Department of Respiratory Medicine, Shrewsbury and Telford Hospitals NHS Trust, Telford, Shropshire, UK
Keele University School of Medicine, Keele, Staffordshire, UK.
BMJ Case Rep. 2021 Jul 8;14(7):e243556. doi: 10.1136/bcr-2021-243556.
An 85-year-old ex-smoker being managed conservatively over 2 years for a small right apical pneumothorax presented to the respiratory clinic with suddenly worsening shortness of breath and chest pain. A chest radiograph demonstrated sudden deterioration in the size of his pneumothorax. Previous CT scans had found emphysematous cystic changes within the lungs, and his new presentation warranted definitive surgical intervention with a right bullectomy and talc pleurodesis through a video-assisted thoracoscopic surgery procedure. The patient made a good recovery and was discharged from clinic a year later. This case demonstrates the importance of follow-up in patients with unresolved pneumothoraces due to the potential for sudden deterioration, and highlights the significance of respecting patient involvement and autonomy in the decision-making process.
一位 85 岁的曾吸烟者，因右侧肺尖小气胸接受了 2 年多的保守治疗，因突发呼吸困难和胸痛到呼吸科就诊。胸部 X 光片显示气胸大小突然恶化。之前的 CT 扫描发现肺部有气肿性囊性改变，他的新表现需要通过电视辅助胸腔镜手术进行明确的手术干预，包括右肺大疱切除术和滑石粉胸膜固定术。患者恢复良好，一年后从诊所出院。本例说明了对未解决气胸患者进行随访的重要性，因为气胸可能会突然恶化，同时强调了在决策过程中尊重患者参与和自主权的重要性。
