PLEURA, DISEASES OF. (See also PLEURISY.) Pneumothorax (Hydropneumothorax; Pyopneumothorax).
Definition.—Air in the pleural cavity is designated pneumothorax. With rare exceptions, fluid, either serous or puru lent, is also present; hence the terms hydropneumothorax and pyopneumo thorax.
Symptoms.—In the majority of cases the onset is sudden and markedly severe: pain in upper part of the chest, an ago nizing feeling of want of breath, rapid feeble pulse, and some cyanosis. The patient may have a sensation of some thing having given way and of fluid trickling down inside the chest. Any or all these symptoms may be absent. The severity of these symptoms depends chiefly on the functional activity of the lung affected and on the rapidity of the escape of air into the pleural cavity.
If the perforated lung has performed the greater part in respiration the dis tress will be extreme and death quickly follow; but if it has previously been much diseased and restricted in function, its loss will be but little felt, if at all perceived. If the escape of air into the pleural cavity is rapid, the urgency of clyspncea will be much increased, espe cially if the perforation is valvular, pre venting the return of the air into the bronchus and thus increasing the press ure effect of the escaped air.
In advanced phthisis, in which general debility is marked, the respiratory needs are small. In such cases perforation may pass unnoticed, an unsuspected pneu mothorax being found at the post-mor tem examination. Pain is the most con stant symptom in such cases, but it is apt to he attributed to a simple localized pleurisy which occurs very frequently in these cases. This indicates the neces sity for careful examination to discover the cause of such attacks of pain in chronic pulmonary phthisis.
As the shock effects pass off the pa tient may become comfortable, although the respiration continues rapid and may increase in frequency as the air and pleural effusion increase in the pleura. As in tuberculous disease of the lungs, so here, the patient may be breathing fifty times or more to the minute and yet make no complaint of dyspncea.
In marked cases, especially with in creased intrapleural tension, the phys ical signs are very distinctive.