I'm Dr. Shadow. How does a pneumothorax form? I have taught this principle to every intern I have ever taught, and as an imaging intern, you must be able to see a pneumothorax as a critical condition. When you see a pneumothorax on chest radiograph or CT, you must report the critical value and write down how much volume the lung has compressed. A large pneumothorax requires immediate management and prompt placement of a closed drain. This allows the compressed lung to reopen.

To understand pneumothorax, you must first know the structure of the pleural cavity

A pneumothorax, is the presence of gas in the pleural cavity. What is the pleural cavity? Our lung tissue is covered with a membrane called the dirty pleura, and a membrane near the chest wall is called the mural pleura. Between these two membranes is the structure of the pleural cavity. Normally there is a small amount of fluid present, which serves a lubricating function.

However, the presence of fluid in the pleural cavity due to various reasons is what is referred to in the imaging report as pleural effusion, which is also known as pulmonary effusion.

There is no gas present in the normal pleural cavity. If gas is present in this location, then it is a pneumothorax.

Why does a pneumothorax form?

Why is there gas in the pleural cavity? As just stated, the pleural cavity consists of a cavity made up of the dirty pleura, which is close to the lung tissue, and the wall pleura, which is close to the chest wall.

1. gas is present, then the pleura of the dirty layer has broken and gas from the alveoli has run into this pleural cavity, such as ruptured alveoli, spontaneous pneumothorax, and so on.

Elderly people, most of the pulmonary alveoli, especially the subpleural alveoli, close to the dirty layer pleura, a cough, exertion, there is a risk of breaking the dirty layer pleura, the alveoli of the gas to run into the pleural cavity, the formation of pneumothorax. Therefore, if you have pulmonary alveoli, especially those with subpleural alveoli, you may have recurrent pneumothorax. Avoid strenuous activities.

Spontaneous pneumothorax, which tends to occur in tall, thin, and tall young people, may be caused by rupture of an alveolus under the pleura. Spontaneous pneumothorax is also common. Being thin is not necessarily good.

2. The second reason is that either the wall pleura is broken and the gas from outside the body runs into this pleural cavity. The most common is pneumothorax caused by trauma.

As an imaging physician, when a patient with chest trauma comes in for a chest X-ray or CT, you must pay special attention to whether there is a rib fracture and whether there is a pneumothorax. Rib fractures and pneumothorax are reciprocal; if you see a pneumothorax, you must look at the ribs. If you have a rib fracture, be sure to look for a pneumothorax. A small amount of pneumothorax, which may not be visible on a chest X-ray, will be visible on a CT. This is why sometimes a pneumothorax is not written on the chest X-ray report and a CT shows it. Also, a rib fracture, a minor rib fracture after a traumatic injury, may not be visible, but after two weeks, the fractured bone scabs come out. This is why, when you first get injured a chest x-ray says there is no fracture, but can say two weeks later that there is a fracture. The clearest way to see a rib fracture is to have a chest CT, not a chest x-ray.

The arrow points to a massive pneumothorax that has compressed the non-tissue into a mass, with complete loss of lung function, and immediate intubation to drain the gas out.

A small amount of pneumothorax can be absorbed on its own. A large amount of gas can compress the normal lungs, making them unable to breathe and causing symptoms such as dyspnea. If the compressed lung is not reopened for a long time, it will break down and stick together, and the lung's respiratory function will not be restored. Therefore, a pneumothorax should be treated aggressively, and a tube should be inserted to drain the gas out, so that the lung can be reopened. This is the treatment of pneumothorax.

I am.Dr. ShadowPlease follow me if you want to learn more about medicine.

The principle of the formation of pneumothorax which has a little bit of the mechanism of the brain, this is to start from the mother's womb, people from birth have always been shoulders wider than the head, in fact, it is not the mother's womb so, before birth, the diameter of the body is actually smaller than the head, especially in the chest, this is because of the oxygen in the body of the fetus rely on the supply of the placenta, so the fetus does not need to breathe, the lungs are atrophied and not expand, do not look down on this not expanding the adult completely! Expansion of the capacity of the lungs of the adult male 3.61 ~ 9.41L, female 2.81 ~ 6.81L, all of these gas out, the volume can be smaller than half, the fetal lungs are more likely to be only two or three soup dumplings so big, after the birth of the placenta inside the oxygen cut off the supply of oxygen, hypoxic stimulation of the cerebral nerves immediately notify the thoracic contour to be expanded to breathe.

The focus came, what is the thorax, in fact, the thorax is used to hold the container of the lungs, by the spine, the rib cage, attached to the top of the many muscles involved in respiration, these muscles will stretch and contraction will pull the thorax stretch and contraction, the bottom of the thorax there is a sealing of the bottom of the muscle called the diaphragm, the normal diaphragm is puffed up, the contraction of the diaphragm will fall, the entire thorax volume increases, lungs follow the expansion of the air is passively Air is then passively "pumped" into the lungs from the mouth and trachea. So the lungs will not actively inhale, it is pulled by the thorax and diaphragm expansion, the same way, diaphragm diastole again upward expansion, the lungs inside the air used to be discharged, usually breathing on the diaphragm, when breathing strenuously, the thorax will also be a large movement, the amount of air being pumped into and out of the air will be greatly increased.

Then the lungs and the thorax are long together, not, the breathing process, the thorax and the lungs are slightly relative movement between the surface of the lungs and the thorax, in fact, there is a potential cavity between the thorax and the lungs, this cavity is composed of the pleura, we eat small chops will find that one side of the small chops is meat, the other side of the slippery membrane, which is the pleural membrane, the thorax lined with a layer of the internal lung surface is covered with a layer of between the two layers is the thoracic cavity is normally closed, there is no gas except for a small amount of fluid to lubricate the inside. The thorax is lined with a layer, the surface of the lung is covered with a layer, between the two layers is the thoracic cavity, the normal thoracic cavity is closed, in addition to a small amount of liquid to play a lubricating role, there is no gas, if we assume that if the pleura on the surface of the lungs broke a small hole will happen, is not in the expansion of the thorax the lungs are pumped into the thoracic cavity of the gas, which is the pneumothorax.

What is the consequence of pneumothorax, it depends on the working principle of the lungs, the important function of the lungs is divided into two sides, one side is the ventilation function, that is, the trachea and bronchial tubes to the alveoli of the function of the successful transmission of gases, and the other is the diffusion function, is the lungs successfully from the air into the oxygen intake of the alveoli around the vascular ability of blood, both of these need to be sufficiently expanded as a safeguard of the lung tissues, if the gas into the chest cavity what are the consequences of the gas? What happens if gas enters the chest cavity is obvious: the gas occupies the space that originally belonged to the lungs, the lungs are compressed, and both functions mentioned above are affected, resulting in the lungs not being able to take up enough oxygen and leading to hypoxia. A more serious problem is that if the gas accumulates more and more, it eventually compresses the heart and the large blood vessels connected to the heart, which may lead to the interruption of blood circulation and jeopardize the life of the patient. Therefore, a pneumothorax is an emergency that requires a hole to be punched out and pumped out in the emergency room.

Pneumothorax can be divided into many types, and here I would like to mention spontaneous pneumothorax alone. There are some tall and very thin men who are especially prone to sudden onset of pneumothorax without any warning, and they often have an onset of pneumothorax after a forceful breath hold. These alveoli may rupture at any time, and when the pressure in the chest cavity increases after holding the breath with force, the alveoli are hardened and burst, resulting in pneumothorax. Generally, the first attack of pneumothorax does not need surgery, but if there are many repeated attacks and the pneumothorax pumping treatment is not effective, surgery should be considered.

Pneumothorax is still very good to explain, want to know how the pneumothorax is formed, just need to understand the structure of the chest cavity and lungs, you can know, let me cite an ion, put home will be very easy to understand.

The human lungs are made up of alveoli, which are like bunches of grapes, except that the grapes are not filled with grapes, but with gas. The thoracic cavity and the lungs can be compared in this way; the thoracic cavity is like grapes in a vacuumed plastic bag; normally, the pleural cavity does not contain gas, but the grapes (that is, the alveoli) do contain gas.

Once you understand the structure of the chest and lungs, it is easy to understand how the chest cavity forms in two main ways:

(1) Grapes broken

The skin of the grapes inside the vacuum bag breaks, and the gas inside the grapes runs into the chest cavity, which creates a pneumothorax, which is most often seen in patients with ruptured alveoli and spontaneous pneumothorax, where the gas inside the grapes continues to enter the pleural cavity, which creates a pressure that leads to the other grapes being flattened, and respiratory distress. This condition is called closed pneumothorax.

(2) Vacuum bag broken

The vacuum bag is broken, which means that there is trauma to the chest wall, causing the chest cavity to become identical to the outside air. The outside air is pressurized and rapidly enters the chest cavity, causing positive pressure, which leads to alveolar atrophy and severe dyspnea. This condition is called open pneumothorax.

So, don't you understand better, the principle of pneumothorax production. The principle of treatment for pneumothorax is also very simple, that is, to close the pleural cavity and expel the gas as much as possible. If it is a closed pneumothorax, it can be absorbed by itself if it is not serious and does not need special treatment. If the pneumothorax has a large breach and there is a lot of gas, then it is necessary to place a closed drain to expel the gas out of the body.

In patients with open pneumothorax, the incision needs to be closed to make a closed pneumothorax, and then a drain is placed to drain the gas out of the body.

Lungs, an important organ for gas exchange, with which we humans can live on earth, inhaling oxygen and exhaling carbon dioxide.

The lungs are made up of many small air sacs that are used for gas exchange, and when rupture occurs for some reason, a pneumothorax is formed.

There are two broad types of pneumothorax: spontaneous pneumothorax, and secondary pneumothorax.

How does a spontaneous pneumothorax develop?

Some people grow and develop weak zones at the edges of their lungs, which may trigger rupture when coughing violently or changing position drastically, creating a spontaneous pneumothorax.

This condition is most common in tall, thin people of both sexes, and occurs suddenly in some cases without a clear trigger.

The 19-year-old above had a sudden onset of chest tightness at school that was not relieved by half a day's rest, and CT revealed a right-sided spontaneous pneumothorax with a large pulmonary alveolus at the margin (green arrow).

This is a mild case that requires no treatment, a severe case that requires gas aspiration, and a surgical repair if it recurs.

This young man had a pulmonary blister removed and repaired because of the discovery of an alveolus at the edge of his lung:

In addition spontaneous pneumothorax has a high risk of recurrence within 1 month, care should be taken to prevent colds and avoid violent coughing.

How does a secondary pneumothorax develop?

Common causes are trauma, and some puncture operations.

This male patient had a car accident trauma with multiple rib fractures, one of which punctured the lung, causing a pneumothorax and bleeding (hemopneumothorax), and some subcutaneous emphysema, which was the result of gas spilling out of the lungs and into the subcutaneous space.

This kind of is life threatening in severe cases and needs to be treated aggressively.

There are also some percutaneous lung punctures where a small amount of pneumothorax can occasionally occur, which usually does not require special treatment.

This is Dr. Howe, Imaging, thank you for reading and for your interest!

I've admitted 2 patients with pneumothorax in the past 2 days.

1, 45-year-old male, driving a car accident, resulting in chest injuries, feeling chest pain, came to the hospital emergency room, a chest X-ray, saw that there are a number of multiple rib fractures, as well as the left side of the pneumothorax, but fortunately did not find that there is a hemothorax.

How did this patient's pneumothorax come about? Pneumothorax means that the lung broke and air poured into the pleural cavity.

This is a pneumothorax. You can see that the left lung has shrunk. The human lungs have two membranes (the dirty layer and the wall layer), the dirty layer pleura is tightly attached to the lung surface, while the wall layer pleura is attached to the chest wall. Under normal circumstances, the gap between the two layers of pleura is called the pleural cavity, which is very, very small, during which a very small amount of pleural fluid flows and serves as a lubricant. However, when the lung ruptures (the dirty pleura is close to the surface of the lung, and when the lung ruptures, the dirty pleura naturally breaks down as well), air enters the pleural cavity and enlarges the very small pleural cavity, as shown in the figure above. With that much gas entering the pleural cavity, it naturally compresses and expands the lungs. This is a pneumothorax.

When this person suffered a trauma to the chest, it is assumed that the lung was punctured after a rib fracture, or the lung ruptured as a result of a direct external force, or in any case, the lung was broken, resulting in a pneumothorax. This type of pneumothorax is very serious because as more and more gas comes out of the pleural cavity, breathing becomes more and more difficult and must be dealt with as soon as possible.

The second patient is a 70-year-old man, has more than 20 years of old chronic bronchitis, emphysema history, in recent years diagnosed with chronic obstruction of the lungs, perennial cough, sputum, wheezing, cough aggravated in the past few days, did not expect a serious cough, suddenly appeared on the right side of the chest pain, and rushed to the hospital, initially thought that it was an acute myocardial infarction, the back of the examination found that the right side of the breath sounds low, the radiographs confirmed that it is a pneumothorax! The first time I saw this was when I was in the hospital!

Why pneumothorax? Because this patient with chronic obstructive pulmonary disease has emphysema and alveoli, the quality of the lung itself is poor, just like a balloon that has been blown up and has no elasticity, and has become very thin, and at this time the violent coughing and the impact on the lungs is big, and all of a sudden the air cuts the alveoli and ruptures them, causing the gas to enter the pleural cavity and forming a pneumothorax.

This is the formation of pneumothorax.

There are several other types of pneumothorax, open and closed, traffic and tension, and so on. These are the ones that professionals have to master.

In the past, I even admitted a tall, skinny boy who suddenly became short of breath while playing basketball, and when he came to the emergency room, a chest X-ray revealed a pneumothorax. It's true that tall, skinny guys are prone to pneumothorax.

People need to be vigilant.

I'm Panda. Leave a comment below to discuss any questions you have, I'm guessing I know everything you want to ask.

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pneumothorax (medicine)It is the accumulation of gas in the pleural cavity. Depending on the pressure in the pleural cavity, pneumothorax is categorized into three types:.Closed pneumothorax, open pneumothorax and tension pneumothorax.

etiology

Pneumothorax is formed mostly due to rupture of lung tissue, organs, bronchial tubes, esophagus, and air entering into the pleural cavity, or due to a wound in the chest wall that pierces the pleura, and outside air enters the pleural cavity.

Closed pneumothorax:After air enters the pleural cavity through the chest or lung injury site, the entry channel closes, the gas no longer enters the pleural cavity, the negative pressure in the pleura is canceled out, but the pressure in the pleural cavity is still lower than the atmospheric pressure, which will make the affected side of the lung partially compressed, the effective gas exchange area is reduced, which will affect the ventilation and gas exchange function of the lungs. In mild cases, chest tightness and chest pain will occur, and in severe cases, dyspnea will occur.

Open pneumothorax:The pleural cavity is connected to the outside atmosphere through a chest wall wound or soft tissue defect, and outside air can enter and exit the pleural cavity freely with respiration. The amount of air entering and exiting the pleural cavity is also closely related to the size of the chest wall wound.3cmIn this case, the pressure in the pleural cavity is almost equal to atmospheric pressure, and the lung on the affected side will be completely compressed, resulting in respiratory dysfunction. Significant dyspnea, cyanosis of the lips, and in severe cases, shock will occur.

Tension pneumothorax:It is due to the trachea, bronchus or lung injury fissure and the pleural cavity, and the formation of a living valve, the gas in each inhalation will be from the fissure into the pleural cavity, when the exhalation of the fissure living valve will be closed, the gas can not be discharged, resulting in the accumulation of a continuous increase in gas in the pleural cavity, the pressure will be more and more high, and finally there will be the pressure of the pleural cavity is higher than the atmospheric pressure. The person often experiences severe or extreme dyspnea, irritability, impaired consciousness, coma, shock, or even asphyxiation.

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Pneumothorax, a word that many of us have probably heard before. It is an acute condition that can even be life-threatening in severe cases. Pneumothorax, as the name suggests, is when gas enters the pleural cavity.

In normal humans, there is an underlying cavity between the lungs and the chest wall, which is called: the pleural cavity. The function of the pleural cavity is to drive the lungs to breathe through the chest wall. When we breathe normally, the contraction and expansion of the pleural cavity is driven by the movement of the respiratory muscles, which in turn drives the exhalation and inhalation of the lungs.

The pleural cavity has negative pressure under normal conditions, and gas cannot enter the pleural cavity due to the presence of negative pressure. However, due to trauma or other pathological factors (such as rupture of the lung itself), the negative pressure in the pleural cavity disappears, and the gas will easily enter the pleural cavity, making the lungs unable to follow the movement of the chest wall to complete the respiratory movement, and this pathological process we call it pneumothorax.

There are different causes of pneumothorax, one category belongs to open pneumothorax, where gas from the outside world enters due to damage to the chest wall, in most cases due to trauma, and generally the pneumothorax we are referring to rarely involves this type of patient. Instead, most are spontaneous pneumothoraces, which means that our normal human lungs rupture for some reason resulting in a pneumothorax. The incidence of this type of spontaneous pneumothorax is actually quite low, with men having a slightly higher incidence than women.

Therefore, for us, once suddenly appear chest pain, chest tightness and accompanied by dyspnea, irritating cough symptoms, must promptly emergency department to seek medical treatment, so as not to delay the condition.

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　　Pneumothorax is a condition in which gas enters the pleural cavity and causes a buildup of air. Pneumothorax is most often caused by lung disease or external influences that rupture the lung tissue and the pleura of the dirty layer, or rupture the tiny emphysematous bubbles near the surface of the lungs, and the air in the lungs and bronchial tubes overflows into the pleural cavity.

　　Generally speaking, traumatic pneumothorax is caused by trauma to the chest wall or lungs; spontaneous pneumothorax is caused by rupture of lung tissue due to disease; and artificial pneumothorax is caused by injecting air into the pleural cavity artificially for treatment or diagnosis. Pneumothorax can be divided into closed pneumothorax, open pneumothorax and tension pneumothorax. Spontaneous pneumothorax is most common in male young adults or people with chronic bronchitis, emphysema, tuberculosis. This disease is one of the pulmonary emergencies, serious cases can be life-threatening, timely treatment can be cured.

　　Patients with pneumothorax should have absolute bed rest and talk as little as possible to minimize lung activity and facilitate gas absorption. Severe pneumothorax can be treated with pleural puncture and closed chest drainage. Patients with recurrent pneumothorax should have pleural fixation.

　　The key to treating pneumothorax is timely management. In case of closed pneumothorax with severe compression symptoms, immediate aspiration with a long needle or closed drainage without immediate venting can be life-threatening in severe cases. For those who have a history of pneumothorax or emphysema, they should be wary of sudden overexertion, loud shouting, and straining to defecate. Preventing respiratory infections is also an important factor in preventing the development of pneumothorax. Pneumothorax should be actively treated as soon as possible, mainly depending on the degree of pneumothorax, compression of more than 30% need to take surgical treatment. According to the different types of pneumothorax, it is necessary to ventilate appropriately in order to relieve the obstacles generated by the accumulation of air in the chest cavity on breathing and circulation, so that the lungs can be reopened as soon as possible to restore their functions, and at the same time, it is also necessary to treat the complications and the original disease.

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To talk about pneumothorax, we have to start with this gas.

Outside air enters the body through the mouth and nose, passes through the trachea, and enters the lungs.

Dang it, here comes the lead, the spotlight, shine it on my lungs!

Let's take a look at the structure of the lungs!

The lungs are made up of bronchial tubes and alveoli.

The bronchial tubes are attached to the trachea and rooted into the lungs, branching out constantly, like a tree growing upside down, medically called a bronchial tree.

This tree is not only responsible for supporting the entire lung tissue, but also for ensuring that the gases are delivered to the peripheral "suburbs of the lungs".

At the end of the bronchial tree there are many balloons, and around the balloons there are many small bubbles, which are the legendary alveoli.

The trachea, the bronchi, and the bronchial tree are, to put it bluntly, tubes for gases, and the alveoli are like balloons attached to these tubes.

When you inhale, the alveoli are blown up like a balloon to hold the gas.

When you exhale, the alveoli contract in order to expel the gas out of the body.

Come on, follow the deep readers, take a deep breath and hold on to ...... find out what it feels like when all the alveoli are bulging and swollen.

People's alveoli have a very important function in addition to their retraction, yo!

The surface of the alveoli, wrapped with a thin layer of capillary network, with this network, this small alveoli has become a transit station for blood gas.

The little blood train unloads its full load of negative energy, carbon dioxide, all over the alveoli, and then loads the alveoli's early prepared oxygen on board to run all over the body.

Here's a little science plug for the chest.

The space surrounded by the chest wall made up of ribs and muscles is the chest cavity, in which the lungs, heart and blood vessels are contained.

The lungs, being the focus of protection, have a close-fitting, double-layered, sealed special protective layer called the pleura.

The pleura is attached to the chest wall on one side and to the lungs on the other.

Under normal circumstances, the two layers of the pleura are close together, and there is not a trace of gas in the middle except for a little bit of plasma, and the cavity surrounded by these two layers of pleura is called the pleural cavity.

With all the padding out of the way, this goes to the scene where the pneumothorax occurred.

A hard-working alveolus, inflating and contracting, inflating and contracting ......

Suddenly one day, inflate and collect ...... can't shrink?

Yet the air is still filling up, like a balloon, and the alveoli are getting bigger and bigger and thinner, which is medically known as alveoli.

"Poof," it burst! The lung alveolus was blown through a hole along with the pleura that was right next to it.

Breathe more than you can, inflate more than you can, and the gas inflates directly against the pleural cavity.

The pleural cavity is sealed ah, with more and more air in the cavity, the pleural cavity continues to expand, directly pressing on the lungs, so that the lungs can not inflate and expand, this time the person will have difficulty breathing.

What happens when air enters the pleural cavity, besides compressing the lungs?

It hurts!

The pleura is covered with nerves, normally the pleura is tightly pressed together, air breaks in and forcefully rips the pressed together pleura, just like the FEEL of wax paper when removing hair, can it not hurt?

I'm going to cough!

In addition to pain nerves in the pleura, there are also "cough reflex" nerves, and when the air stimulates, coughing will come.

If you don't want to get a pneumothorax, you need to take care of your lungs.

These four little things can easily trigger a pneumothorax Oh!

physical exercise

Pneumothorax is easily induced when people do strenuous exercises, especially those like weightlifting that require the body to instantly explode with tremendous energy in a short period of time.

Boxing, push-ups, lifting iron, tug-of-war, and basketball are all sports that require high alveolar quality, so be careful if you have weak alveoli!

Laughing or yelling

When a person is shouting and laughing, it all messes with the pressure inside the lungs rubbing and dripping up, which is certainly a severe test for the alveoli.

Poof, the alveolus ruptures, omigod, pneumothorax comes in.

smoking

This cigarette contains several harmful substances, so many of which can directly cause damage to the alveolar walls and form alveoli.

As time goes by, the alveoli get bigger and bigger, and one deep breath can blow up ah! That's how a pneumothorax finds you.

Big bro, hurry up and quit smoking!

Change in ambient air pressure

"I love Hada, I love barley wine, I love Everest ......"

Watch out for your alveoli, honey!

If you travel from a high pressure area to a low pressure area, such as a plateau, there is a risk of developing a pneumothorax if you have bad alveoli.

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