巨大肺大疱与自发性气胸鉴别分析

Differential Diagnosis for Huge Pulmonary Bulla and Spontaneous Pneumothorax

目的通过1例巨大肺大疱诊疗经过,探讨巨大肺大疱与自发性气胸的鉴别方法。方法回顾分析武汉市江夏区第一人民医院呼吸内科2016年12月收治的1例巨大肺大疱病例的临床资料、治疗经过。结果1例巨大肺大疱患者,发病后出现呼吸困难、咳嗽,低氧血症,胸部CT室危急值回报左侧气胸,经过胸外科会诊并没有立即胸腔闭式引流,阅CT见透光区考虑巨大肺大疱压缩肺组织所致,不是自发性气胸,患者呼吸困难考虑支气管哮喘急性发作所致。结论巨大肺大疱合并肺部感染,易出现胸闷气急等症状,且胸片上与气胸不易区别,极易误诊导致误治。巨大肺大疱与气胸有时鉴别有一定难度,需要一定的经验,通过个案查阅相关文献,了解两者鉴别要点。

Objective To discuss the distinguish method for huge pulmonary bulla and spontaneous pneumothorax with diagnosis and treatment of one case of huge pulmonary bulla.Methods This paper retrospectively analyzed the clinical data and treatment process of one case of huge pulmonary bulla in Dec.2016at respiratory department of the People′s Hospital of Jiangxia District,Wuhan City.Results The case of huge pulmonary bulla appeared dyspnea,cough and hypoxemia after onset of the disease,the chest CT room emergently reported left pneumothorax.After surgery consultation,the doctor did not immediately carry out chest closed drainage.After reading of CT,it was considered that the photic zone was caused by tissue compression of huge pulmonary bulla and it was not spontaneous pneumothorax.The dyspnea was considered by acute attack of bronchial asthma.Conclusion In huge pulmonary bulla with pulmonary infection,it very easy appears chest distress,shortness of breath and other lung symptoms,and the huge pulmonary bulla is difficultly distinguished with pneumothorax,it may be cause misdiagnosis.The diagnosis of huge pulmonary bulla needs experience,reading of literature and knowledge of differential diagnosis.