What Is Traumatic Pneumothorax?

The incidence of traumatic pneumothorax accounts for 15% to 50% of blunt injuries and 30% to 87.6% of penetrating injuries. Mostly because the lungs are punctured by fractured ends of the ribs, they can also be caused by violent bronchial or lung tissue contusion or laceration, or bronchial or lung rupture caused by a sharp rise in airway pressure. Sharp wounds or firearm injuries penetrate the chest wall and hurt the lungs, bronchial tubes, and trachea or esophagus. They can also cause pneumothorax, and most of them are pneumothorax or pneumothorax. Occasionally, a closed or penetrating diaphragm rupture is accompanied by a gastric rupture and pneumothorax.

Basic Information

English name: traumatic pneumothorax
Visiting department: surgical
Common locations: chest

Common causes: Traffic accidents; iatrogenic injuries; fall injuries; stab wounds; gunshot wounds, etc.
Common symptoms: Chest tightness, shortness of breath, severe dyspnea, cyanosis, weak pulse frequency, shock, etc.

Causes of traumatic pneumothorax

The disease is mostly caused by the following reasons: traffic accidents; iatrogenic injuries; fall injuries; stab wounds; gun injuries.

Clinical manifestations of traumatic pneumothorax

Closed pneumothorax

It can be divided into small amount, medium amount and large amount of pneumothorax according to the volume of pleural space and lung collapse. A small amount of pneumothorax means that the lung collapses below 30%, and the patient does not have obvious respiratory and circulatory disorders. Moderate pneumothorax collapse is between 30% and 50%, and a large number of pneumothorax collapses above 50%, and hypoxemia such as chest tightness and shortness of breath can occur. On examination, the trachea was shifted to the healthy side, and the percussion of the injured chest showed drum sounds, and the breathing sounds were significantly weakened or disappeared. A small number of wounded patients may have subcutaneous emphysema and are often at the site of rib fractures.

2.Tensile pneumothorax

Patients often present with severe dyspnea and cyanosis, and the percussion of the injured chest is highly drummed, and the auscultatory breathing sounds disappear. If the second or third intercostal space is punctured with a syringe, the needle plug can be ejected by the air. These are of diagnostic value. In addition, during the examination, it was found that the pulse was weak, blood pressure decreased, the trachea was significantly shifted to the healthy side, the chest wall on the injured side was full, the intercostal space was flattened, and the respiratory momentum was significantly weakened. Subcutaneous emphysema can be found on the chest, neck, and upper abdomen, and there are twisted sounds. If severe, subcutaneous emphysema can extend to the face, abdomen, scrotum, and limbs.

3. Open pneumothorax

Patients with open pneumothorax often experience severe dyspnea, panic, pulse frequency, cyanosis, and shock immediately after injury. During the examination, there was a clear wound in the chest wall that penetrated into the chest cavity, and a "sizzle-sizzle" sound of air entering and exiting with the breath was heard. Percussion drum sounds on the injured side, respiratory sounds disappeared, and mediastinal swing sounds were sometimes heard.

Traumatic pneumothorax

Thoracentesis

If the patient has both blood pneumothorax and peritoneal irritation, thoracentesis should be performed as early as possible. Thoracoabdominal puncture is a simple and reliable diagnostic method.

2.X-ray inspection

It is an important method for diagnosing pneumothorax, the pathological changes in the lungs, the presence or absence of pleural adhesions, pleural effusion, and mediastinal displacement. The presence of a light-transmitting band next to the mediastinum indicates mediastinal emphysema. Pneumothorax lines have increased transillumination and no lung texture. Sometimes the pneumothorax line is not obvious enough. Patients can be instructed to exhale, the lung volume is reduced, the density is increased, and it is in contrast to the outer zone of the air-storage zone, which is helpful for the discovery of pneumothorax. When there is a large amount of pneumothorax, the lungs retract toward the hilum, and the outer edge is curved or lobulated.

3.CT inspection

Hemothorax and pneumothorax coexist in blunt chest trauma, which is basically caused by lung contusion and lung rupture at the corresponding site caused by chest compression and rib fracture. Gas-liquid planes that traverse one or both thoraxes are characteristic of this.

4.B-ultrasound

It is more sensitive than X-rays in blunt chest injuries, and the "sliding" of the pleura can be seen under B-mode ultrasound, and the presence or absence of pleural effusion can also be found.

Traumatic pneumothorax diagnosis

According to the patient's medical history and clinical manifestations, combined with X-rays, it is not difficult to confirm the diagnosis by auxiliary CT and B-ultrasound if necessary.

Traumatic pneumothorax treatment

Closed pneumothorax

A small amount of closed pneumothorax can be absorbed by itself without special treatment. Thoracocentesis can be performed first for medium and large pneumothorax. If the pump is not exhausted, and the volume of gas before the pump is reached shortly, the other side also has pneumothorax, combined with hemothorax, general anesthesia, or mechanical ventilation. Place closed chest drainage. People with poor lung function and the elderly, as well as those with severe injuries in other parts, such as patients with severe head injury and severe shock, should take a positive attitude towards closed pneumothorax. Be alert to the development of tension pneumothorax during treatment.

2.Tensile pneumothorax

The first aid of tension pneumothorax is to quickly decompress the chest cavity. You can use a large needle to pierce the pleural cavity in the 2nd or 3rd intercostal space of the midclavicular line, and immediately decompress. At present, special thoracic drainage trocars and closed thoracic drainage devices have been developed. They are sealed and sterilized and ready for use. If a small penetrating wound on the chest wall of the tension pneumothorax is caused, it should be closed, bandaged and fixed immediately.

Suspected of severe pulmonary laceration or bronchial rupture, or diagnosis of esophageal rupture (observation of chest injection with oral melanin or oral radiography of lipiodol), a thoracotomy should be performed. Mediastinal emphysema and subcutaneous gas types generally do not need to be treated, and they can stop developing after chest chest gas decompression, and then absorb by themselves. Very few severe mediastinal emphysema, especially occasionally due to pleural cavity adhesions without obvious pneumothorax, can make a 2 to 3 cm long incision in the upper sternal fossa, incision of the skin, superficial cervical fascia and broad neck Muscle, bluntly separate the neck muscles up to the frontal fascia, gauze strips are used for drainage within the incision, and gas can be discharged from the incision.

3. Open pneumothorax

Close the chest wall wound as soon as possible, and change the open pneumothorax to closed pneumothorax. A large first-aid kit, multiple layers of cleaning cloths or thick gauze pads can be used to cover the wound at the end of deep exhalation and bandage it. It is more suitable if there is a large piece of Fanlin gauze or sterile plastic cloth. The closed dressing is required to be thick enough to avoid air leakage, but it cannot be stuffed into the wound; the range should be more than 5 cm above the wound edge, and the bandage should be firmly fixed. Give blood transfusion, fluid replacement, and oxygen therapy to correct respiratory and circulatory disturbances, while further examining and clarifying injuries. After the general condition improves, perform debridement under tracheal intubation as early as possible and place closed chest drainage. If the chest wall defect is too large, it can be repaired with transfer muscle flaps and transfer flaps. If there is serious damage to the internal organs of the chest such as the lungs, bronchus, heart, and blood vessels, a thoracotomy should be performed as soon as possible.

Traumatic pneumothorax prevention

Pay attention to traffic safety, avoid falls and stab-gun injuries, and pay close attention to surgical indications during medical procedures to avoid iatrogenic pneumothorax.