Excessive reverberation in the chest

Introduction Excessive reverberation in the chest can be seen in the chest with gas accumulation, the patient's chest is uplifted, respiratory movements and tremors are weakened, percussion is excessive reverberation or drum sounds, auscultation breath sounds weaken or disappear, common in pneumothorax.

Cause

1. Traumatic pneumothorax: common chest trauma, including sharp stab wounds and gunshot penetrating rib fractures, staggering lungs, and diagnosis of lung injury during therapeutic medical operations, such as acupuncture and lung biopsy, artificial pneumothorax Wait

2. Secondary pneumothorax: for the bronchopulmonary disease into the chest cavity to form a pneumothorax. Such as chronic bronchitis, obstructive pulmonary disease caused by pneumoconiosis and bronchial asthma, pulmonary interstitial fibrosis, vesicular emphysema and pulmonary bullae produced by partial occlusion of the airway in cellular and bronchial lung cancer, and suppuration near the pleura Pneumonia, tuberculous cavity of lung abscess, pulmonary fungal disease, congenital pulmonary cyst, etc.

3. Idiopathic pneumothorax: refers to a history of no respiratory disease, but there may be a large alveolar spleen under the pleura. Once the rupture forms a pneumothorax, it is called an idiopathic pneumothorax.

4. Chronic pneumothorax: refers to the chest after 2 months of no full recurrence. The reasons are: a packaged liquid pneumothorax that is difficult to absorb, a pneumothorax that is difficult to heal, a pneumothorax formed by a pleural lacunar bullous sac or a congenital bronchial cyst, and a thicker mechanism of airway obstruction or atrophic lung adhesion to the pneumothorax. The envelope obstructs lung recruitment.

5. Traumatic pneumothorax pleural cavity gas is called pneumothorax. The incidence of traumatic pneumothorax accounts for about 15% to 50% of blunt trauma, and about 30% to 87.6% of penetrating injuries. In most cases, the air in the pneumothorax is caused by the lungs being pierced by the broken ends of the ribs (the superficial one is called the lung rupture, the deep bronchus is called the lung laceration), and the bronchial or lung tissue is also blocked due to violence. Injury, or bronchial or pulmonary rupture caused by a sharp rise in pressure in the airway. Sharp injury or firearm injury through the chest wall, injury to the lungs, bronchial tubes and trachea or esophagus, can also cause pneumothorax, and mostly blood pneumothorax or pus pneumothorax. Occasionally, the rupture of the closed or penetrating diaphragm is accompanied by a rupture of the stomach that causes a pus.

an examination

Related inspection

Thoracic plain thoracoscopic hematology special function examination

1. History and symptoms: may or may not increase the cause of chest, skin pressure and other causes, sudden onset, the main symptoms are dyspnea, chest pain, irritating dry cough, tension pneumothorax symptoms are severely irritated, may appear purpura , sweating and even shock.

2. Physical examination found: There were no positive signs in a small or limited pneumothorax. In the typical case, the trachea is displaced to the healthy side, the thoracic side of the affected side is full, the respiratory motility is weakened, the deduction is over-voiced, and the breath sounds are weakened or disappeared. In the left pneumothorax complicated with mediastinal emphysema, sometimes the precordial phase (Hamman sign) consistent with the heartbeat can be heard in the precordial region.

3. Auxiliary inspection:

(A) X-ray chest examination: for the most reliable diagnosis method, can determine the degree of pneumothorax, lung compression, presence or absence of mediastinal emphysema, pleural effusion and other complications.

(2) Other inspections:

(1) blood gas analysis: hypoxemia can occur in patients with lung compression >20%.

(2) thoracic puncture pressure measurement: help to determine the type of pneumothorax.

(3) Thoracoscopy: For chronic, recurrent pneumothorax, it helps to clear the surface of the lungs and pleural lesions.

(4) Hematological examination: No positive findings were found without complications.

Differential diagnosis

Spontaneous pneumothorax sometimes resembles other heart and lung disorders and should be identified.

First, bronchial asthma and obstructive emphysema

There are shortness of breath and difficulty breathing, and the signs are similar to spontaneous pneumothorax, but emphysema dyspnea is a long-term slow increase. Patients with bronchial asthma have many years of recurrent asthma. When asthma and emphysema patients have sudden increase in breathing difficulties and chest pain, the possibility of complicated pneumothorax should be considered. X-ray examination can be used for identification.

Second, acute myocardial infarction

Patients also have acute chest pain, chest tightness, and even breathing difficulties, shock and other clinical manifestations, but often have a history of hypertension, atherosclerosis, coronary heart disease. Signs, electrocardiogram and chest X-ray are helpful for diagnosis.

Third, pulmonary embolism

Chest pain, dyspnea and purpura are similar to the clinical manifestations of spontaneous pneumothorax, but patients often have hemoptysis and hypothermia, and often have lower extremity or pelvic embolic phlebitis, fractures, severe heart disease, atrial fibrillation, etc., or occur in Elderly patients who have been bedridden for a long time. Physical examination and X-ray examination are helpful for identification.

Fourth, pulmonary bullae

Pulmonary bullae located in the peripheral part of the lung is sometimes mistaken for pneumothorax under the X-ray. Pulmonary bullae may be formed due to congenital development, or a tension cyst or giant cavity may be formed due to obstruction of the intrabronchial valve. The onset is slow, the air is not severe, and the chest is seen from different angles. The bullae or bronchial source can be seen. The cyst is a round or oval translucent area, and there is no line of pneumothorax at the edge of the bullae. The blister has a small strip of texture, which is a remnant of the pulmonary lobules or blood vessels. The bullae are inflated to the surrounding area, and the lungs are pressed toward the apical region, the rib angle and the palpebral angle, while the pneumothorax is the light-transmitting belt on the outer side of the chest, in which no lung pattern is visible. The pressure inside the bullae was similar to that of atmospheric pressure. After pumping, the volume of the bullae did not change significantly.

Others such as peptic ulcer perforation, sputum, pleurisy and lung cancer, etc., sometimes due to acute chest pain, upper abdominal pain and shortness of breath, should also pay attention to the identification of spontaneous pneumothorax.

Sudden side chest pain, accompanied by difficulty breathing and pneumothorax signs, can make a preliminary diagnosis. X-ray shows that the pneumothorax sign is the basis for diagnosis. In the unconditional or critical condition, X-ray examination is not allowed. It can be tested on the affected side of the pleural effusion gas, and the pressure is measured. If it is positive pressure and the gas is extracted, it indicates that there is a pneumothorax, that is, the gas should be extracted. Relieve symptoms and observe changes in intrathoracic pressure after pumping to determine the type of pneumothorax. When the pneumothorax is based on the original severe asthma or emphysema, symptoms such as shortness of breath and chest tightness are sometimes difficult to detect, and should be carefully compared with the original symptoms.

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