内科学课件气胸.pptVIP

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 Primary spontaneous (idiopathic) pneumothorax which occurs in healthy persons Secondary spontaneous pneumothorax which occurs in persons with diseases that affect the lung Aetiology 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 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 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 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 edg