七年制医学ppt课件-肺科-14气胸

Click to edit Master title style,Click to edit Master text styles,Second Level,Third Level,Fourth Level,Fifth Level,七年制医学ppt课件-肺科-14气胸,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.,Definition,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,Spontaneous pneumothorax,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,Aetiology,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,Clinical,types,2.Open pneumothorax,The air moves freely in and out of the pleural space during respiration.,Clinical types,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 types,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 patients lung.,Clinical features,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,Clinical features,Radiographic appearances,Sharply defined lung edge separated from the bony cage by a clear zone devoid of lung markings,and there may be mediastinal shift to the opposite side.,Radiographic appearances,Diagnosis and differential diagnosis,Diagnosis,Sudden onset with chest pain and dyspnoea,Physical signs of pneumothorax,Radiographic appearances,Diagnostic aspiration by needle,Diagnosis and differential dia,Diagnosis and differential diagnosis,Differential diagnosis,Chronic obstructive emphysema and large emphysematous bullae,Bronchial asthma,Acute myocardial infarction,Pulmonary embolism or infarction,Diagnosis and differential dia,Therapy,The,basic tenets,of therapy,to evacuate the space,to achieve closure of the leak,to assess the risk of recurrence or ensure,some means of reducing this risk.,Therapy,Therapy,Observation(conservative treatment),Asymptomatic patients with a small,(,20 per cent)unilateral pneumothorax.,Aspiration,by needle or catheter,Closed pneumothorax with collapsed lung,more than 20%and accompanied by dyspnoea.,Emergency treatment for tension pneumothorax,to relieve symptoms.,Therapy,Therapy,3.Chest tube drainage(long-term aspiration),Insertion of a chest tube into the pleural space attached to water seal(closed)chamber for continual removal of the interpleural gas.,Chest tube drainage system,TherapyChest tube drainage sys,Three bottle chest tube drainage system,Suction,Patient,Fluid collection,chamber,Water seal,chamber,Manometer,chamber,Three bottle chest tube drain,Therapy,4.Operative therapy(Thoracotomy or Thoracoscopy),Thoracotomy,The most effective in assuring expansion of the lung with,the lowest recurrence rate.,Indication:,Failure to reexpand the collapsed lung with tube drainage,Recurrence of the peumothorax,Haemopneumothorax,Therapy,Therapy,4.Operative therapy(Thoracotomy or Thoracoscopy),Thoracoscopy,(Video-Assisted Thoracoscopic Surgery VATS),Less invasive surgery,and more acceptable by the,patient,Therapy,Therapy,5.Pleurodesis,Pleurodesis is an adjunct to the other forms of therapy.The goal is to achieve adhesion of the visceral and parietal pleura and to close the pleural space.,Doxycycline and talc are the most recommended pleural irritants,Therapy,Complications,Subcutaneous emphysema and mediastinal emphysema,Infection of the pleural space,Reexpansion pulmonary edema,Hemopneumothorax,Complications,Thanks,Thanks,