Differential diagnosis
AECOPD and Asthma：
1）Patients with AECOPD or acute exacerbation of asthma can also have the syndromes of dyspnea. 2）Differential points: Post history, recurrent short of breath, allergen
Symptom：Slight chest pain and no dyspnea
Chest X-ray: middlelarge amount of pneumothrax
An old man with COPD Sever dyspnea， Orthopnea，cyanosis，RR:
Diagnosis (★重点掌握)
Typical syndrome (chest pain in early stage，dyspnea，caugh,
inducing causes)
Classical sign (Inspection, palpation, percussion, auscultation) Chest X-ray—— To establish the diagnosis Diagnostic thoracocentesis
吸音恢复，经透视或胸片证实肺已复张)
如无气泡冒出，患者症状缓解不明显，应考虑为导 管不通畅，或部分滑出胸膜腔，需及时更换导管或 其他处理。
Methods： Intrapleural injection of sterilized Talc(灭菌滑石粉)
side.
Chest X –ray
无肺纹 理区（ 积气带 ）
压缩肺 组织
CT-scan
Chest X –ray
无肺纹 理区（ 积气带 ）
压缩肺 组织
CT-scan
1.Minimal pneumothorax; 2. Find the disease in lung; 3. Find the blebs of lung. (发现潜在的肺大疱)
Acute myocardial infarction
1）History， angina，Physical examination no pulmonary signs 2）ECG、 Myocardial enzymes
pulmonary embolism
high risk factor of DVT 、D-dimer、CTPA
壁层胸膜
（parietal pleura）
脏层胸膜
(visceral pleura)
胸膜腔
(pleural cavity)
characteristi c
a hermetic cavity(密闭)
no air
3 ～15ml liquids a negative pressure
(呼气末-5~-3mmHg； 吸气末-10~-5mmHg)
Circulation disorder
disturb venous reflux Heart: FV↓、SV↓
HR↑ BP↓ Shock
The fracture of parietal pleura The fracture of visceral pleura Infection of aerogen(产气菌感染)
Conservative treatment (保守治疗) ★ Air exhausting： Thoracentesis , Closed drainage of pleural cavity,
suction drainage pleurodesis（胸膜固定术） Surgery Treatment of the primary disease
40~50 /min Need oxygen therapy Chest CT
Clinical sign
Inspection：Trachea shift to uninjured side, full chest of the
injured side
Palpation: deceased vocal fremitus/chest expansion of the
胸腔穿刺抽气Thoracentesis 胸腔闭式引流 Closed drainage of pleural cavity 负压吸引闭式引流suction drainage 紧急时，消毒针插入直接排气
Emergency Diagnostic Thoracentesis
Indication: lung collapse >10%，Patient without dyspnea，Closure pneumothrax; emergency for tension pneumothorax Location： midclavicular line, 2nd ICS Volume： ＜1000ml for the 1st time
Principle ： To discharge the retentive air，To promote the
healing of crevasse，To promote the pulmonary re-expansion， reduce recurrence
Therapeutic measures
1. AccΒιβλιοθήκη rding to thepathogenesis
Spontaneous Pneumothorax
The fracture of visceral pleura
Primary Secondary
自发性气胸（ Spontaneous Pneumothorax ）：Pneumothrax without trauma
Indication：Invasion first time, no severe symptoms, mild closure pneumothrax（<20%）
rest in bed，analgesic， keep your bowels open. Oxygen therapy（FiO2≥40%） Treatment of primary disease Pay attention to reexamine the chest-X-ray 2-3 days
闭合性气胸 Closure pneumothorax
1.Crevasse openned persistently 2. Air flows into the pleura space and back to lung tissue through the crevasse fredomly
Unclosure pneumothorax
Indication： No effect after Closed drainage of pleural cavity
接胸膜腔
吸引机
标本瓶
水1-2封cm 瓶
调压瓶
Indication for extubation(拔管指征)：Air bubbles never
appear in the water-sealed bottle from thoracic tube. After 1-2 days reexamine the chest X-ray and determine the fully re-expansion of lung. (未见气泡冒出1~2天后，症状好转，呼
Tension pneumothorax Sever respiratory failure and shock. Orthopnea, restless, sweating.
Case Case
1
2
A young man with no respiratory disease before.
Indication：
poor effect after thoracentesis
Tension/Unclosue pneumothrax
hemopneumothorax
Recurrent pneumothorax
Some closure pneumothorax with severe symptom
张力性气胸
Tension pneumothorax
闭合性 交通性 张力性
破裂口
胸腔内压
纵隔移位
呼吸循环 影响
小小破口 接近大气
自行闭合
压
无
轻
持续开放 =大气压 不明显
轻
自由出入
单向活瓣 只进不出
↑↑
明显
严重
intense activity, lifting, fierce cough chest pain, dyspnea, cough
injured side, (subcutaneous emphysema) subcutaneous crepitation
Percussion：hyper-esonance/tympany Ausculation：decreased of respiratory sound of the injured
1. According to the
pathogenesis
Spontaneous Pneumothorax★
The fracture of visceral pleura
Traumatic Pneumothorax
The fracture of visceral/ parietal pleura
2、 clinical classification （★重点掌握）
闭合性（单纯性）气胸（Closure pneumothorax） 交通性（开放性）气胸（Unclosure pneumothorax） ★张力性（高压性）气胸（Tension pneumothorax ）