What Is Tension Pneumothorax?

Tensile pneumothorax refers to a large lung bubble rupture or a large and deep lung laceration or bronchial rupture. The slit is connected to the pleural cavity and forms a one-way valve. It is also called high-pressure pneumothorax. When inhaling, the air enters the pleural cavity through the cleft, and the valve closes when exhaling. The air in the cavity cannot be expelled, which causes the pressure in the pleural cavity to continuously increase, compressing the lungs to gradually collapse, and pushing the mediastinum to the healthy side. Squeezing the healthy side of the lungs creates severe disturbances in breathing and circulation. If the high-pressure air in the pleural cavity is squeezed into the mediastinum, it spreads to the subcutaneous tissue, forming subcutaneous emphysema in the neck, face, and chest.

Basic Information

nickname

High-pressure pneumothorax

English name

tension pneumothorax

Visiting department

Thoracic Surgery

Common causes

Emphysema, bullae, external force on the chest, etc.

Common symptoms

Extreme difficulty breathing, sitting breath, cyanosis, restlessness, etc.

Causes of tension pneumothorax

Tension pneumothorax refers to a unidirectional flap in the pleural cavity. The pleural cavity pressure decreases during inhalation, the valve opens, and gas enters; the pleural cavity pressure increases during expiration, the valve closes, and gas cannot escape . Traumatic pneumothorax of the lung, bronchus, and chest wall can be a single-channel valve, and spontaneous pneumothorax rupture can also form such a valve.

Clinical manifestations of tension pneumothorax

The patient presented with extreme dyspnea and sat breathing. People with severe hypoxia develop cyanosis, irritability, coma, and even suffocation. On physical examination, the injured chest is full, the intercostal space is widened, the breathing range is reduced, and subcutaneous emphysema may be present. Percussion was drum sound. Auscultation breath sounds disappeared. A chest X-ray examination showed a large amount of gas in the pleural cavity, the lungs could collapse completely, and the trachea and heart shadow shifted to the healthy side. The pleural cavity is punctured with high-pressure gas flushing out. After venting, the symptoms improved and soon became worse. This performance also helps diagnosis. Severe chest injury, such as the rapid signs of tension pneumothorax, bronchial rupture should be suspected, prompt rescue, or even thoracotomy.

Tension pneumothorax

1. X-ray performance

A chest radiograph can show the degree of lung collapse, lung conditions, presence or absence of pleural adhesions, pleural effusion, and mediastinal displacement. On the chest radiograph, there is a uniform translucent area of the pleural space with no lung texture. The inner side of the pleural cavity is a curved linear lung edge parallel to the chest wall. A small amount of gas is confined to the upper part of the thorax and is often covered by bones. Patients are asked to exhale deeply to shrink the collapsed lungs and increase their density, which is in marked contrast with the transmissive air-storage zone of the outer zone, thus showing the pneumothorax. When there is a large amount of pneumothorax, the affected lung is compressed and gathers in the hilar region as a spherical shadow. The patient's X-ray showed bullae at the apex of the lung; in the presence of blood pneumothorax, the liquid-gas plane was visible; when there was an adhesion in the chest, the collapsed lung lost uniform compression toward the hilum, showing irregular compression or The compressed edges of the lungs are lobulated; the diaphragm on the affected side moves down, and the trachea and heart shift to the healthy side. When mediastinal emphysema is combined, the mediastinum and subcutaneous gas shadow can be seen.

2. Chest CT scan

Clearly show the scope of pleural effusion, the amount of stagnant air, the degree of lung compression, or the presence of bullae at the tip of the lung, and the chest CT can also show the amount of pleural effusion. Especially for pneumothorax with low gas content and localized pneumothorax mainly located in the anterior midpleural cavity, it is easy to miss diagnosis on X-ray bust, and CT has no weak points of image overlap, which can make a clear diagnosis.

Tension pneumothorax diagnosis

According to the medical history, clinical manifestations, and X-ray examination, it is easier to diagnose. It can also be based on thoracentesis, and the high-pressure gas pushes the core of the syringe outward to further confirm the diagnosis.

Tension pneumothorax

The principle of emergency treatment for tension pneumothorax is to vent immediately and reduce the pressure in the pleural cavity. In an emergency, a thick needle can be used to pierce the pleural cavity at the midline of the second intercostal collarbone on the injured side, and a jet of gas can be discharged to obtain the effect of exhaust decompression. During the transfer process, the patient binds a rubber finger cover at the connector of the pin, cuts the hard end of the finger cover by 1 cm, and acts as a flap, so that the air in the chest cavity can be easily discharged, and the outside air cannot enter the chest cavity; or One end of the long rubber tube or plastic tube is connected to the inserted needle connector, and the other end is placed under the water surface of the sterile water seal bottle.

The formal treatment of tension pneumothorax is to place the pleural cavity drainage tube (usually the second intercostal clavicle midline) at the highest position of gas accumulation, and connect the water-sealed bottle. Sometimes a negative pressure suction device is needed to facilitate the exhaustion of gas and swell the lungs. Use antibiotics to prevent infection. After closed drainage, the small fissures in the lungs can be closed within 3 to 7 days. After stopping the leak for 24 hours, the X-ray examination confirmed that the lungs had swelled before removing the intubation. Patients with long-term air leaks should undergo thoracotomy. If after the pleural cavity is intubated, the air leakage is still serious, and the patient's dyspnea does not improve, suggesting that the laceration of the lungs and bronchus is large or broken, the thoracotomy should be explored early to repair the laceration, or the lung segment and lobectomy should be performed.

It should be pointed out that most cases of tension pneumothorax after thoracic drainage can temporarily control the condition, but the potential for its potential recurrence still exists. After the lung is re-expanded, a chest CT examination should be performed. If there is a bullae, it should be removed under thoracoscopy or thoracotomy.