How to check for hemothorax and pneumothorax?

Written by Zhang Zhi Gong
Cardiothoracic Surgery
Updated on January 07, 2025
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Actually, the examination methods for hemothorax and pneumothorax are quite simple. From their definitions, we know that hemothorax means the abnormal presence of blood in the pleural cavity, and pneumothorax means the presence of gas in the pleural cavity where it shouldn't be. Therefore, the simplest examination is an X-ray, a standard frontal and lateral chest X-ray, which usually costs about 52 yuan, can detect whether a patient has pneumothorax. As for hemothorax, of course, it involves the use of a syringe. After injecting some lidocaine local anesthesia into the patient, if blood is withdrawn from the pleural cavity, then it indicates a hemothorax. Thus, the first step in examining for hemothorax and pneumothorax is to perform an X-ray to check for the presence of gas. If gas is detected, then it is pneumothorax. If liquid is found, a syringe under ultrasound guidance can be used to withdraw it. If the withdrawal yields fluid, it indicates pleural effusion; if blood is drawn, then it indicates hemothorax.

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Written by Zhang Zhi Gong
Cardiothoracic Surgery
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How to treat recurrent pneumothorax for the second time?

Patients with recurrent pneumothorax, we recommend proactive minimally invasive surgical intervention. For patients experiencing their first recurrence of pneumothorax, the likelihood of a second recurrence is about 20-30%. For those who have had two episodes of pneumothorax, it indicates the presence of a small rupture on the lung, or an area that has not healed well, or is particularly weak. Thus, for patients who have had two episodes or a second occurrence of pneumothorax, if they do not receive active treatment, the probability of a third recurrence rises to about 70-80%. Whether using minimally invasive surgery or the conservative method of simple tube insertion, both are certainly burdensome for the patient. However, for patients with a second occurrence of pneumothorax, undergoing a small minimally invasive surgery, which involves a small incision of one to two centimeters under the armpit to treat the pneumothorax, dramatically reduces the likelihood of subsequent occurrences from the previous 70-80% to below 10%. Therefore, the best treatment for a second pneumothorax episode is through minimally invasive surgical intervention.

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Written by Hao Ze Rui
Pulmonology
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What are the main signs of pneumothorax?

If it is a small amount of pneumothorax, the physical signs are generally not obvious, especially when patients with emphysema develop pneumothorax, it is difficult to detect any signs. However, when a larger amount of pneumothorax occurs, inspection will reveal that the affected side of the chest is bulging and respiratory movements are reduced. Upon palpation, the trachea usually shifts towards the healthy side, tactile fremitus on the affected side is reduced, percussion results in hyperresonance or tympany, and auscultation shows reduced breath sounds, which can disappear in severe cases.

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Written by Xia Bao Jun
Pulmonology
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How is pneumothorax treated?

The treatment of pneumothorax aims to promote the reexpansion of the affected lung and reduce recurrence, while considering the possibility of eliminating the cause of the disease. Treatment measures include non-surgical and surgical treatments. Non-surgical measures include observation, thoracic puncture for air evacuation, closed thoracic drainage, and pleural fixation. Surgical treatments include thoracoscopic surgery and open chest surgery. Choices should be made based on the type and frequency of occurrence of the pneumothorax, the degree of compression, the state of the condition, and the presence of complications, etc. Most patients can be cured through non-surgical treatment, while only a minority, approximately 10%-20% of patients, require surgical treatment.

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Written by Han Shun Li
Pulmonology
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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.

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Written by Xia Bao Jun
Pulmonology
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Pneumothorax tracheal shift to which side?

When a patient suffers a pneumothorax, the trachea is displaced to the opposite side, and the heart is also shifted to the opposite side. In cases of left-sided pneumothorax, the heart's dullness boundary and the upper boundary of the liver during right-sided pneumothorax are both undetectable. There can be manifestations of subcutaneous emphysema in the neck, chest, and even the head and abdomen. The patient may exhibit diminished respiratory movements and a significant reduction or absence of breath sounds. When a small amount of air accumulates in the pleural cavity, weakened breath sounds on the affected side may be the only suspicious sign.