There are two types of pulmonary macules, congenital and acquired. Congenital is mostly seen in pediatric patients due to congenital abnormal bronchial development, flap-like mucosal folds, and poorly developed cartilage, which causes activation of the flap. Acquired is mostly seen in adult and elderly patients, often with chronic bronchitis and emphysema. In children, it is most often seen in Staphylococcus aureus pneumonia, due to fine bronchial inflammation, edema, and mucus plugging, forming a local obstruction to the valve action. Small pulmonary blisters themselves do not cause symptoms, and patients with simple pulmonary blisters are often asymptomatic. Some pulmonary blisters may remain unchanged for many years, and some may gradually increase in size. The enlargement of pulmonary blisters or the appearance of new pulmonary blisters at other sites can cause pulmonary dysfunction and the gradual development of symptoms. Large pulmonary blisters can cause chest tightness and shortness of breath. The sudden enlargement and rupture of a pulmonary blister can produce a spontaneous pneumothorax, which can cause severe dyspnea and chest pain similar to angina pectoris. Patients with pulmonary blisters are often combined with chronic bronchitis, bronchial asthma, and emphysema, and clinical symptoms are also mainly caused by these diseases, only that they are further aggravated after the formation of pulmonary blisters. Secondary infection of pulmonary herpes can cause cough, cough, chills and fever, and in severe cases, cyanosis. If the draining bronchus is obstructed and the lung blister cavity is filled with inflammatory material, the cavity may disappear. It may occur clinically that the symptoms of infection disappear after treatment, while the shadow of pulmonary blister on chest radiograph persists for weeks or months without resolving. Spontaneous pneumothorax is the most common complication of pulmonary maculoplasm, followed by infection and spontaneous hemopneumothorax. Spontaneous pneumothorax Pneumomediastinum can be asymptomatic. When the pressure suddenly increases during sudden exertion, such as violent coughing, heavy lifting or sports, the pulmonary blister ruptures and gas enters the pleural cavity from the lung, forming a spontaneous pneumothorax, dyspnea, shortness of breath, shortness of breath, panic and rapid pulse may occur. The degree of atrophy depends on the amount of gas entering the chest cavity and the pathology of the original lesions of the lung and pleura. If the patient has emphysema, pulmonary fibrosis, long-term chronic infection of lung tissue, etc. in addition to pulmonary herpes, when the pulmonary herpes ruptures, although some of the gas enters the chest cavity, and the degree of lung tissue atrophy can be less, but because the patient’s original lung function has been reduced, the symptoms are also more serious. After the rupture of the pulmonary blister, a small part of the fissure is small, and the fissure closes by itself after the lung tissue atrophy, the air leakage stops, the air accumulation in the chest cavity is gradually absorbed, the negative chest pressure is restored, and the lung reopening is healed. Tension pneumothorax If the lung blister ruptures and forms a live valve, the negative pressure in the chest cavity increases when inhaling, and the gas enters the chest cavity; when exhaling, the live valve closes, and the gas cannot be discharged, especially when coughing, the airway pressure increases when the vocal valve closes, and the gas enters the chest cavity; after the vocal valve opens, the airway pressure decreases, and the fissure closes again. In tension pneumothorax, the lung tissue on the affected side is completely atrophied and the mediastinum is pushed to the healthy side, while the lung tissue on the healthy side is also compressed and the large blood vessels of the heart are displaced and the large veins are distorted and deformed, which affects the blood return and causes serious obstruction to the respiratory circulation. The affected side of the thorax is elevated, mostly accompanied by subcutaneous emphysema on the affected side, and the trachea is obviously displaced to the healthy side, which is critical and often requires emergency treatment. Spontaneous hemothorax Spontaneous hemothorax caused by pulmonary blister mostly consists of bleeding from adhesions and adhesive tearing activities of the pulmonary tissue around the apical pulmonary blister or blister with the apex of the chest. The small arteries in the adhesion zone can be up to 0.2 cm in diameter, and the vessels originate from the body circulation with high pressure, while the thoracic cavity is under negative pressure, which increases the tendency of bleeding. In addition, the bleeding is difficult to stop automatically because the blood in the thoracic cavity does not coagulate due to the defibrotic effect of lung, heart and diaphragm movements. Clinical symptoms may vary depending on the speed of bleeding. When bleeding is slow, patients may present with gradually increasing chest tightness, dyspnea, blunted diaphragm angle visible on X-ray, or parabolic images of pleural effusion. When bleeding is rapid, shock can be manifested within a short period of time. Spontaneous hemopneumothorax When the adhesions between the pulmonary blister and the surrounding lung tissue and the chest wall are torn, if there is a rupture of blood vessels in the adhesion zone and the lung tissue is also damaged, spontaneous hemopneumothorax forms. In recent years, some scholars have pointed out that the amplitude of diaphragm activity may play a decisive role in the occurrence of spontaneous hemopneumothorax, and that the amplitude of diaphragm activity increases during strenuous activities such as rejection of air and force, resulting in a sudden direct or indirect pull on the adhesive band at the top of the chest. If the tear is on the wall side or central part of the cord, only a hemothorax will occur. The diaphragm is more active in long and lean young people and relies more on abdominal breathing because the pectoral muscles are less developed, but the accumulation of fat in the abdominal cavity gradually increases after middle age, which limits the diaphragm activity to varying degrees, so even though the above pathological changes exist, the disease rarely develops. Women are predominantly thoracic breathers and have a lower incidence. The right lung is triple-lobed, and its lobe space plays a buffering role against violent downward pulls, and there is still a liver under the right lung, which may be the reason why the right side has less morbidity. Therefore, patients with spontaneous hemopneumothorax are characterized by young age, more males than females, more left side than right side, and more long and lean body type. Bilateral spontaneous pneumothorax also occurs from time to time, mostly on the left side first and on the right side later, and in individual cases, it occurs bilaterally at the same time, which is critical and even life-threatening. Secondary infection of pulmonary blister In most cases, pulmonary blister occurs in the distal end of the bronchus above the eighth grade, and most of them are not infected, but if the draining bronchus is blocked and the bronchus of pulmonary blister is filled with inflammatory secretions, the patient may have fever, cough, sputum and other symptoms of infection, and sometimes the clinical symptoms improve after anti-infection treatment, but the signs of infection on chest X-ray can still last for a longer period of time. In pediatric congenital pulmonary maculopathy with clinical symptoms or recurrent attacks, surgical treatment may be used. In the case of pulmonary herpes with secondary inflammation, drug control of inflammation is the mainstay. In adults, pulmonary herpes with respiratory distress, infection, bleeding and recurrent complications of pneumothorax are all indications for surgery. The principle of surgery is to remove the herpes and preserve as much healthy lung tissue as possible. When surgery is necessary for bilateral pulmonary herpes, the more severe side should be removed first, and then the other side should be operated on 6 months later if necessary. For elderly people, long duration of disease, extensive and severe lesions that affect respiratory function, preoperative pulmonary function tests and arterial blood gas analysis and radionuclide lung scan with 133 xenon (133Xe) or 113m indium (113mIn) are required. Pulmonary scans are recorded to provide an understanding of regional pulmonary ventilation and pulmonary perfusion. Pulmonary maculopathy in isotope scans shows an occupying lesion in the form of a defective area. This method is non-invasive and readily accepted by patients and can also be applied for postoperative review.