Cough with difficulty breathing

Introduction Cough with dyspnea is a spontaneous pneumothorax (spontaneous pneumothorax refers to rupture of lung tissue and visceral pleura due to lung disease, or rupture of fine emphysema vesicles near the surface of the lungs. Air in the lungs and bronchial tubes escapes into the pleural cavity. Male young adults or suffering from chronic bronchitis, emphysema, tuberculosis. This disease is one of the pulmonary emergency, severe cases can be life-threatening, timely treatment can be cured.) One of the symptoms. The clinical manifestations of spontaneous pneumothorax are often atypical and often masked by the primary disease. About 1/4 of the cases started slowly and gradually worsened.

Cause

The pleural cavity is a closed cavity between the visceral-parietal pleura. Due to the elastic retractive force of the lung, it is a negative pressure chamber [-0.29 ~ 0.49 kPa (-3.5 cm H2O)]. When a certain cause causes the alveolar pressure to rise sharply, the lung-pleural rupture of the lesion ruptures, the pleural cavity communicates with the atmosphere, and the airflow flows into the chest cavity to form a spontaneous pneumothorax. Spontaneous pneumothorax is mostly secondary, because some patients' lung tissue has been adhered to the parietal pleura. When the pneumothorax is formed, the lung tissue ruptures the pupil or the bronchiole pleural pupil can not be closed with the compression of the lungs, causing the pupil to remain open. The chest pressure is close to zero, and it becomes an "open pneumothorax"; some patients form a flap like bronchoconstriction and semi-obstruction, so that air enters the chest cavity during inhalation, and is still left here when exhaling. The chest pressure can exceed 1.96kPa. (20cmH2O), become a "tensional pneumothorax"; due to the above reasons, spontaneous pneumothorax is often difficult to heal, re-ventilated chest, localized pneumothorax is more common, and simple closed pneumothorax is less.

an examination

Related inspection

Expiratory flow rate, respiratory exercise, lung ventilation, pulmonary impedance, blood flow

Spontaneous pneumothorax is mainly characterized by the difficulty in explaining the difficulty of dyspnea in the primary disease; some cases have no clear cause of morbidity, which is sudden or rapid exacerbation of chest tightness and shortness of breath; 40% to 60% of cases are severely coughed after sudden cough Shortness of breath, chest tightness, palpitation and difficulty breathing. A small number of patients can also be induced by physical activity, forced bowel movements, sneezing, weight bearing and other reasons.

Chest pain, especially the sudden sudden pain of a typical pneumothorax is rare. Other common symptoms include coughing, cyanosis, and inability to lie flat. A cough can be an irritating dry cough or a cough due to a underlying condition. The clinical manifestations of massive pneumothorax or tension pneumothorax sometimes resemble pulmonary infarction or myocardial infarction. Chest tightness, chest pain, difficulty breathing, palpitation, sweating, pale face, and restlessness can occur early.

When a small amount of pneumothorax is not obvious, when the lung is compressed by more than 30%, the trachea is displaced to the healthy side, the thoracic bulge of the affected side, the respiratory movement is weakened, the percussion is drum sound, the heart sounds are disappeared, or the liver is dull, the breath sounds and the language The tremor is weakened or disappeared, which is sometimes confused with emphysema. Some elderly patients are similar to asthma-like episodes, and the lungs can smell wheezing while suffering from severe breathing. These patients have multiple emphysema, pulmonary insufficiency, and pleural adhesions and multiple compartments. In this type of patient, the air rush and wheezing sound disappeared rapidly after pneumothorax drainage.

Pulmonary function tests: Restrictive ventilation damage (lung volume and decreased lung capacity) may occur when the pneumothorax is compressed more than 20%. Due to the existence of underlying diseases, senile pneumothorax often has severe pulmonary dysfunction when the lungs are compressed by less than 20%. Clinically suspected pneumothorax is not suitable for pulmonary function tests for forced breathing, so as not to cause the disease to deteriorate. Arterial blood gas examination: In patients with acute pneumothorax, hypoxemia occurs due to ineffective perfusion of collapsed lung tissue, causing a right-to-left shunt. In the later stage, hypoxemia can be alleviated due to the decrease of blood flow in the collapsed lung. Young and middle-aged people generally have hypoxemia when the lungs are compressed by 20% to 30%. Spontaneous pneumothorax often occurs in hypoxemia when mild lung compression occurs.

X-ray examination: The typical X-ray of the pneumothorax is a spherical shadow of the lung to the hilar collapse. The gas often gathers on the outside of the thoracic cavity or the tip of the lung. This part has increased brightness and no lung pattern. The rib angle appears sharp when the pneumothorax extends to the lower part of the lung. When a small amount of pneumothorax is accumulated, it is mostly confined to the tip of the lung and is easily covered by the clavicle. At this time, the X-ray signs of deep gas phase are helpful for diagnosis. Some patients with spontaneous pneumothorax appear as "limited pneumothorax" due to pleural adhesion separation. The gas accumulation shadow may be obscured by the lung or mediastinum, which can be found by rotating the fluoroscopy.

Differential diagnosis

Spontaneous pneumothorax must sometimes be distinguished from the following diseases:

1. Spontaneous pneumothorax exacerbation secondary to COPD closed pneumothorax, and sometimes even open pneumothorax is often mistaken for COPD exacerbation. Patients with pneumothorax have shortness of breath, and most of them are sudden or progressive aggravation, while cough and cough are correspondingly lighter; COPD exacerbation is often caused by climate change. The above feelings are the leading, and the prominent manifestations are cough and cough. Purulent sputum. The gas accumulation sign is limited or unilateral, bilateral asymmetry, and the lung hyperinflation sign is mostly diffuse, bilateral; the new tracheal displacement is a strong evidence of pneumothorax. X-ray examination and, if necessary, artificial pneumothorax diagnostic puncture and pressure measurement can help confirm the diagnosis.

2. Pneumatic bullae with a small or localized pneumothorax sometimes needs to be differentiated from bullae. The development of pulmonary bullae is very slow, and the clinical manifestations are generally stable; small streak shadows are still visible in the area of increased brightness on the chest X-ray. The review compares the lesions of the previous chest radiographs; the size of the bullous shadow after diagnostic puncture It is different from the pneumothorax.

3. Pleural effusion: patients with pleural effusion often also present with chest pain and shortness of breath, but physical examination and X-ray examination are effusion signs and are not related to pneumothorax.

4. Myocardial infarction, pulmonary infarction, tension, pneumothorax, clinical manifestations sometimes resemble myocardial infarction, pulmonary infarction, all manifested as sudden severe chest pain, shortness of breath, difficulty breathing, palpitation, pale or cyanosis, sweating, irritability, etc., but tension Obvious pleural effusion sign and contralateral tracheal displacement on the affected side of the pneumothorax are helpful for identification. X-ray examination and artificial pneumothorax diagnostic puncture can be diagnosed.

5. Bronchial Asthma Some elderly patients with pneumothorax have similar symptoms to asthmatic episodes. Severe breathing difficulties can be heard in the lungs. The pleural effusion sign, the antispasmodic-corticosteroid-oxygen therapy is ineffective, the dyspnea after pumping and the wheezing sound disappears and is different from asthma.

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