Iqbal Beenish, Hallifax Rob, Rahman Najib M
Pleural Research Fellow, Oxford Respiratory Trials Unit, University of Oxford, Oxford OX3 7LJ, UK.
Consultant in Respiratory Medicine: Pleural, Lung Cancer and COPD, Oxford University Hospitals NHS Foundation Trust, Senior Clinical Lecturer in Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7LJ, UK.
Clin Med (Lond). 2025 May;25(3):100327. doi: 10.1016/j.clinme.2025.100327. Epub 2025 May 13.
Pneumothorax is defined as air in the pleural space and is characterised by chest pain and breathlessness. It is commonly divided into spontaneous and non-spontaneous subtypes based on the underlying mechanism. Chest X-ray is the most common investigation to diagnose and monitor pneumothorax, but CT-chest is being increasingly used to aid decision making in complex cases and to investigate an underlying lung disease. There should be a low threshold to investigate for an underlying familial or catamenial cause in suspected cases. Treatment for pneumothorax is based on clinical condition and symptoms of the patient rather than the size of pneumothorax. Conservative care can be offered to minimally symptomatic primary spontaneous pneumothorax patients, while needle aspiration, ambulatory Heimlich valve device and chest drain remain the interventional treatment options. Chest drain is a common treatment for patients with secondary spontaneous pneumothorax due to poor lung reserve. Recurrence after spontaneous pneumothorax is common and smoking cessation reduces the risk of future recurrence in active smokers. Surgical treatment with pleurodesis ± bullectomy should be considered for treatment of suitable patients with persistent air leak and for pneumothorax recurrence prevention in high-risk populations.
气胸被定义为胸膜腔内有空气，其特征为胸痛和呼吸急促。根据潜在机制，气胸通常分为自发性和非自发性亚型。胸部X线是诊断和监测气胸最常用的检查方法，但胸部CT越来越多地用于辅助复杂病例的决策制定以及排查潜在的肺部疾病。对于疑似病例，应降低对潜在家族性或月经性病因进行排查的阈值。气胸的治疗基于患者的临床状况和症状，而非气胸的大小。对于症状轻微的原发性自发性气胸患者，可以采取保守治疗，而针吸、门诊使用海姆利克瓣膜装置和胸腔闭式引流仍是介入治疗的选择。由于肺储备功能差，胸腔闭式引流是继发性自发性气胸患者的常见治疗方法。自发性气胸后复发很常见，戒烟可降低现吸烟者未来复发的风险。对于持续漏气的合适患者以及高危人群中预防气胸复发，应考虑采用胸膜固定术±肺大疱切除术进行手术治疗。
