What is spontaneous pneumothorax? And what are the causes of spontaneous pneumothorax? Nowadays, many people certainly do not know enough about spontaneous pneumothorax. So it is necessary for us to learn some medical knowledge about spontaneous pneumothorax together with you.
What is spontaneous pneumothorax? Spontaneous pneumothorax is the formation of human lung without obvious lesions by rupture of subpleural emphysematous vesicles called idiopathic pneumothorax; secondary pneumothorax is called secondary pneumothorax if it is secondary to pleural and lung diseases such as chronic obstructive pulmonary tuberculosis.
What are the causes of spontaneous pneumothorax?
Generally speaking, the etiology of spontaneous pneumothorax often wind up including the following.
1, tuberculosis
In the last century, tuberculosis is one of the important causes of spontaneous pneumothorax, and its pathogenesis is mainly: old structural scar contraction, resulting in small bronchial distortion, obstruction, formation of limited pulmonary blister rupture; direct rupture of the active tuberculosis cavity of the lung; indirectly caused by tuberculosis damage to the lung contralateral lung tissue compensatory emphysema, when there is infection, bronchial obstruction, causing its distal alveoli over-expansion and Rupture, in recent years, the incidence of tuberculosis has been on the rise again, and attention should be paid to the ensuing complications of spontaneous pneumothorax.
2.Rupture of subpleural pneumothorax
Most of the spontaneous pneumothorax in adolescents is caused by the rupture of subpleural pulmonary blisters in the apical part of the lung, most of the subpleural pulmonary blisters are divided into two categories, subangular tiny pulmonary blisters, less than one centimeter in diameter, often multiple, can occur in the apical part of the lung, the edge of the interlobular fissure, such tiny blisters are often caused by bronchial and pulmonary inflammation healing, fibrous tissue scar formation in the process of pulling and poor ventilation, the spontaneous pneumothorax caused by subpleural tiny pulmonary blisters Subpleural pulmonary blisters are often solitary, mostly occurring in the carcass department, due to congenital hypoplasia of the dirty pleura and the gradual appearance of pulmonary blisters, this type of spontaneous hypoplasia, in addition to the gradual appearance of pulmonary blisters, often cannot be found in the lung parenchyma associated with the These two types of spontaneous pneumothorax caused by ruptured pulmonary blisters can be induced after vigorous activity, coughing, sneezing, or can occur in a quiet state.
3.Rupture of large alveolar emphysema
Due to chronic obstructive pulmonary disorders, the alveolar unit is over-inflated, and the alveolar wall is destroyed, i.e., lobar-centered emphysema and full lobar emphysema, and the alveoli are further fused to compress the alveolar septum and interstitial lung to form alveolar emphysema, which is characterized by the extremely thin blood vessels and alveolar septum that are compressed in the alveoli on X-ray chest films and chest CT films, so as to distinguish from giant pneumothorax when the residual air volume in the lung parenchyma is further increased and the pressure is too high. When the volume of residual air in the lung parenchyma increases further, the rupture of the dirty pleura caused by high pressure will appear, which is common in men over 40 years old, often accompanied by chronic cough, long-term smoking history, bronchial asthma history, etc.
4.Other causes
Among the other etiologies of spontaneous pneumothorax, the main ones are Staphylococcus aureus pneumonia and congenital pulmonary cysts secondary to infection, malignant tumor spread, spontaneous pneumothorax during menstruation and pneumothorax in patients with acquired immunodeficiency syndrome.
After these understandings of the causes of spontaneous pneumothorax, we should be alert and concerned about this disease, and if the pneumothorax is detected in the hospital, it should be treated early.
Pneumothorax refers to the rupture of the pleura that causes gas to enter the pleural cavity, resulting in a state of pneumatization. Patients often have triggering factors such as holding heavy objects, breath-holding and strenuous exercise, but pneumothorax may also occur during sleep. Patients suddenly feel chest pain, shortness of breath and breath-holding on one side, and may have cough but little sputum. A small amount of closed pneumothorax starts with shortness of breath, which gradually stabilizes over several hours, and the X-ray does not necessarily show lung compression. If the pneumothorax is large or if there is an existing extensive lung disease, the patient often cannot lie down. The degree of difficulty of the patient’s inspiration is related to the amount of pneumoperitoneum and the extent of the original intrapulmonary lesion. When there are pleural adhesions and pulmonary function impairment, even a small amount of limited pneumothorax may cause significant chest pain and shortness of breath.
According to its clinical manifestations, it is divided into closed (simple) pneumothorax, tension (high-pressure) pneumothorax and traffic (open) pneumothorax.
The three major clinical classifications of pneumothorax are.
1.Closed (simple) pneumothorax: It means that the pleural rupture closes by itself when the whistling lung retracts, and no more air leaks into the pleural cavity. Pressure measurement in the pleural cavity shows an increase in pressure, and after pumping, the pressure drops and does not rise again, indicating that the rupture no longer leaks air. The residual gas in the pleural cavity will be absorbed by itself, and the pressure in the pleural cavity can be maintained at negative pressure, and the lung will be reopened gradually.
2.Traffic (open) pneumothorax: Because of the adhesion and pulling between the two layers of pleura, the rupture is continuously opened, and the air goes in and out of the pleural cavity freely when inhaling and whistling.
3.Tensional (high-pressure): the pleural rupture forms a movable obstruction, which opens during inspiration and allows air to leak into the pleural cavity; it closes during whistling, so that the gas in the pleura cannot return to the whistling tract through the rupture and is discharged out of the body. The result is that more and more gas accumulates in the pleural cavity, forming a high pressure, so that the lungs are pressurized, the whistling because of the difficulty, the need for emergency exhaust to relieve symptoms.
The liquid pneumothorax is the pneumothorax and at the same time, the water accumulates in the chest cavity. The liquid pneumothorax is actually nothing different from the pneumothorax in terms of treatment, but the liquid pneumothorax cannot be treated by puncture.
I. Etiology
1, trauma pneumothorax: a variety of common chest trauma, including sharp-edged stab wounds and gunshot wounds and gunshot penetration wounds rib bone dislocation end stab wounds lung, as well as diagnostic and therapeutic engineering operations in the process of lung injury, such as acupuncture puncture lung biopsy, artificial pneumothorax, etc.
2, secondary pneumothorax: for bronchial carcass disorders broken into the thoracic cavity to form a pneumothorax. Such as chronic bronchitis, pneumoconiosis bronchitis asthma caused by obstructive pulmonary disorders, interstitial fibrosis, cellular lung and bronchitis lung cancer partially occluded airways produced by vesicular emphysema and pulmonary alveoli, as well as near the pleura of purulent pneumonia, lung abscess tuberculous cavity, pulmonary fungal disease, pre-open pulmonary cysts, etc.
3, idiopathic pneumothorax: refers to the usual history of no inspiratory tract disease, but there can be subpleural pulmonary alveoli, once ruptured to form a pneumothorax called idiopathic pneumothorax more wind in the lean and long body type of male young adults.
4, chronic pneumothorax: refers to the pneumothorax after 2 months without full reopening. The reasons for this are: absorption difficulties of the wrapped liquid pneumothorax, not easy to heal bronchial negotiation pleural fistula alveoli or congenital bronchial cysts formed by pneumothorax, as well as airway obstruction or atrophy of the lung connected with the pneumothorax covered with a thicker mechanized envelope hinder this reopening.
5, traumatic pneumothorax: the pneumothorax is called pneumothorax in the pleural cavity. The incidence of traumatic pneumothorax accounts for about 15%-50% in blunt injuries, and about 30%-87.6% in penetrating injuries. In most cases, the air in pneumothorax comes from the lung being punctured by the broken end of the rib bone (superficially called lung rupture, deep into the fine bronchus called lung laceration), or due to the contusion of bronchus or lung tissue caused by the action of violence, or due to the rupture of bronchus or lung caused by the rapid increase of pressure in the airway. Pneumothorax can also be caused by sharp or firearm injuries penetrating the chest wall and injuring the lung, bronchitis and trachea or esophagus, and is mostly hemopneumothorax or pus pneumothorax. Occasionally, closed or penetrating diaphragmatic rupture is accompanied by gastric rupture and causes pneumothorax.
II. Mechanism
Subpleural pneumothorax can be congenital or acquired; the former is a congenital elastic fiber hair bad alveolar wall elasticity is reduced, expanding the formation of large alveoli, mostly seen in lean and long male lung X-ray examination without obvious disease, the latter is more common in obstructive emphysema or post-inflammatory fibrous lesions on the basis of fine bronchial semi-obstruction distortion, produce live valve mechanism and the formation of alveoli, distended pneumothorax alveoli due to impaired nutrient circulation and The distended emphysematous vesicles degenerate due to impaired nutrient circulation, resulting in rupture upon coughing or increased intrapulmonary pressure.
On routine X-ray examination, there is no obvious lesion in the lung, but the pneumothorax formed by subpleural (mostly in the apical part of the lung can have a pulmonary blister, once the erotic cleft is formed is called idiopathic pneumothorax, which is mostly seen in lean and tall male young adults. Non-specific inflammatory scarring or poor congenital development of elastic fibers may be the cause of this subpleural pneumothorax.
Spontaneous pneumothorax is often secondary to underlying pulmonary pathology, such as tuberculosis (necrosis of the focal tissue; or rupture of the pneumomediastinum formed by semi-obstruction of the fine bronchi during healing), chronic obstructive pulmonary disorders (hypertension and rupture in the alveoli of emphysema), lung cancer (semi-obstruction of the fine bronchi or invasion of the pleura by cancer, obstructive pneumonia, followed by rupture of the dirty pleura), lung abscess, pneumoconiosis, etc. Sometimes the pleura has ectopic endometrium, which can rupture during menstruation and cause pneumothorax (menstrual pneumothorax).
Spontaneous pneumothorax secondary to chronic obstructive pulmonary disease and tuberculosis is the most common, followed by idiopathic pneumothorax. Spontaneous hemopneumothorax can be formed by rupture of the dirty-conducting pleura or tearing of the pleural adhesion zone, in which the blood vessels rupture. Pneumothorax can occur in aviation, diving operations with appropriate protective measures, sudden entry from a high-pressure environment to a low-pressure environment, and continuous positive pressure artificial whistling with too much pressure, etc. Lifting heavy objects and other forceful movements, coughing, sneezing, breath-holding or shouting and laughing are often triggers of pneumothorax.