内科学2、pneumothorax教程文件.ppt

Pneumothorax ;Definition;Classification ;Primary spontaneous pneumothorax : ;Primary spontaneous pneumothoraces result from apical pleural blebs lying under the visceral pleura. ;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). 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. ;Tension pneumothorax is a medical emergency. It is caused when excessive pressure builds up around the lung, forcing it to collapse. The excessive pressure can also prevent the heart from pumping blood effectively, leading to shock.;Symptoms and signs;Note: Symptoms may begin during rest or sleep. Pneumothorax may present with life-threatening respiratory failure if underlying COPD or asthma is present; this is true irrespective of the size of the pneumothorax. ;Signs:;Auxiliary Examination;CT scan;;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. ;Large spontaneous tension pneumothorax. ;Right-sided pneumothorax;Diagnosis;Treatment;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. 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