【医学PPT课件】气胸(英文版)PPT

Primary spontaneous pneumothoraces result from apical pleural blebs lying under the visceral pleura.
Primary spontaneous pneumothorax affects tall, thin men between 20 and 40 years old most frequently. Cigarette smoking and family history are contributing factors.
Chest radiograph (confirms pneumothorax) A linear shadow of visceral pleura with lack of lung markings may be observed, indicating collapsed lung.
Visceral pleural line is observed clearly, with the absence of lung marking beyond this line.
Primary spontaneous pneumothorax :
Primary spontaneous pneumothorax occurs when there is no known underlying lung disease. It is thought to be caused by the rupture of a small, air-filled sac in the lung called a bleb or a bulla.
traumatic pneumothorax usually requires chest tube placement.
Iatrogenic pneumothorax is frequently treated with observation or simple aspiration.
Tension pneumothorax is a medical emergency that requires immediate needle decompression and chest tube placement.
Small pneumothoraces may resolve on their own. In a reliable patient with a small (<15% of a hemithorax ), closed spontaneous pneumothorax without significant breathlessness, observation alone may be appropriate.
Traumatic pneumothorax results from a traumatic injury to the chest. The trauma may be penetrating (stab wound, gunshot) or blunt (blow from a motor vehicle accident).
Auxiliary Examination
Chest X-ray : Chest X-ray determine presence of air outside
the lung . Demonstration of a visceral pleural line on chest radiograph is diagnostic .
Note:
Symptoms may begin during rest or sleep.
Pneumothorax may present with lifethreatening respiratory failure if underlying COPD or asthma is present; this is true irrespective of the size of the pneumothorax.
All patients with pneumothorax must stop smoking in order to reduce the risk of recurrent pneumothorax. Administer oxygen to all patients. Most patients are admitted to the hospital.
Secondary spontaneous pneumothorax :
Secondary spontaneous pneumothorax is a complication of underlying pulmonary diseases (COPD, asthma, cystic fibrosis, tuberculosis, pneumocystis pneumonia ).
Pneumothorax
Definition
Pneumothorax is defined as air in the pleural cavity.
Classification
Etiological classification Spontaneous pneumothorax: ( primary and secondary )
Symptoms and signs
Symptoms: sudden sharp chest pain, especially made worse by
a deep breath or a cough shortness of breath chest tightness easy fatigue rapid heart rate cyanosis of the skin caused by lack of oxygen
Iatrogenic pneumothorax may follow procedures such as thoracentesis, pleural biopsy, subclavian or internal jugular vein catheter placement, percutaneous lung biopsy and positive-pressure mechanical ventilation.
Large spontaneous tension pneumothorax.
Right-sided pneumothorax
Diagnosis
(1) Acute onset of ipsilateral chest pain and dyspnea.
(2) Minimal physical findings in mild case; If pneumothorax is large, you can finding characteristic signs of penumothorax; cyanosis in tension pneumothorax.
Treatment for pneumothorax includes observation, simple aspiration, closed drainage of pleural cavity( chest tube placement or tube thoracostomy), chest drain suction, chemical pleurodesis and thoracic surgery.
Arterial blood gas: Arterial blood gas analysis reveals hypoxemia
and acute respiratory alkalosis in most patients but is often unnecessary.
CT scan
CT scan is not recommended for routine use but can help to accomplish the following:
Closed drainage of pleural cavity
The placement of a chest tube between the ribs into the pleural space allows the evacuation of air from the pleural space.
Distinguish between a large bulla and a pneumothorax
Indicate underlying emphysema or emphysemalike changes
Determine the exact size of the pneumothorax, especially if it is small
(3) Presence of visceral pleural line on chest radioive of treatment is to remove the air from the pleural space, allowing the lung to re-expand.
The puncture site is commonly in the second or third intercostal space in the midclavicular line or in the fourth or fifth intercostal space over the superior rib margin in the anterior axillary line.
Signs:
If pneumothorax is small (less than 15% of a hemithorax ), physical findings, are unimpressive. If pneumothorax is large, we can find some signs. Inspection: unilateral chest expansion Palpation: decreased tactile fremitus Percussion: tympany Auscultation: diminished breath sounds