Pneumothorax

Introduction There is both effusion and gas accumulation in the pleural cavity called liquid pneumothorax. Liquid pneumothorax can be produced after bronchopleural fistula, trauma, postoperative surgery and thoracic puncture. Can be divided into free liquid pneumothorax and wrapped liquid pneumothorax. Subpleural emphysema can be congenital or acquired; the former is congenital elastic fiber dysplasia, the alveolar wall is elastically reduced, and the lungs are formed after expansion. It is more common in the thin and long-term male lung X-ray examination without obvious disease. The latter is more common on obstructive pneumothorax or post-inflammatory fibrous lesions. The thin-branched gas negotiates semi-blocking distortion, resulting in a valve mechanism to form emphysema, and the enlarged emphysema bubble degenerates due to nutritional circulation disorder. It ruptures when coughing or intrapulmonary pressure increases.

Cause

The cause of liquid pneumothorax:

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 and so on.

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: Gas accumulation in the pleural cavity 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

Chest pleural examination chest radiograph pleural effusion examination chest perspective

X-ray examination is an important method for the diagnosis of pneumothorax. It can show the degree of lung compression, the pathological changes in the lungs, and the presence or absence of pleural adhesions, pleural effusion and mediastinal shift. The typical X-ray of the pneumothorax is a thin-lined shadow with a convex curved shape called a pneumothorax line. The brightness of the extra-line is increased, there is no lung texture, and the lungs are compressed lung tissue. When a large number of pneumothorax is used, the lungs retract to the hilum and have a spherical shadow. A large number of pneumothorax or tension pneumothorax often shows the mediastinum and the heart shifts to the healthy side. Combined with mediastinal emphysema, a light-transmitting band was seen beside the mediastinum and next to the heart.

Pulmonary tuberculosis or chronic inflammation of the lungs causes multiple adhesions to the pleura. When pneumothorax occurs, it is often covered with a localized package, and sometimes the pneumothorax is connected to each other. If the pneumothorax extends to the lower chest, the rib angle becomes sharp. When the pleural effusion is combined, the gas-liquid level is displayed, and the liquid level is also changed when the body position is changed under fluoroscopy. The localized pneumothorax is easy to be missed in the posterior anterior chest, and the lateral chest radiograph can assist in the diagnosis, or the pneumothorax can be found by rotating the position under fluoroscopy.

CT manifests as a very low-density gas shadow in the pleural cavity, accompanied by varying degrees of atrophy changes in the lung tissue. CT is more sensitive and accurate for the identification of small pneumothorax, localized pneumothorax, and bullae and pneumothorax than X-ray.

The size of the pneumothorax can be judged by the chest x-ray. Since the pneumothorax volume approximates the ratio of the lung diameter cube to the unilateral chest diameter cube [(unilateral chest diameter. One lung diameter.) / unilateral chest diameter. )], when the distance from the side of the chest wall to the edge of the lung is 1cm, it accounts for about 25% of the unilateral chest volume and about 50% at 2cm. Therefore, the distance from the lateral chest wall to the edge of the lung is 2cm for a large number of pneumothorax, and <2cm for a small amount of pneumothorax. For example, the size of the pneumothorax is estimated from the apex of the lung to the top of the chest, the distance is 3cm for a large number of pneumothorax, and <3cm for a small amount of pneumothorax.

Differential diagnosis

Symptoms of liquid and gas chest confusion:

Tension pneumothorax: The wound on the chest wall, lung, bronchus or esophagus is a one-way flap, which communicates with the pleural cavity. When inhaling, the flap is open, air enters the pleural cavity, the flap is closed during exhalation, and air cannot be removed from the pleural cavity. Excretion, therefore, with the breathing, the pressure in the pleural cavity of the injured side is continuously increased, so that the tension is exceeded, and a tension pneumothorax is formed, which is also called a pneumothorax or a flapped pneumothorax.

Pneumothorax: Air entering the pleural cavity is called pneumothorax. At this time, the pressure in the thoracic cavity rises, and even the negative pressure becomes a positive pressure, so that the lungs are compressed, and the blood flow to the heart is yin, resulting in different degrees of lung and heart dysfunction. In recent years, scholars at home and abroad have conducted in-depth research on its etiology, pathogenesis and diagnosis and treatment methods, and made some progress.

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