PNEUMOTHORAX DR.LIU ZHONG DEPARTMENT OF CHEST MEDICINE THE FIRST ASSOCIATED HOSPITAL OF CHONGQING UNIVERSITY OF MEDICAL SCIENCES
PNEUMOTHORAX DR. LIU ZHONG DEPARTMENT OF CHEST MEDICINE THE FIRST ASSOCIATED HOSPITAL OF CHONGQING UNIVERSITY OF MEDICAL SCIENCES
Definition The accumulation of air in the pleural space with secondary lung collapse. Spontaneous pneumothorax,which occurs without trauma or obvious cause 。Traumatic pneumothorax (iatrogenic), which occurs as a result of direct trauma to the chest
Definition The accumulation of air in the pleural space with secondary lung collapse. • Spontaneous pneumothorax, which occurs without trauma or obvious cause • Traumatic pneumothorax (iatrogenic), which occurs as a result of direct trauma to the chest
Spontaneous pneumothorax Spontaneous pneumothorax is by far the commonest form in clinical practice and is always secondary to pulmonary or pleural abnormality. This may be congenital or due to acute or chronic acquired disease. Classification 1.Primary spontaneous (idiopathic)pneumothorax which occurs in healthy persons 2.Secondary spontaneous pneumothorax which occurs in persons with diseases that affect the lung
Spontaneous pneumothorax Spontaneous pneumothorax is by far the commonest form in clinical practice and is always secondary to pulmonary or pleural abnormality. This may be congenital or due to acute or chronic acquired disease. Classification 1. Primary spontaneous (idiopathic) pneumothorax which occurs in healthy persons 2. Secondary spontaneous pneumothorax which occurs in persons with diseases that affect the lung
Aetiology 1.Primary spontaneous pneumothorax (idiopathic) Defined as a pneumothorax occurring in patients without obvious pulmonary disease clinically or on chest X-ray, although chest CT usually reveals subapical blebs and bullae. 2.Secondary spontaneous pneumothorax Defined as a pneumothorax occurring in patients with underlying lung disease
Aetiology 1. Primary spontaneous pneumothorax (idiopathic) Defined as a pneumothorax occurring in patients without obvious pulmonary disease clinically or on chest X-ray, although chest CT usually reveals subapical blebs and bullae. 2. Secondary spontaneous pneumothorax Defined as a pneumothorax occurring in patients with underlying lung disease
Clinical types 1.Closed pneumothorax There is no movement of air takes place because the hole through which air entered has been sealed off
Clinical types 1. Closed pneumothorax There is no movement of air takes place because the hole through which air entered has been sealed off
Clinical types 2.Open pneumothorax The air moves freely in and out of the pleural space during respiration
Clinical types 2. Open pneumothorax The air moves freely in and out of the pleural space during respiration
Clinical types 3.Tension pneumothorax (valvular pneumothorax) A one-way valve is created where air enters pleural space in inspiration but cannot exit in expiration
Clinical types 3. Tension pneumothorax (valvular pneumothorax) A one-way valve is created where air enters pleural space in inspiration but cannot exit in expiration
Clinical features 1.Symtoms ★ Strenuous activity,unilateral chest pain and dyspnoea. *The clinical manifestations of pneumothorax depend on its size,type,and the healthy condition of patient's lung
Clinical features 1. Symtoms ★ Strenuous activity, unilateral chest pain and dyspnoea. ★ The clinical manifestations of pneumothorax depend on its size, type, and the healthy condition of patient’s lung
Clinical features 2.Physical signs Signs of air accumulation in the thorax decreased expansion of the involved hemithorax decreased fremitus tympanitic percussion decreased breath sounds on the involved side
Clinical features 2. Physical signs Signs of air accumulation in the thorax • decreased expansion of the involved hemithorax • decreased fremitus • tympanitic percussion • decreased breath sounds on the involved side
Radiographic appearances Sharply defined lung edge separated from the bony cage by a clear zone devoid of lung markings,and there may be mediastinal shift to the opposite side
Radiographic appearances Sharply defined lung edge separated from the bony cage by a clear zone devoid of lung markings, and there may be mediastinal shift to the opposite side