Tension pneumothorax

Introduction Tension pneumothorax, also known as hypertensive pneumothorax, is a thoracic surgery. It is common in the rupture of larger lung air bubbles or larger and deeper lung lacerations or bronchial ruptures. The ruptures communicate with the pleural cavity and form a flap. Therefore, the air enters the pleural cavity from the rupture when inhaling, and the flap is closed when exhaling, so that the air in the cavity cannot be returned to the airway. If the treatment is not timely, the gas exchange will be severely restricted, the venous return will be blocked, the cardiac output will decrease, and the tissue will be hypoxic. The patient's injured side was full of thoracic, severe breathing difficulties, cyanosis and shock.

Cause

Tension pneumothorax refers to the pleural cavity of the pleural cavity. The pleural cavity pressure is reduced when inhaling, the valve opening gas enters, the pleural cavity pressure rises during exhalation, and the valve closing gas cannot be discharged. The lung, bronchus and chest wall injury wounds of traumatic pneumothorax can be a single-channel valve, and the pleural rupture of spontaneous pneumothorax can also form such a flap. When the intrapleural pressure increases to a certain extent, the gas enters the mediastinum or chest wall through the parietal pleural or mediastinal pleura, resulting in mediastinal emphysema or subcutaneous emphysema of the affected chest, head, face and neck. Subcutaneous emphysema marks the pleural cavity. The degree of gas accumulation can also reduce the pressure in the pleural cavity.

an examination

Related inspection

Chest CT examination of respiratory mucus - cilia removal function to determine the pressure of gas components in the pleural cavity

1. X-ray performance: chest X-ray is the most reliable method for diagnosing pneumothorax. It can show the degree of lung collapse, the presence or absence of pleural adhesions in the lungs, pleural effusion and mediastinal shift, etc. The chest image shows uniform transparency without lung texture. The area of the pleural effusion zone, the inner side of which is a curved linear lung edge parallel to the chest wall, a small amount of gas is often confined to the upper part of the chest, often covered by bones, at this time the patient exhales deep, making the collapsed lung more Reduced, increased density, and a more striking contrast with the exposed air-transmitting area, thus showing the pneumothorax, when the pneumothorax is large, the affected lung is compressed, and the lungs in the hilar area are spherically shadowed. Some patients are on the chest X-ray. You can see the lung bullae in the tip of the lung. When the blood pneumothorax is present, the liquid-vapor plane can be seen. When there is an adhesive band in the chest, the collapsed lung loses its uniform compression to the hilum, showing no on the X-ray image. Regular compression or lung compression edge is lobulated; the affected side of the diaphragm is obviously moved down, the trachea, the heart is displaced to the healthy side, and mediastinal and subcutaneous gas is seen when the mediastinal emphysema is combined.

2. Chest CT scan: can clearly show the extent of pleural effusion and the amount of gas, the degree of compression of the lungs, in some patients can see the presence of lung bullae, and chest CT can also show how much pleural effusion Especially for pneumothorax with very small amount of gas and localized pneumothorax mainly located in the anterior middle pleural cavity, it is easy to miss the diagnosis on the X-ray image, while CT has no weakness of image overlap, which can confirm the diagnosis.

Differential diagnosis

Differential diagnosis of tension pneumothorax :

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.

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