重庆医科大学：《内科学》课程教学课件（PPT讲稿）气胸 PNEUMOTHORAX

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