bubble_chart Overview

It refers to the pathophysiological condition caused by the rupture of the visceral pleura without external trauma or human factors, allowing gas to enter the pleural cavity and resulting in pneumothorax. When there are no obvious lung lesions and the pneumothorax is caused by the rupture of pleural blebs due to lowered qi, it is called spontaneous pneumothorax; when it is secondary to chronic obstructive pulmonary disease, pulmonary subcutaneous nodules, or other pleural and pulmonary diseases, it is called secondary pneumothorax. Based on pathophysiological changes, it is further classified into three types: closed (simple), open (communicating), and tension (high-pressure) pneumothorax.

bubble_chart Diagnosis

1. History and Symptoms:

There may or may not be predisposing factors such as increased thoracic or abdominal pressure. The onset is usually sudden, with the main symptoms being dyspnea, chest pain on the affected side, and irritating dry cough. In cases of tension pneumothorax, symptoms are severe, including dysphoria, restlessness, and possible cyanosis, profuse sweating, or even shock.

2. Physical Examination Findings:

Small or localized pneumothorax often shows no positive signs. In typical cases, the trachea shifts to the healthy side, the affected side of the chest appears full, respiratory movement is weakened, percussion reveals hyperresonance, and breath sounds are diminished or absent. In left-sided pneumothorax complicated by pneumomediastinum, a crunching sound synchronous with the heartbeat (Hamman's sign) may sometimes be heard over the precordium.

3. Auxiliary Examinations:

(1) Chest X-ray: The most reliable diagnostic method, which can determine the severity of pneumothorax, the degree of lung collapse, and complications such as pneumomediastinum or pleural effusion.

(2) Other examinations: (1) Blood gas analysis may reveal hypoxemia in cases where lung compression exceeds 20%. (2) Pleural puncture and pressure measurement help determine the type of pneumothorax. (3) Thoracoscopy: Useful for chronic or recurrent pneumothorax to assess lung surface and pleural membrane lesions. (4) Hematologic tests: No positive findings in uncomplicated cases.

4. Differential Diagnosis:

Should be distinguished from acute myocardial infarction, subpleural bullae, bronchial cysts, diaphragmatic hernia, etc.

bubble_chart Treatment Measures

1. Symptomatic Treatment:

Bed rest should be ensured, with oxygen administration, analgesia, and antitussive measures. Antibiotics should be given if infection is present.

2. Thoracic Decompression:

(1) For closed pneumothorax with lung compression <20%, simple bed rest may allow spontaneous absorption. If lung compression >20% with significant symptoms, thoracentesis should be performed 1-2 times daily, with 600-800ml per extraction recommended. (2) For open pneumothorax, closed thoracic drainage should be applied for air evacuation. If the lung fails to re-expand, continuous negative-pressure suction may be added. (3) For tension pneumothorax, emergency decompression is required, and immediate closed thoracic drainage or continuous negative-pressure suction should be prepared.

3. Surgical Treatment:

Surgery may be considered for cases where the lung fails to re-expand despite aggressive medical treatment, chronic pneumothorax, or bronchopleural fistula. Recurrent pneumothorax may be treated with pleurodesis.

4. Active treatment of the primary disease and complications.