Causes, decomposition of liquid effusion, perforation from a
bronchium, the stomach, a thoracic wound. Symptoms, metallic tinkling,
splashing, succussion, drum-like resonance, suppressed respiratory
murmur, distance of cough sound, distress, anxiety, dyspnœa, bulging
intercostal spaces, sometimes a wound. Treatment, closure of wound,
calmatives, aspiration of gas. Treatment for pleurisy.
The collection of air or gas in the cavity of the pleura has already
been noticed as coexisting with liquid effusion in some cases of
advanced pleurisy. It may arise from other causes, among which may be
noted: 1. When a mass of pulmonary tubercle connected with a bronchial
tube has opened into the pleural sac. 2. When a communication has been
established between the pleural cavity and the alimentary canal, as in
combined rupture of the stomach and diaphragm, or of the double colon
and diaphragm. 3. When a rib is fractured and the broken end penetrates
the lung tissue and opens into one or more small bronchial tubes. 4.
When a wound has been inflicted penetrating the walls of the chest and
forming a valvular orifice through which air is drawn inward during each
inspiratory act, but out of which it cannot pass when the thorax
collapses.
The amount of gas present may be extremely slight, or in a case such as
that from a valvular wound it may cause complete collapse of the lung,
filling up the entire half of the thorax and bulging into the opposite
half.
The _symptoms_ are often very obscure. If with liquid the metallic
tinkling after rising, in small animals the splashing when shaken and
the other sounds of auscultation and percussion will point it out as
described under _pleurisy_. In the case of a broken rib the distortion,
swelling and tenderness, will lead to suspicion. A penetrating sound
will be sufficiently evident, and in the case of tubercle previous cough
and ill-health will have been manifest.
The specific signs of uncomplicated pneumothorax are: 1st, A drum-like
resonance on percussion over the seat of the gas, usually at the upper
part of the chest; 2d, A partially suppressed or distant respiratory
murmur over the same area; 3d, A muffled or suppressed sound of the
cough; 4th, Sometimes, especially if the gas is abundant, prominence of
the chest on that side; 5th, There are also more or less distress and
anxiety, difficult breathing, quick, weak, rapid pulse, and other signs
of illness.
Some cases of this kind recover spontaneously or with the liquid
effusion with which they are associated; in traumatic cases the wound is
sometimes sealed up by a pleuritic exudation which here becomes a
curative process; while in some examples of valvular wound of the lung
or walls of the chest death may ensue in a period varying from a few
minutes and upwards to weeks.
_Treatment_ is limited to the prevention of the ingress of air through
an external wound where that exists; the employment of opiates and other
agents to moderate attendant suffering; to measures calculated to
moderate the intensity of resulting pleurisy, and, in cases where there
is imminent danger from accumulation of gas, to the puncture of the
chest and the careful withdrawal of the gas by aspiration. If necessary
sterilized air may be made to replace the aspirated gas.