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Pneumothorax
The difference between tension pneumothorax and open pneumothorax
The main difference between a tension pneumothorax and an open pneumothorax lies in the difference in pressure. If the pressure inside the pleural cavity is approximately the same as the atmospheric pressure, it is referred to as an open pneumothorax. In this case, typically after an injury, the wound allows air to freely enter and exit during breathing. When inhaling, air can enter the pleural cavity, and the air can be expelled during exhalation. At this time, because the system opens and closes with each inhale and exhale, the pressure is roughly equal to atmospheric pressure. On the other hand, in a tension pneumothorax, under certain conditions, when air enters the pleural cavity and cannot escape during exhalation, such as when a sort of flap forms, for example after a trauma causing a rupture in the bronchus or trachea, this flap prevents the expulsion of air from the pleural cavity. Therefore, the pressure in the pleural cavity continues to increase, significantly higher than atmospheric pressure. This is the difference between a tension pneumothorax and an open pneumothorax.
How to Read a Pneumothorax X-ray
Pneumothorax has typical manifestations on a chest X-ray. Normally, the pulmonary markings on both sides are quite clear and visible. However, when a pneumothorax occurs, the part of the lung tissue with these markings tends to be compressed due to the accumulation of a large amount of gas in the surrounding pleural cavity, pushing the lung to contract towards the center. Around the periphery, these lung margins, which are outside the lung, meaning inside the pleural cavity, display the gas as very uniform and fine, without any markings. This is because it is pure gas, simply air, hence it is impossible for it to have markings. There is a particularly distinct demarcation line, a thin line, between this part of the pleural cavity and the lungs. Through these features, one can determine the presence of a pneumothorax.
How to treat rib fractures and pneumothorax?
The most significant complication of an acute rib fracture is pneumothorax, often seen in traffic accidents, such as when an airbag deployment causes barotraumatic injury to the chest, or directly from a vehicular collision that breaks the ribs and causes air leakage from the lungs. The leaked air from the lung compresses it by accumulating in the chest cavity. In cases of pneumothorax, if it is severe, it is essential to go to the hospital. The treatment involves a doctor performing a closed chest drainage procedure, which practically means inserting a tube at the midclavicular line of the second intercostal space. One end of this tube is inserted into the chest cavity, while the other end connects to a negative pressure drainage bottle. After the surgery, the gas in the chest cavity is expelled directly into the drainage bottle and then out of the bottle, effectively resolving the issue. Therefore, for the treatment of pneumothorax caused by rib fractures, firstly, one must go to the hospital and consult thoracic surgery; secondly, the doctor performs a minor procedure, closed chest drainage, to expel the air from the chest cavity. After observing for a period to ensure no further leakage and good lung expansion, the drainage tube can be clamped off. After two to three days of observation, the tube can be removed, which successfully treats the pneumothorax.
Pneumothorax should go to which department?
Pneumothorax is caused by a rupture of the pleura, allowing air to enter the pleural cavity, leading to symptoms such as coughing, chest pain, and chest tightness. If there is a substantial amount of air accumulation, the symptoms can be quite pronounced, and severe cases can lead to respiratory failure and hypoxia. If one seeks medical attention for a pneumothorax, they could visit either the respiratory medicine department or thoracic surgery department. After consulting a doctor, treatment may involve procedures like pleural cavity puncture for air extraction or pleural cavity tube drainage to relieve the symptoms of pneumothorax as quickly as possible.
Pneumothorax should be seen by which department?
If it is the patient's first pneumothorax occurrence and they are relatively young with no obvious lung bullae on the surface of their lungs, then seeing the emergency department should be sufficient to resolve the issue. Generally, if less than 20% of the lung is compressed, the patient can simply breathe oxygen at home or at a community hospital to gradually recover. However, if the patient is older and the degree of pneumothorax exceeds 20%, even reaching above 30%, it is advisable to insert a small tube between one and two millimeters into the pleural cavity to extract the air. At this point, it is recommended to consult thoracic surgery. After the air is released, a CT scan is also necessary to check for obvious lung bullae or small tears on the lung surface. If a small tear is found, it is best to use minimally invasive thoracoscopy to suture or seal the tear to prevent recurrence. Therefore, if possible, directly consider consulting thoracic surgery for pneumothorax; if thoracic surgery is not available, then consider seeing the emergency department.
Pneumothorax is more likely to recur in which season?
Regarding the seasonal issue of pneumothorax recurrence, the causes of pneumothorax vary among patients of different ages, so the seasons prone to recurrence are also not exactly the same. For young patients, pneumothorax tends to recur easily, often in thin and tall patients, usually related to recent colds and coughs, or intense physical activities like basketball, soccer, or seasons with more outdoor activities; these times are relatively more prone to recurrence. Particularly, the cooler seasons of spring and fall are also prone to recurrences. However, for elderly patients, the causes of pneumothorax recurrence are usually associated with smoking in older patients, or a history of chronic obstructive pulmonary disease and bullae. For these elderly patients, recurrences typically occur in the autumn and winter seasons. This is because the autumn and winter seasons are comparatively more problematic for patients with chronic bronchitis and obstructive lung diseases. Thus, pneumothorax recurrence in young people often happens more in the spring and autumn, while in older people, it occurs more in the autumn and winter seasons.
Pneumothorax clinical manifestations
Pneumothorax is primarily caused by various factors, both internal and external to the lungs, leading to a significant accumulation of gas within the chest cavity. Patients exhibit symptoms such as chest tightness, breathlessness, including coughing, chest pain, and other related symptoms, which are collectively referred to as pneumothorax. Patients with pneumothorax can be classified into mild and severe types. Generally, after the onset of pneumothorax, patients who only experience symptoms like panting, chest tightness, chest pain, or coughing, but maintain stable blood pressure and heart rate, are considered to have a mild condition. However, if in addition to these respiratory symptoms, the patient clearly exhibits a drop in blood pressure, a decrease in oxygen saturation, or a reduction in heart rate, these conditions are considered severe and require urgent treatment.
How many days after pneumothorax can one smoke?
For patients with pneumothorax, it is advised to strictly quit smoking, as smoking greatly increases the recurrence of pneumothorax. Smoking leads to airway inflammation and respiratory bronchitis. Among male patients with pneumothorax, compared to non-smokers, smokers have a significantly higher incidence of pneumothorax, which is related to the degree of smoking. If the patient smokes less than half a pack, the recurrence rate of his pneumothorax is about 7 times higher. For moderate smokers, those who smoke between half a pack and one pack, the recurrence rate increases to 21 times. If one smokes a pack a day, the recurrence rate rises to 102 times, this is in males. In females, for those smoking less than half a pack, between half a pack and one pack, and more than one pack, the recurrence rates of pneumothorax become 4 times, 14 times, and 68 times respectively. Therefore, for both male and female patients with pneumothorax, smoking significantly increases the probability of recurrence. So, once pneumothorax is resolved, quit smoking as well, to prevent any future recurrences.
How is the fluid in pneumothorax drained?
Pneumothorax with effusion is mostly due to trauma or structural issues in the lungs themselves, leading to lung rupture, accompanied by intrathoracic hematomas, effusion, or pneumothorax. This condition is known as hydro-pneumothorax. Generally speaking, the treatment method depends on the severity of the hydro-pneumothorax. Usually, a mild case can be absorbed by the patient naturally. However, if the pneumothorax occupies more than 30% of the thoracic cavity, closed thoracic drainage should be implemented, along with the removal of pleural effusion for absorption to take place. Of course, the specific disease must be clearly identified, which might require repair, tumor resection, or anti-tuberculosis treatment to ultimately address the cause of the disease.
Causes of pneumothorax
The causes of pneumothorax vary with age. In young people, the condition often occurs in tall, thin individuals, somewhat akin to a balloon. We can liken the lung to a balloon: for shorter, heavier individuals, the balloon is rounder and experiences more uniform stress, whereas for tall, thin individuals, it's as if the balloon is being stretched vertically. Therefore, the tips of the balloon (or the lung) in tall, thin individuals are more prone to rupture. Additionally, for tall, thin individuals, the blood supply to the apical alveoli may not be as robust, making them more susceptible to micro-ruptures. Microscopic anatomical structures have also proven that there are tiny pores in the apical bubble tissues in these individuals. In older adults, the causes of pneumothorax are usually underlying lung diseases, such as chronic smoking, chronic obstructive pulmonary disease (COPD), chronic bronchitis, and other conditions like tuberculosis or HIV infections can also lead to pneumothorax. Some cases are due to traumatic causes like physical injuries or stab wounds, which can lead to secondary or iatrogenic pneumothorax. In summary, while the causes of pneumothorax vary by age, in young people, it more commonly stems from being tall and thin. In older individuals, smoking, tobacco use, chronic bronchitis, and infections are more common causes.