Spontaneous hemothorax
Introduction
Spontaneous hemothorax Spontaneous hemothorax refers to non-traumatic hemothorax, and there is a history of no known systemic or pulmonary or chest disease. Young adults are more common, more men than women. There are often induced factors such as heavy physical labor, strenuous exercise, cough, and forced bowel movements. Clinical manifestations vary with the amount of bleeding, the rate of bleeding, the trauma of the intrathoracic organ, and the patient's constitution. basic knowledge The proportion of illness: 0.001% Susceptible people: more common in young adults, more men than women Mode of infection: non-infectious Complications: shock
Cause
Spontaneous hemothorax
Spontaneous hemothorax, refers to non-traumatic hemothorax, more often has no clear systemic or lung, history of chest disease, more common in young adults, more men than women, often have heavy physical labor, strenuous exercise, cough Inducing factors such as forced defecation, the pathogenesis may be: Wall pleural vasculature originates from systemic circulation, high pressure, and negative pressure in the thoracic cavity, when the blood vessels in the pleural wall layer or membrane adhesion zone are damaged, it can cause massive bleeding After the occurrence of hemothorax, not only the signs of anemia appear due to blood loss, but also the accumulation of blood in the chest and the increase of pressure, causing the lungs to shrink, pushing the mediastinum to the healthy side, seriously affecting the respiratory and circulatory functions, such as timely diagnosis and treatment, It can be life-threatening, blood in the chest, because the lungs, heart and diaphragm muscles play the role of defibrin, and do not coagulate. If the effect of a large amount of hemoglobin in the short term is not perfect, it can be solidified into a blood clot. After the formation of fiberboard, affecting lung re-expansion, because the blood is a good medium for bacteria, so the pleural cavity blood is not discharged in time, easy to concurrent infection, the formation of pus and chest.
Prevention
Spontaneous hemothorax prevention
The cause of this disease is mostly severe cough, so active treatment of cough is to prevent the occurrence of this disease. At the same time, attention should be paid to clear the pleural hemorrhage during treatment, to prevent the infection and fibril formation from compressing the lungs, and it is not possible to determine whether there is active bleeding. At the same time, the closed thoracic drainage should be placed as soon as possible to facilitate further observation and judgment, and prevent blood from accumulating in the chest cavity to prevent further development of the disease.
Complication
Spontaneous hemothorax complications Complications
If the blood chest is not treated in time, it will lead to dyspnea, shock, chest infection, coagulative hemothorax and other complications. It is often characterized by rapid pulse, low blood pressure, shortness of breath, etc. when the shock occurs. At the time, there are symptoms such as high fever, chills, fatigue, and sweating.
Symptom
Spontaneous hemothorax symptoms Common symptoms High fever, rapid breathing, sudden skin, chest, cold, low blood volume, shock, low blood, chest, breath, weakened, dyspnea, pulse, fast and weak
The clinical manifestations of hemothorax vary with the amount of bleeding, the rate of bleeding, the trauma of the intrathoracic organs, and the physical condition of the injured. The rib fractures are accompanied by a small amount of hemothorax. The blood loss is generally small. The clinical symptoms are not obvious, and the amount of bleeding is more than 1000 ml. And the bleeding speed is fast, the face is pale, the pulse is fast and weak, the shortness of breath, the blood pressure is reduced, and other hypovolemic shock symptoms, and the pleural cavity massive blood pressure, lung and mediastinum lead to dyspnea and hypoxia, etc., small amount of hemothorax Often there are no abnormal signs, a large number of hemothorax can present the trachea, the heart shifts to the healthy side, the intercostal space of the injured side is full, the percussion is solid, and the blood and pneumothorax cases are drumy on the upper chest, the lower chest is actually sounded, and the breath sound is weakened. Or disappear, blood-thorax wounds caused by lung tears often have hemoptysis, a small amount of blood chest accumulated in the rib sinus, chest X-ray examination may not be easily found, or see the disappearance of the cost of the ribs, the amount of blood chest In many cases, the density of the injured chest is increased. It is clearly displayed on the lateral chest radiograph. A large number of hemothorax shows large dense effusion shadows and mediastinal shift signs. Blood and pneumothorax cases show fluid. Plane, pleural cavity puncture blood can determine the diagnosis, hemothorax patients through puncture blood, pleural effusion decreased, can increase, blood in the pleural cavity coagulation, puncture failed to extract blood or only a small amount of blood, However, the symptoms of shock increased or X-ray examination increased the amount of pleural effusion; after the drainage of pleural cavity more than 200ml per hour and continued for more than 2 hours, there is suggestive of progressive bleeding, need to be treated in time.
Pleural effusion can cause hypothermia, but if there is a sign of purulent infection such as chills and high fever, increased white blood cell count, the puncture should be sent for bacterial smear and culture examination.
The blood chest develops to form a fiber chest. If the range is larger, the thoracic collapse of the disease side may occur, the respiratory movement is weakened, the trachea and mediastinum are displaced to the disease side, and the lung ventilation is reduced. X-ray examination shows the dense shadow caused by the fiber plate.
Examine
Spontaneous hemothorax examination
1. X-ray examination showed gas-liquid signs, radiological signs on the x-ray image, a small amount of hemothorax visible to the injured side of the rib angle became dull, the liquid surface did not exceed the dome; the medium amount of blood chest surface reached the hilar level; A large number of blood chest fluid levels exceed the hilar level.
2. Diagnosis can be confirmed after thoracic puncture and gas extraction.
Diagnosis
Spontaneous hemothorax diagnosis
diagnosis
Can be diagnosed based on clinical performance and laboratory tests.
Differential diagnosis
1. Tuberculous pleurisy
Spontaneous hemothorax is most easily misdiagnosed as tuberculous pleurisy in the clinic.
Tuberculous pleurisy is a pleural inflammation and allergic reaction caused by tuberculosis invading the pleura. It is more common in adolescents and can be divided into dry and wet pleurisy.
(1) Dry pleurisy can occur in any part of the pleural cavity. The symptoms are different. Some patients have little or no symptoms, and they can heal themselves. Some people have more acute onset, chills, mild or Moderately low-grade fever, but the main symptom is localized acupuncture-like chest pain. The chest pain is caused by the close friction between the parietal and visceral pleura. Therefore, the chest pain is mostly located in the front of the anterior or posterior tibial line with the largest thoracic respiratory motion, deep breathing and Chest pain is even worse when coughing, such as lesions occur in the apex of the lungs, chest pain can be radiated along the brachial plexus, causing hand pain and sensory disturbances, such as in the center of the diaphragm, pain can be radiated to the ipsilateral shoulder; lesions in the periphery of the diaphragm, pain It can be radiated to the upper abdomen and the heart. Because the patients with chest pain do not dare to take a deep breath, the breathing is rapid and superficial. When the vagus nerve is stimulated, it can cause intractable cough. The physical examination shows that the respiratory movement is limited, local tenderness, and respiratory sounds are reduced. The pleural friction sound is touched or heard. This sound can be heard regardless of exhalation or inhalation, and it is characterized by coughing. At this time, pleural friction sound is an important sign.
(2) Tuberculous exudative pleurisy.
Most of the lesions are unilateral, there are a number of exudates in the pleural cavity, generally serous, occasionally bloody or purulent, according to the site of their occurrence can be divided into: rib pleurisy (also known as typical pleurisy) wrapped pleurisy, Inter-leaf pleurisy, mediastinal pleurisy, hernia pleurisy, apical pleurisy, typical exudative pleurisy, more acute onset, moderate or high fever, fatigue, night sweats and other symptoms of tuberculosis, chest pain at the beginning of the disease, mostly irritating Acute pain, with the appearance and increase of pleural fluid, hindering the friction between the parietal and visceral pleura, the chest pain will be reduced or disappeared, but different degrees of shortness of breath and dyspnea may occur, and there are many irritating coughs at the beginning of the disease. Less, metastatic position due to pleural effusion stimulation of the pleura can cause reflex dry cough, physical signs vary with pleural fluid, a small amount of pleural fluid can be no obvious signs, after the effusion absorption, often left pleural adhesions or thickening.
2, blood pneumothorax
Blood pneumothorax is a serious disease in spontaneous pneumothorax. The disease is more dangerous. Most patients have obvious causes of onset, such as strenuous activity, excessive weight bearing, etc. Most of the causes of hemothorax are suddenly torn by two layers of interthoracic adhesions between the chest wall. Crack, a small number of tumor invasion and giant lung vesicle rupture, because the disease has both lung compression and bleeding, so the symptoms are heavier, the patient has both air urgency, chest tightness and other respiratory symptoms, but also palpitations, shock and other circulatory symptoms The severity of the patient's symptoms is related to lung compression and bleeding.
The disease has always advocated surgery after diagnosis. It is believed that delaying surgery may endanger the life of the patient, and chest cavity can be caused by thoracic congestion, which may cause lung damage. Some researchers also pointed out that as long as the observation is close and the treatment is proper, most blood-thoraxers Surgical trauma can be avoided, because most of the tears in the adhesion zone are small blood vessel damage or capillary oozing, which is not a major vascular trauma caused by direct violence. Therefore, it is appropriate to give sufficient observation and conservative treatment time, specifically in closed drainage. Under the observation of the amount of bleeding, as long as there is no obvious blood pressure drop and the heart rate gradually increase, the majority of patients with hemothorax can be cured by conservative treatment, especially in the early stage of closed drainage, due to partial re-expansion of the lungs. In the extraction of thoracic coagulation, the patient may have lower blood pressure due to the relative lack of circulating blood volume, and the heart rate is accelerated. This is a transient shock. Do not think that bleeding is caused by it. Some researchers have pointed out that in practice, closed drainage In the early stage, the method of interrupting the tube was used to avoid the occurrence of shock.
3, pleural effusion
There is a potential pleural cavity between the visceral and parietal layers. Under normal circumstances, the pleural cavity contains a small amount of lubricating liquid, and its production and absorption are often in dynamic equilibrium. When there is pathological reason, it increases and/or absorbs. When reduced, pleural effusion will occur. The pleural effusion is divided into two types: leakage and exudate. Due to the nature and amount of the primary disease, the effusion is less than 300ml. It can be asymptomatic and moderate. When the amount or a large amount of dyspnea is obvious, there is no positive sign when a small amount of fluid is accumulated. In the middle or a large amount of effusion, the respiratory movement of the affected side is weakened, the tremor disappears, the percussion area is cloudy or the sound is heard, and the auscultation breath sound is weakened or disappeared. The trachea and mediastinum are all moved to the healthy side.
