Spontaneous pneumothorax refers to the rupture of lung tissue and dirty pleura due to lung disease, or the rupture of a tiny pneumothorax bubble near the surface of the lung and the escape of air from the lung and bronchus into the pleural cavity. It is most common in young and middle-aged men or in those who suffer from chronic bronchitis, emphysema, or tuberculosis. This disease is one of the pulmonary emergencies and can be life-threatening in severe cases.
Disease information
2. Emergency suction should be done for high-pressure pneumothorax, followed by closed drainage. 3. Treat the primary disease.
Medication principles
1. If the primary disease is tuberculosis, apply anti-TB treatment such as isoniazid, rifampin, streptomycin and pyrazinamide.
2. Apply penicillin, pioneer bicillin, etc. if there is infection.
3. Those with multiple episodes or poor drainage treatment can apply tetracycline powder, thrombin, talc for pleural adhesions.
Auxiliary examination
1. Pneumothorax must be examined by chest X-ray, if the condition is critical, chest X-ray can be done temporarily;
2. If the condition is repeatedly treated with poor results, thoracoscopy or thoracostomy, CT and other examinations should be done.
Symptoms and signs
The clinical manifestations of spontaneous pneumothorax are often atypical and often concealed by the primary disease. About 1/4 of the cases have a slow onset and
Causes of disease
It is a negative pressure cavity [-0.29 to 0.49 kPa (-3.5 cmH2O)]. When the alveolar pressure rises sharply due to a certain cause, the damaged lung-pleura ruptures and the pleural cavity is connected to the atmosphere, so that the airflow flows into the chest cavity and forms a spontaneous pneumothorax. Most of the spontaneous pneumothorax is secondary, because some patients’ lung tissues have adhered to the wall pleura, and the fistula or fine bronchopleural fistula cannot be closed with lung compression when the pneumothorax is formed, resulting in continuous opening of the fistula, and the pressure of the chest cavity is close to zero, and it becomes “open pneumothorax”; some patients become “open pneumothorax” because of bronchial stenosis, semi-obstruction, and the formation of live valve. Some patients form a live valve, so that the air enters the chest cavity during inspiration and remains there during expiration, and the pressure in the chest cavity can exceed 1.96kPa (20cmH2O), which becomes “tension pneumothorax”; due to the above reasons, spontaneous pneumothorax is often difficult to heal, recurrent pneumothorax and limited pneumothorax are more common, while simple closed pneumothorax is is less common.
Pathophysiology
Pneumothorax is called spontaneous pneumothorax except for traumatic injury or treatment for artificial pneumothorax. Most of the spontaneous pneumothorax is caused by the rupture of subpleural pneumothorax bubble, but it is also seen due to the collapse of subpleural lesions or cavities, tearing of pleural adhesion band, etc. Subpleural pneumothorax bubble can be congenital or acquired; the former is due to congenital elastic fiber dysplasia, alveolar wall elasticity decreases, and large pulmonary alveoli are formed after expansion, mostly seen in lean and long men with no obvious disease on lung X-ray. The latter is more common on the basis of obstructive emphysema or post-inflammatory fibrous lesions, where the fine bronchi are semi-obstructed and distorted, producing a valve activation mechanism and forming emphysematous alveoli. The distended alveoli degenerate due to nutritional and circulatory disorders, resulting in rupture when coughing or intrapulmonary pressure is increased.
Diagnostic tests
Diagnosis
The clinical manifestations of spontaneous pneumothorax are very atypical and can be easily misdiagnosed or missed because they are masked by the primary disease. Patients should be considered for pneumothorax can when they present with the following.
① Sudden unexplained dyspnea, or sudden aggravation of shortness of breath on the basis of pre-existing dyspnea, which cannot be explained by the primary disease;
Examination protocol
2. CT is more sensitive to the diagnosis of small amount of gas in the chest cavity. For recurrent pneumothorax and chronic pneumothorax, observe whether there are lesions causing pneumothorax at the edge of the lung, such as large pulmonary alveoli, pleural band adhesions, lung being stretched and fissures not easily closed, etc. The basic 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.
3. Pleural cavity angiography This method can clarify the situation of the pleural surface, which can easily clarify the cause of pneumothorax. When the compression area of the lung is 30% to 40%, it is appropriate to perform the imaging, and the pulmonary alveoli will show single or multiple cystic low-density shadow within the lung lobe outline; the pleural fissure will show the bubble spray phenomenon, especially when the patient coughs, this sign is more obvious due to the increase of intrapulmonary pressure.
4. Thoracoscopy can easily detect the cause of pneumothorax, with flexible operation, up to interlobular fissure, lung tip and lung door, almost without blind area, and observe whether there are fissures in the dirty pleura, whether there are large alveoli under the pleura and whether there are adhesion bands in the chest cavity.