There is underlying disease of embolus origin, no pneumothorax signs, chest X-ray examination helps to identify.
4.Chronic obstructive pulmonary disease and bronchial asthma
Chronic obstructive pulmonary disease whistling difficulty is slowly aggravated for a long time, bronchial asthma has a history of recurrent asthma attacks for many years. When chronic obstructive pulmonary disease and bronchial asthma patients with sudden exacerbation of dyspnea and chest pain, the possibility of complicated pneumothorax should be considered, and chest X-ray examination can help to identify.
Eight, the treatment of pneumothorax
1.General treatment
Patients with pneumothorax should absolutely rest in bed, fully absorb oxygen, and speak as little as possible to reduce lung activity, which is conducive to gas absorption and lung reopening. Applicable to the first attack, lung atrophy in 20% or less, not accompanied by inspiratory difficulties.
2.Exhaust therapy
It is suitable for patients with obvious inspiratory difficulty and heavy lung compression, especially for those who need emergency venting for tension pneumothorax. Hemodynamic instability suggests the possibility of tension pneumothorax and requires immediate decompression by second intercostal puncture in the midclavicular line.
(1) Pleural puncture and aspiration method.
(2) Closed chest drainage.
(3) Surgical treatment.
9.Cautions for pneumothorax
1.The recurrence rate of pneumothorax is high, and patients need to be informed which symptoms suggest recurrence of pneumothorax and the need for timely consultation.
2.Patients are advised that they need to be seen in the Department of Whistling 2 to 4 weeks after the initial onset of pneumothorax to review the absorption of the pneumothorax, check for the presence of underlying lung disease, and whether further treatment is needed.
3.Patients can be considered to participate in normal work and activities after the symptoms disappear. However, they need to do so only after the imaging examination suggests that the pneumothorax has completely disappeared.
4.Patients with pneumothorax need to quit smoking, which can reduce their risk of recurrence.
5.For patients who have only a small amount of pneumothorax without closed chest drainage, it is recommended not to travel by airplane to avoid serious consequences.